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Photo: Kelly Barnes AAP

Staff ratios won’t cost you a thing: royal commission day three

Properly staffing aged care facilities with an adequate nursing skill mix and at least four hours and 18 minutes per-patient per-day care minimum would not cost the sector anything more than it currently outlays.

That’s according to a report presented to the Royal Commission by the Australian Nursing and Midwifery Federation (ANMF) federal secretary Annie Butler. The ANMF-funded, Flinders University National Aged Care Staffing and Skills Mix Project Report made a cost-benefit analysis of the paper's recommendations and found that although it would cost $5.3 billion to implement, any costs would be offset through tax measures and other features.

Savings made by avoiding staff attrition is one such feature, which currently costs the sector $500 million.

“If you had proper staffing in the places, people would feel satisfied, fulfilled in their jobs as nurses and carers and we wouldn’t see the churn that we see,” Butler told the commission.

Staffing levels were the running theme in Butler’s testimony as well as skills mix and the pay gap between the public sector and the aged care sector.

“What we hear most often from our members now is the increasing pressure they’re experiencing with workloads. So many of them across the country describe their workloads now as unsafe. They’re untenable. They report to us that that’s why they’re leaving the sector,” she said.

These shortages affect nurses' ability to properly attend residents in the mornings during their personal hygiene routine, during meal times and handover between shifts, Butler said. We heard a particularly disturbing account of a man, post-stroke and aphasic. He was experiencing pain in his penis and because of a poor handover he was found to have an indwelling catheter wound.

Council assisting Paul Bolster read a statement from an aged care nurse about the incident that read: “I am blown away the staff did not report the erosion as it was happening and take steps to prevent it. More educated staff had not looked at the source of his pain. He had Panadol every night.”

Nurse testimonies from ANNF surveys also highlighted their concerns about nurse hours.

One nurse wrote:

I have been a registered nurse since 1972 and worked in aged care since 1988, and for almost all of that time worked in senior management positions running large aged care facilities for the same not-for-profit organisation.

“Last year, there was a roster review at the facility I was running and the organisation made the decision to cut 16 hours per day from my care staff roster.

“I am now working as a registered nurse seven shifts per fortnight in an aged care facility for another-not-for profit organisation, and they have just reviewed their staffing hours, and are going to cut nine hours per 25 day from the care staff roster."

It is incidents like these that led the ANMF to put forward their hourly care model and a mandated skill mix of 30 per cent registered nurse, 20 per cent enrolled nurse and 50 per cent personal care worker.

“What we think our research clearly indicates is there’s just a gaping hole in the Aged Care Act currently in terms of how you actually staff against genuine care needs in residential aged care,” Butler said.

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