Home | Industry+Policy | Path to better aged care: mandated staffing ratios or better funding base?

Path to better aged care: mandated staffing ratios or better funding base?

When quality of residential aged care is called into question, two paths to improvement seem to form: improved funding and mandated staffing ratios.

The peak body for all providers of age services, Leading Age Services Australia (LASA), is helping forge the former.

Following last week’s 7.30 report into a recent death at a Bundaberg aged care facility – which most people interviewed in the story attributed to lack of quality care and inadequate staffing levels – LASA chief executive Sean Rooney said it was vital that the Federal Government delivered a stable and equitable funding base.

Rooney said: “The Government is well aware that current funding for the aged care system is not sustainable and a national solution to pay for the growing cost of aged care is required.

“We need to design and develop a sustainable funding strategy underpinned by detailed research, analysis and modelling.

“Funding options for consideration should include examples from other countries, such as national insurance schemes, taxpayer levies, user-pays models, taxation concessions/supplements and the like.”

The Australian Nursing and Midwifery Federation (ANMF) said while more funding may be necessary the most pressing issue is the “chronic understaffing” of aged care facilities.

The union said: “Without adequate measures to ensure that government funds are used to increase care through higher staffing levels there is no point in increasing funding.

“The Federal Government, Opposition and all other Federal politicians must stop ignoring the staffing crisis in aged care. They must stop conducting reviews, inquiries and reports and start fixing the problem by making ratios in aged care law.”

But Rooney said the provision of appropriate levels of care for older Australians in residential care facilities is not as simple as the number of staff on duty or arbitrary staffing ratios.

“The needs of people in residential aged care are highly variable and, within a stringent quality control system, a flexible staffing mix can deliver the best quality of care targeted at individual care needs.

“Flexibility to adjust the staffing mix as the profile of residents changes is a very important consideration, as is the adaptability to move to new models of care driven by innovation and new technology,” he said.

All sector stakeholders agree that the wellbeing and care of residents should be a priority and that change is needed to avoid incidents like the one explored in the 7.30 report. But what is the best way forward? Aged Care Insite spoke with both LASA’s Rooney and ANMF’s federal vice-president, Lori-Anne Sharp, to further explore these two potential paths to better quality care.

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  1. I am surprised the ANMF is not more concerned with the skilling of those in the delivery of Age Care. The daily basic care is provided by the majority of staff who the ANMF do not represent. There are various levels of education provided to care workers by sometimes less than desirable approved RTO’s who provide no face to face contact or support and often leave fee paying students to find their own placement and then provide no support to the facility hosting the student but still put both hands our for the government funding.

  2. As a manager in a small, not-for-profit stand alone provider, I can see some merit to the mandated staffing ratio’s, but not as a KPI for determining a level of care. You can put a ratio in as low as you like, but it is no guarantee of quality. a “minimum” level, base on rules similar to those being considered in the R-ACFI (namely the “baseline funding” where it is accepted that all Aged Care Providers undertake the same basic “care activities” for all residents in one form or another). this might provide a model on which to examine to validity of a “minimum” ratio however, there are so many variables involved in care that setting a mandated level of staffing has the potential for a raft of unintended consequences.

    Increase is in funding is most definitely needed, as Stewart Brown has highlighted in their annual report about the alarming number of providers reporting a financial loss. Once again, there are drawbacks. Giving funding to providers who have systemic poor practices is useless, and then there are two other issues which it seems don’t get much spotlight, but I at least, believe should be looked at comprehensively.

    1: the incredible disparity between the cost of “caring” for an elderly person in a hospital. A complex, but long term fix for this would be to gradually close the gap by increasing the daily funding levels (both subsidies and ACFI) for Residential Care, while at the same time reducing the funding in hospitals for the SAME CARE. I am not talking about pre and post op, or acute illness requiring Hospitalisation, rather the large number of elderly Aussies waiting for weeks and sometimes months for a place in Residential Care or, as many people in this situation have reported to us, a loved one being discharged to go home, when they and their families are clearly not able to do so.

    2: ACFI and the punitive nature of validations. The recent validation visits have shown some alarming facts which I have not seen reported in any news feed. I will give an example. My organisation was validated last year. The number of residents validated was over double that from any previous validation. Yes, we made a couple of errors which unfortunately cost us a lot, and we have since closed the gaps and learned from our mistake. (Not everyone “games” when claiming!!). My incredulity with this system was formed from the following information. A resident was receiving regular 4b attention from our physio (1 to one, 20 minutes a time, as per the guidelines). Our paperwork for the previous 12 months clearly showed that this treatment was an assessed need, and was being regularly provided. The validators found an “incongruence” which was for a period of 4 days during the 12 months, the resident was in hospital. The “misleading and fraudulent” information was found. Our physio, using the forms provided by their company (a reputable provider of Allied Health Services) had inadvertently ticked that the treatment had been provided, and forgot to note on the sheet that she had gone to visit the resident, but they were will in hospital. The validators stated on the day “we can clearly see this treatment is needed and regularly being applied, but we cannot validate this information is correct now because of this “incongruence” We asked that they just walk 20 metres down the corridor to speak to the resident, who would easily and readily confirm she gets her treatment pretty much every day. As a result, we lost the whole claim, and were written down over $30 thousand dollars. The irony to this story, is that as the resident was still in hospital if our physio had “noted” this on the treatment sheet, we wouldn’t have been written down. Even worse Irony is that the Quality Agency now is focussing on the residents thoughts and opinions, (quite rightly), but the ACFI validations don’t allow resident feedback to be considered, as in our case the resident would have confirmed she was receiving treatments. (we could also have provided CCTV footage of the physio visiting the resident, etc, etc, etc…)

    I have worked in this industry now for 10 years, I can’t recall anytime when there wasn’t a crisis, or a heap of reviews underway all at once. It is time for the Federal Government to get this sorted so that us providers can stop trying to second guess where the next regulatory review is going to push us, and allow us to focus our efforts on the most important part of the industry, OUR RESIDENTS!!

  3. When will the unions understand that staffing ratios equals more funding in any case? Under the existing funding envelope the 49% of RACS losing money will rise to at least 70% and then where will employment opportunities present? Or is it all about getting older Australians back to hospital where the nurses have more industrial pull?

  4. As a not for profit manager and a union member, I found that the unions have it wrong!!
    The ratios are not going to improve anything at all, it will not continue to sink residential aged care into more deficits if funding does not improve.
    Not for profit aged care also put care above anything else but with the constant cuts we face we are left with no other choice but to start cutting staff to survive as a home. In 16 years that I have been In aged care this is the worse 2 years of cuts I have ever seen. There is nothing in it to cushion yourself against it, staff costs go up, funding go down, cost of living go up such as food and electricty but we have nothing else to give so we are left with no other choice but to cut. If aged care homes continue to be left with a choice to cut or close… its no wonder the sector is failing. Stefan is right no one but us are looking out for our residents. The media and the government are just heading towards user pays system and the residents and their families are the ones going to pay for what normally the government would have. I just hope that our society see this before its too late.