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Let’s scratch the surface of the government response to the Royal Commission before celebrating

The federal government’s response to the outcomes of the Royal Commission into Aged Care Quality and Safety is a recognition that the system needs to change.

Superficially, there are aspects of the response that are encouraging and others disappointing, but it will not be until we are provided with more details that we can be optimistic about the future.

It is the issue of transparency in all aspects of the government response that is the key to sustainable and effective reform.

As someone who has worked for over 30 years across so many aspects of aged care, especially in clinical care of older people, I am concerned about who provides the care, who supports those providing the care, and the quality of the education provided to anyone interacting with older people.

The government has provided $650 million to grow and upskill the workforce with 33,800 training packages for care workers. But how do you attract these workers when the level of payment for their work does not reflect the significance of what they do and the responsibility they carry?

There are also tenders being processed that will provide newly graduated registered nurses with a Transition to Practice program to support them in their role.

This is a start but there are hidden challenges. As we have seen in the past, the provision of education to aged care workers varies widely despite the oversight of the regulatory agency TEQSA and the requirements of the Australian Training Framework.

How can we be assured that these new training opportunities are going to be robust, relevant and of a consistently high standard to ensure aged care workers are able to fulfill their role and provide quality care?

Initial training is a start, but the end of the introductory training is just another beginning. Who is going to be beside the care worker as they translate what they learnt in the tutorial room into real life situations?

It is a quantum leap to make meaning from training to real life situations, especially when we have such a heterogenous group of older people.

Strategies that may assist the care worker with one individual may not be effective with another.

Further challenges are presented when a care worker tries to make sense of someone whose behaviour is incomprehensible as a result of dementia or delirium. Who can help differentiate between the two conditions? What interventions are appropriate and effective?

The presence of clinical mentors is essential to support the care workers as they develop their skills and knowledge. So, it is not just the initial training that should be the focus. Care workers, and older people reliant on their support, need ongoing input from skilled mentors and educators who are available to them in real time and who can build skills based on the situations the care worker is confronted with.

Having skilled mentors may reduce the number of serious incident situations (SIS) in residential care facilities. Presently, the suggested response to these SIS is to call the police in the case of aggression between residents.

So, instead of having specialised staff to instigate strategies to prevent incidents of aggression or to intervene when there is an incident and coach the staff to intervene to de-escalate, we have the presence of police officers with their guns and other equipment, entering a dementia unit and further escalating the situation. What education do the police have to manage these situations? Is this the most effective use of their skills and time?

An encouraging response from the federal government is the requirement to have at least 40 minutes of Registered Nurse time allocated for each resident. The anguished cry from industry is “where will we get enough registered nurses?”.

Before the changes to aged care policy in 1998, there were many skilled and experienced registered nurses working in aged care. It was through government policy, beholden to industry and the quest for profit, that registered nurses were driven from the industry and discouraged from working there. This was done by eliminating opportunities for career progression, closing education departments in aged care facilities, and the introduction of a different pay schedule to the acute sector.

The registered nurse was de-valued and seen as a drain on the income of the owner of the aged care facility. I remember one aged care facility I considered working in until I was told, as a registered nurse, it was my role to cut up the fruit for breakfast while the care workers undertook the significant role of getting residents out of bed, showered and ready for their meal.

So, encouraging registered nurses back to working in aged care is going to take time and assurance that their role will be respected. Introducing a transition-to-practice is one step, and the other is an incentive payment of $3,700 if they remain with their employer for 12 months.

There is also the requirement that a facility have a registered nurse on duty for at least 16 hours a day. What happens in the remaining 8 hours?

However, there is no talk of pay parity with the acute sector and no provision for career progression.

Of significance for rural and remote facilities is that there is no support in attracting registered nurses to these areas. Police officers and teachers taking up opportunities in rural and remote areas are incentivised, so why not registered nurses?

It has taken many years for the aged care sector to deteriorate to the state we heard about in the submissions to the Royal Commission. It is going to take many years and collaboratively working together to restore the community faith in a system in which all involved are supported and respected.

Maree Bernoth is Associate Professor at Charles Sturt University School of Nursing, Midwifery & Indigenous Health

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  1. Well said Maree. At its core aged care is work – or the better said, care is the product of those who perorm the work. There are so many ways in which the points you make are just so important and basic. Changing the way we recognise, reward and prepare the staff of aged care services is an essential first step to developing a world standard of care. How can we possibly have confidence in a response to the Royal Commission that does not even take the first step towards acknowledging that?

  2. Thank you for the comment Michael. How do we ensure quality education for registered nurses when the tender for the transition practice education goes to an industry body that oversaw the industry when abuse and neglect was prevalent, which was demonstrated in the hearings from the Royal Commission? It’s as if the status quo is protected, critical thought and evidence is disregarded and once the spotlight is removed, it will be back to what existed previously. I am fearful for the future workforce and the older people reliant on that workforce.

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