Who will be caring for our elderly

A new report paints a bleak picture of aged care, particularly when it comes to nurse numbers, write Annie May.

The ratio of aged care residents per nurse will double in the next decade if the current rate of decline in nurses continues.

This is according to a new report which also found the quality of care in residential aged care (RAC) has deteriorated in the past five years as the ratio of more qualified to less qualified staff has declined.

It is a situation that is unacceptable, said Michael O’Neill, chief executive of National Seniors, which released the report.

The Access Economics report, The Future of Aged Care in Australia, finds the current system is: plagued by staffing and bed shortages, crumbling under current financial pressures and unable to meet the future demands of an ageing population.

Unless policy-makers implement viable funding alternatives, burgeoning costs will render the sector unsustainable, it concludes.

All this spells bad news for consumers, said O’Neill.

“Older Australians are already feeling the effects of a system in decline. In the past five years the ratio of more qualified to less qualified staff has dropped and the ratio of residents to staff has increased,” he said.

“Not only do nurses get paid $300 a week less in aged care but when the system is run as a business, cost-cutting comes in the way of staffing reductions.

“This means consumers aren’t getting the quantity or quality of care they should. They’re waiting longer and longer for help – either in nursing home beds or at home – that just isn’t there.”

The report shows emerging critical shortages in the next 20 years as demand for labour escalates.

The supply of RAC staff will increase by around 14.1 per cent by 2020 in contrast to an increase in demand of 56.8 per cent, says the report.

In addition to residents being older and the imbalanced ratio of patients per nurse, it found each nurse on average would need to supervise three, rather than two personal carers.

As well as the wage gap being a deterrent for nurses to join the sector, the poor public image associated with RAC and a lack of education and training opportunities have reduced the attractiveness of the profession.
Concerns have also been raised about unfavourable working conditions. This includes excessive documentation and workloads, occupational health and safety issues – such as longer working hours to cover staff absences.

“The current shortages have exacerbated the problem by increasing the stressfulness of the job for the nurses who remain, thereby creating a vicious circle,” says the report.

The National Institute of Labour Studies (2008) found that 44 per cent of RAC workers felt their jobs were ‘more stressful than ever imagined’.

“Demographic ageing will intensify these problems because the declining proportion of the population of working age will increase competition for labour. The RAC industry will need to provide competitive conditions in order to attract a quality workforce,” said the report.

However, more nurses with improved skills may not be the answer for all RAC facilities.

“Each facility has its own mix of resident types (low, medium, and high care), so a ‘one size fits all’ approach will reduce flexibility and lead to an inefficient allocation of resources,” the report said.

An optimal care mix would appropriately match care skills to resident care needs.

“Currently, there is a disconnect between the level of funding provided through the Aged Care Funding Instrument (AFCI) model and the actual funding required to employ the required skill mix to deliver assessed care.”

“However, the current ACFI framework is amenable to modifications that would enable care needs to be assessed in terms of skill matching services to residents.”

Under this, the report said, each resident would not only be assessed in terms of low, medium or high care, but also on how their needs rely on care by RNs, ENs, personal carers, specialists and others.

“The total number of full time equivalent RNs, ENs, personal carers, specialists and others required to provide appropriate care to residents of a facility could then be calculated based on the number of hours and types of skills required to deliver appropriate care to each resident.”

The report was released only days after Prime Minister Gillard announced that the “Minister for Ageing” will now be the “Minister for Mental Health and Ageing”.

“This move to a shared portfolio may reflect a downgrading of aged care just as it reaches a critical juncture. Let’s hope it’s not the case”.

The Productivity Commission, currently conducting an inquiry into aged care, is due to report its findings in April 2011.

“Unfortunately, reforms arising out of the inquiry will take several years to roll out.
We have real stories from real people – mums and dads, and grandparents – who are in the system now and really struggling,” said O’Neill.

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