Home | Policy & Reform | Innovation, not ratios the key to fixing aged care: chief executive
Hundreds of nurses, aged care workers campaign for ratios. (AAP Image/ Brenton Edwards)

Innovation, not ratios the key to fixing aged care: chief executive

“Ratios, ratios, ratios. Everybody will tell you that.”

This was the response of aged care resident Merle Mitchell earlier this year at the royal commission when asked to nominate one thing she would change in the sector given the chance.

The debate over staff to patient ratios has raged for years now and the issue has been front and centre during the royal commission. The Queensland state government has committed to staffing level reports and mandated ratios. However, federally, the government has resisted, and the aged care sector is equally unsure of its merits.

One issue consistently raised is the cost of adding more nurses to an already struggling sector. However, a report presented to the royal commission by the Australian Nursing and Midwifery Federation federal secretary Annie Butler – the 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.

One industry veteran who doesn’t want to see ratios implemented is Odyssey Health Group founder Phil Usher. He sees innovation rather than staff quotas as the solution to improving Australia’s aged care system.

“I don’t think a one-size-fits-all solution is the answer,” said Usher. “Cherry picking with mandatory staffing isn’t going to fix the problem because I think the whole aged care system needs an overhaul.”

Aged Care Insite spoke with Usher to hear more about his ideas for a “consumer centric” aged care system.

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  1. It is not how many staff any ACF has. It is more about having ‘the right staff’. That is having people who have compassion and empathy for our older Australians that require the care. Staff that can be innovative rather then be delivering task orientated care. The right staff will be person centered. The right staff will be a good fit in the aged care industry.
    Staff ratios are not a guaranteed fix (costs aside).

  2. Right. With you Mark

  3. I don’t think anyone is arguing that mandated minimum staffing levels and skills mix alone is going to solve the systemic problems with Australia’s aged care sector.

    There is a whole raft of changes that are necessary. Some of these are; transparency regarding providers’ use of funding for the provision of care, a funding system that incentivises safe, person-centred care, appropriate education and training for staff, publicly reported staffing levels to underpin informed decision-making for older people and their families, effective and efficient interfaces and integration with the health care system.

    Without the right number of the right kind of staff, however, no amount of innovation or funding will guarantee safe, quality care. Mandated minimum staffing levels would ensure that there is at least a baseline below which providers cannot go. Ratios are not fixed or inflexible; they simply refer to a relationship between two values, which in this case is staff to residents. Ratios are everywhere; schools, retail, hospitality, healthcare. In aged care where vulnerable people’s health and lives are in other peoples’ hands, is it not reasonable that there are at least enough trained and qualified staff onsite at any one time to provide the care that they need and deserve? There is abundant evidence that improving nurse staffing levels in hospitals leads to better outcomes and reduced harm to patients. This is clearly transferable to residential aged care settings where the care needs of residents are intensifying. Nurses don’t just provide healthcare either. For instance; nurses’ training and expertise means they can undertake skin integrity, swallowing, and falls risk assessments while engaging in personal care such as bathing, helping people get out of bed, and eat dinner. Ratios does not stop at nurses either; there also needs to be at least enough care workers, doctors, and allied healthcare professionals.

    The argument that ratios are a blunt instrument is old, redundant, and misses the point. There is no one panacea for Australia’s broken, neglectful aged care system, but to go back to my central point – without at least the right number of the right kind of staff, how will any other solution work? Ratios – via mandated minimum staffing levels and skills mix is vital part of a complex solution.