Aged care staffing ‘horrifying’ 

9 June 2020

An Australian expert has called for forensic accountants to be engaged to investigate how Australian residential aged care facilities (RACFs) spend their money, according to an InSight+ report by Caitlin Wright, in response to what has been described as a “horrifying” appraisal of staffing levels.

Professor Joe Ibrahim, Head of Monash University’s Health Law and Ageing Research Unit, told InSight+ that part of the confusion about RACF staffing levels and funding, is a lack of transparency for what things cost in the aged care sector. RACFs are currently not required to disclose how many staff they have nor how they spend government funding.

The Australian Nursing and Midwifery Federation (SA Branch) has long raised serious concerns about the lack of transparency in aged care funding as well as the lack of mandated staffing numbers and skills mix to meet the assessed clinical and personal care needs of residents.  

“We need a team of forensic accountants to go through 10 or 20 homes that volunteer to be scrutinised,” Professor Ibrahim told InSight+.

“Then we will know where the money is being spent. We will see if they don’t have enough money or if it’s not being managed as well as it can be. Or whether the market forces are such that no matter how brilliant they are, it’s always going to be a struggle. At the moment we can’t really tell which of those scenarios are there.”

When compared with international staffing benchmarks, Australia’s RACFs meet none of the minimum criteria for adequate staffing, an article published in the Medical Journal of Australia states.

A lack of staffing in aged care is not a new assessment, according to InSight+. In fact, it was one of the key observations from the Royal Commission into Aged Care Quality and Safety and continues to be a major concern voiced by the ANMF. To inform their final report, the Commission requested a research study comparing Australian staffing levels to benchmarks determined overseas.

Just how badly staffing levels sit when compared internationally surprised even one of the article’s authors, Professor Kathy Eagar.

“I’m a professor of health services research and I have been totally horrified,” she said in an exclusive InSight+ podcast. “I think for the average consumer, this is very scary stuff.”

A five-star rating system used in the United States by the Centers for Medicare and Medicaid Services was considered to be the best international system for judging aged care services in Australia.

Using the US metrics, the report found more than half of all Australian aged care residents (57.6%) are in RACFs that have inadequate (one or two stars) staffing levels. Only 1.3% are in RACFs with five stars, which is considered best practice.

“We have [an average of] 180 minutes of total care time per day in Australia, which makes us one-star using the American system,” Professor Eagar said.

The report found that to bring Australia up to a three-star standard would require a staffing increase of 20% nationwide. For all residents to be receiving four-star level of care, staffing would need to increase by 37.2%.

The ANMF, in a submission to the Royal Commission, recommended that nursing homes should at a minimum be staffed to provide, on average, each resident with 4.3 hours (258 minutes); inclusive of 77 minutes of RN Residential Care Hours Per Day, 52 minutes of EN RCHPD, and 129 minutes of PCW RCHPD.

Nursing homes that provide this would achieve a five-star staffing rating according to the US's NHC Rating System, but more importantly the assessed clinical and personal care needs of residents would be met.
The ANMF noted that this would be achievable with a mandated minimum skills mix of 30% RNs, 20% ENs, and 50% PCWs.

“The lack of transparency, inadequate staffing levels and poor quality of care has been an aged care horror story for far too long,’’ said ANMF (SA Branch) CEO/Secretary Adj. Associate Professor Elizabeth Dabars AM.

“We are hopeful that the ANMF’s recommendations to the Royal Commission will help engender a radical revitalisation of an industry that has in many cases put profit before the quality care of our vulnerable elderly community.’’

Click here to read the full InSight+ report.

Click here to read the ANMF’s submission to the Royal Commission.