Aged care staffing under RC microscope

By Chief Advocate Ian Henschke

They say a week is a long time in politics. It seems a week and a half is a very long time in a Royal Commission.

National Seniors was there to give witness on day one, 18 February. Our CEO and Research Director Professor John McCallum put the case for better training for both home and residential care workers, calling for mandatory dementia training. We also wanted the long waiting list for home care fixed.

Staffing ratios focus

As I write, we are a week and a half into the Commission and the issue of staffing of residential aged care and home care is front and centre.

During the first week, the Australian Nursing and Midwifery Federation ( ANMF) National Secretary Annie Butler prosecuted a powerful case for staffing ratios in aged care. She said the primary reason for the lack of care was lack of staff.

At present the Aged Care Act (1997) only requires “appropriately skilled and qualified staff sufficient to ensure that services are delivered in accordance with these standards and the residential care philosophies and standards”.

Last December, the ANMF, Australian Medical Association, Royal Australian College of General Practitioners, and Australian and New Zealand Society of Geriatric Medicine wrote a joint letter calling on the Prime Minister to legislate “minimum staffing ratios that will enable the delivery of the holistic care plans needed to ensure safe and best practice care for all elderly Australians”.

So, we must ask, if the nurses, GPs, specialist doctors, and the geriatricians, who all follow a philosophy of do no harm, want ratios, why is the ‘industry’ and the bureaucracy consistently resisting that call?

‘Blunt instrument’ defence

It’s an intriguing puzzle, isn’t it? When the Secretary of the Department of Health, Glenys Beauchamp, was giving evidence she called staffing ratios “a blunt instrument”. Then surprisingly - or perhaps not - Pat Sparrow, the head of Aged and Community Services Australia, a body representing a large number of not-for-profit providers, echoed the same words: “Ratios are a blunt instrument”.

Emotive language, I thought, sitting in the gallery watching on after I’d seen Annie Butler give her impassioned plea for ratios a week earlier.

In fact, the lawyer questioning Ms Butler asked her what was wrong with the system and she replied: “There’s a gaping hole in the Aged Care Act and that is how you staff aged care.”

She said it was clear current levels of staffing were “not sufficient to ensure safe, quality aged care”.

You must agree, otherwise why are we spending tens of millions of dollars holding this inquiry. The QC then turned out a Shakespearean-style phrase I’ll remember to my final days.

He asked if it were possible to come up with a staffing formula and was told such a formula exists in the public hospital system. “So,” he said, pointedly looking around the court room, “then it is not beyond the wit of man to do this.”

A better trained workforce

Annie Butler produced a dazzling array of data that included financial costings showing that to increase staffing and skills levels to what she said was “proper care” would cost $5.3 billion a year.

And according to a study done by the Australian Industrial Transformation Unit, this would be offset by savings created, in large part, by hospital avoidance, and having a more stable and better trained workforce.

The new Aged Care Quality and Safety Commissioner, Janet Anderson, gave evidence on Monday that revealed some of her auditors and inspectors who assess nursing homes work part-time for the Commonwealth and part-time for providers.

She was questioned on this by Commissioner Richard Tracey who sounded surprised at such an arrangement from a governance perspective.

Janet Anderson attempted to reassure him by saying: “We look very closely at management of conflict of interest.” She added the auditors and inspectors were “obliged to adhere to a code of conduct”.

We also discovered most of the people doing the regulatory work are not nurses or doctors.

Dementia challenge

This week the head of Dementia Australia Maree McCabe also gave evidence of the increasing number of people with dementia and the lack of satisfactorily trained staff.

She repeated National Seniors’ call for more and better trained staff, including mandatory dementia training. She also told me staffing ratios “have to be looked at”.

Perhaps one of the most worrying statistics was provided by Pat Sparrow from ACSA. She said the number of people with “more complex, high-care needs” in care had more than quadrupled in the past 10 years from 12.7% in 2008/9 to 53% last year.

At the same time there has not been a corresponding increase in hours of care provided.

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