Nurse to Patient Ratios

My Full Speech delivered in The Federation Chamber on Monday 18 February


A Royal Commission into aged care services must not put the brakes on urgent reforms in the sector, including greater transparency around staffing ratios.

We need to act quickly to address our community’s very real concerns about understaffing and the low, sometimes non-existent, number of registered nurses in our aged care facilities as well as poor training and retention rates for aged care workers.
The Aged Care Amendment (Staffing Ratio Disclosure) Bill will force residential aged care facilities to provide their staff-to-resident ratios every three months for publication.
This will at least give people a more informed choice about which facility they choose for themselves, or for their family members.
At present, there is no regulation around minimum acceptable levels of staff in residential aged care facilities, just that providers must ‘maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met’.
In my electorate of Wentworth, all eight aged care facilities visited by the NSW Nurses and Midwives’ Association in 2018, failed to provide an acceptable level of nursing care per resident.
This audit of just eight facilities revealed an average ratio of one Registered Nurse to 74 residents on night shift, which is not what families expect or residents deserve. These are vulnerable people needing around the clock care.
This is just a snapshot of what is happening in aged care facilities across the country. This data highlights how widespread the staffing issues are in aged care – even in the most wealthy, affluent suburbs.
The poorest ratio uncovered was just one Registered Nurse to 116 residents. Examples of missed care as a result of understaffing included missed medications, increased falls, limited time to complete hygiene cares and the inability to mobilize residents as often as needed.
Unless we have ratios it will be matter of profit over person.
Last year, the six biggest for-profit aged care providers received over $2.17 billion in taxpayer subsidies, which accounted for around 70% of their revenue. Currently there is no requirement for providers to report how government money is spent or guarantee that it be tied to care.
This is a sector whose providers profit over $1 billion a year, receives healthy government subsidies, large resident deposits and fortnightly part-pension payments, yet it still has no guaranteed staffing or reporting requirement.
Even when argued on pragmatic and detached economic grounds, reducing the information gap between the residents and their families, and providers, will lead to a more efficient, competitive market upon which competing residential aged-care services can more easily attract people through the greater quality of their service.
The Australian Medical Association has continually called for a regulated registered nurse-to-resident ratio, that adapts to the individual care needs of residents and ensures nurses are available 24 hours a day.
According to the AMA there has been a decline in the proportion of full-time equivalent registered and enrolled nurses in the residential care workforce, and an increase in the proportion of personal care attendants. This trend goes against the increasing chronic, complex medical needs of residents.
AMA president Dr Bartone notes that there are not enough registered nurses with aged care experience to provide the clinical governance, oversight and leadership required in these facilities, leading to poor clinical care, inadequate communication and a lack of knowledge about individual residents.
PCA’s cannot duplicate the work of registered nurses. Even then, personal care needs must be considered as a quality of life issue for elderly people with high dependency needs.
My son Carl is an aged care worker, and doctors in our general practice provide GP services to aged care facilities, so I have some insights about the difficulties faced by people trying to provide care for elderly residents, many of whom have significant age related disabilities, including varying degrees of dementia and are on multiple medications.
I am told that personal care attendants have about 20 minutes per day to attend to all the residents personal care needs, including showering, toilet, hair and dental hygiene.
With an ageing population, and aged care reform moving to ensure older people can stay in their home for as long as is appropriate, it is likely that the clinical attention required by those in residential facilities will become more intense.
The Government must, as a matter of urgency, ensure that the health and aged care systems, and their workforces, are prepared for this.

I wholeheartedly support the member for Mayo’s legislation as an important first step in addressing community concerns about staffing ratios in our nursing homes.