Everything providers need to know about the 24/7 nursing requirement

Aged Care Insite delved deeper into the details of reporting, breaks, and exemptions as the round-the-clock nursing mandate is to become law on July 1.

The reform has emerged as a significant concern, especially for small and rural aged care facilities grappling with a nationwide nursing shortage.

Recognising that not all homes could meet the requirement by July, the health department allowed certain facilities to apply for temporary exemptions.

Residential facilities with up to 30 operational places in Modified Monash Model (MMM) 5, 6, and 7 locations can be exempted from the 24/7 nursing mandate between July 1, 2023, and June 30 2024.

The MMM locations are based on data from the 2020 Aged Care Workforce Census showing that smaller, rural and remote facilities had lower RN rates than larger ones.

The 24/7 RN requirement involves only residential aged care facilities, not residential care services, nor does it include flexible care services, such as Multi-Purpose Services.

While enrolled nurses are not allowed to substitute RNs, a graduate agency nurse registered under the National Law as a registered nurse is accepted.

For co-located services within a single facility, only one RN needs to be present and on duty across all services. 

But for split services at different locations, each site associated with the service must have at least one RN on-site and on duty, as they are considered separate facilities.

If there are two or more co-located services within a residential facility, they'll only be eligible for an exemption where their combined operational places are 30 or fewer.

Additionally, exemption criteria are based on operational places, not occupied places, because the department said it would provide 'more stability for providers.'

Using occupied beds as a criterion could lead to homes sometimes being eligible and sometimes not due to changes in the number of residents in care.

If a facility is exempt from the 24/7 RN mandate, they still need to meet the other obligations, including the 200 care minutes from October 1 2023.

The government is providing residential facilities with a 24/7 RN supplement through the AN-ACC funding model that should cover up to 60 residents per home.

Providers who are granted an exemption will continue to receive subsidies for their residents through AN-ACC, but won't receive the 24/7 nursing supplement.

They can opt out of the exemption if the home can meet the 24/7 nursing requirement, after which they'll receive the subsidy.

Eligible aged care homes can apply for an exemption for free anytime since April 3.

From July 1, 2023, all aged care providers are required to report monthly on the 24/7 nursing responsibility, including exempt facilities.

The government is developing a new web-based system called the Government Provider Management System (GPMS) that'll be used for 24/7 RN reporting. 

While more information will become available closer to July, the department indicated that an RN is considered 'on duty' when taking breaks.

But if an RN leaves the premises during a break, the provider must report this period as if no other RN was present on-site and on duty.

Facilities ineligible for exemption and unable to meet the mandate are expected to undertake comprehensive workforce planning to address immediate and long-term workforce supply. 

The department suggested strategies such as having a qualified RN as a supernumerary after-hours coordinator to manage clinical care needs.

Earlier this year, the aged care and quality commission said they'd consider the circumstances and steps taken by the home to meet the responsibilities.

The Commission is 'unlikely to take serious enforcement action against providers' if there are no other compliance or performance issues, according to a recent department webinar.

Several programs and incentives are in place to assist providers in attracting and retaining nurses, including payments for nurses working in aged care for 6 to 12 months. 

It also funds scholarships for nurses and allied health through the Australian College of Nursing and the transition into practice program to attract more students to aged care.

To tackle workforce challenges in rural and remote areas, the department has commissioned independent research to explore evidence-based alternative arrangements.

The final report is expected late in 2023.

Additionally, the department plans to use data from the 24/7 nursing reports to develop a model for identifying issues in specific regions and designing future exemption arrangements. 

These efforts aim to refine the exemptions policy from July 1, 2024.

Last Tuesday, Aged Care Minister Anika Wells told ABC Q+A host David Speers that the 'vast majority of facilities' had 24/7 nursing in place.

However, Ms Wells couldn't share the exact figures. 

"A lot of people have told us they're going to do it from July 1, but they're not doing it yet," she said.

"The numbers will come in when people start reporting on their 24/7 nursing policy from July 1."

Reforming aged care 

Last year, the Albanese government introduced two pieces of legislation to reform the aged care sector.

The Aged Care Amendment (Implementing Care Reform) Bill 2022 included a raise to 200 care minutes per resident per day by October 1 2023, including 40 nursing minutes.

By October 1 2024, care time will increase to 215 care minutes, of which 44 nursing minutes.

From July 1, 2023, all aged care facilities must have an RN on-site and on duty 24 hours a day, seven days a week.

The second bill, the Aged Care and Other Legislation Amendment Act 2022, introduced the new AN-ACC funding model and launched a Code of Conduct for aged care workers.

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