Doctors and nurses call for mandated nursing home staffing and swifter action
Doctors and nurses are calling on the Government to urgently mandate staff ratios of registered nurses in aged care and to act sooner than recommended by the Royal Commission to bring in 24/7 registered nurse (RN) cover in nursing homes.
The AMA and the Australian Nursing and Midwifery Federation (ANMF) are calling for Government to implement the minimum staff time standard recommended by the Royal Commission as an urgent first step, but should go further and raise this standard to a five-star model.
The Royal Commission’s Final Report recommends from July next year, minimum qualified staff time in nursing homes should be 200 minutes per resident per day – about three hours and 20 minutes – with at least 40 minutes provided by a registered nurse. This is a three-star model.
It also recommends the minimum staff time standard require at least one RN on the morning and afternoon shifts from 1 July 2022, but has delayed the introduction of 24-hour RN staffing until July 2024.
The five-star model is 264 minutes of care or more - four hours and 24 minutes - with 63 or more minutes with a RN.
“We’re pleased the Royal Commissioners agreed minimum staff ratios need mandating and we urge the Government to commit to that,” AMA President, Dr Omar Khorshid, said.
“We believe there’s no reason why our older Australians should have to wait another three years until they have nurses available to care for them at all times.
“With the average length of stay in a nursing home at two-and-a-half years, many residents who could benefit now will have died by 2024 and will have suffered needlessly in the meantime.
“Many nursing homes have insufficient numbers of registered nurses, leading older people’s physical conditions to deteriorate so badly they end up in hospital. Conditions like urinary tract infections, nutritional deficiencies and as we’ve seen, even gangrene could have been prevented in the first place.
“The AMA’s new research paper, Putting Health Care Back Into Aged Care shows that once these entirely preventable conditions develop, older people end up in hospitals more frequently, and stay longer. We estimated on average people aged over 85 with potentially preventable conditions stay in hospital one-and-a-half extra days than people with non-preventable conditions* – and that’s putting further pressure on our already over-stretched emergency departments.
“The AMA and the ANMF have stood together before to say Care Can’t Wait and we believe the Government can do better – certainly our older people deserve better.
“The AMA’s latest research shows with GPs at the heart of aged care settings backed by more nurses, our seniors get far better care, and with immediate reform, there are enormous savings for Government and the hospital sector. It has got to be a no-brainer.
“We’ve estimated that over the 12 months until 30 June this year there will have been 27,569 hospital transfers from nursing homes that were potentially preventable, costing $312 million and occupying 160,000 patient days,” Dr Khorshid said.
The Federal Secretary of the ANMF, Annie Butler said: “The Morrison Government must act now to fix the crisis in aged care – every day they delay, is another day vulnerable nursing homes residents continue to suffer.
“Doctors and nurses see no justifiable reason for the 3-year wait to implement what is a basic human right for anyone requiring best practice care. A sufficient, committed and high quality workforce is one of the main factors impacting the quality and safety of aged care.
“Once the visiting GP departs the nursing home, RNs are the only qualified aged care staff able to provide appropriate clinical care to patients.
“So, if the Government wants to do justice by our older Australians and give them the respect they need and deserve enabling them to live in dignity in their old age, it must provide funding for the minimum staff time standard and availability of registered nurses 24/7 in nursing homes in the upcoming Budget. And that funding must be transparent and accountable – with taxpayer subsidies directly tied to the provision of safe, proper care for elderly nursing homes residents.
“As the Royal Commission pointed out, ‘transparency and accountability should be embedded in the new aged care system’. Currently, there is no specific regulation or requirement that aged care providers spend any of the billions they receive each year in Government subsidies on direct care. It’s little wonder that elderly Australians continue to suffer without proper care.
“The AMA and the ANMF are standing together because doctors and nurses know best how to care for our older relatives. We support the AMA’s call for more funding for GPs to visit nursing homes because it’s critical we get the best health care team, working together, into aged care,” Ms Butler said.
The AMA’s research paper, Putting Health Care Back Into Aged Care was launched on 12 April and found:
- Savings of $21.2 billion are available through potentially avoidable admissions, presentations to and stays in hospitals from the aged care sector and could be achieved through better provision of primary care in aged care settings.
- Nursing homes with poorer staff to resident ratios have higher rates of transfer to hospital, compared with those that have better registered nurse availability.
- The AMA estimates that Government investment of $643 million over four years to 2024-25 ($145 million in 2021-22) is needed to increase MBS rebates for GPs and believes this is a relatively modest cost compared with the savings identified.
- * As a result of lack of timely and adequate care, older people end up in hospitals more frequently and stay longer: The average hospital stay of a person aged over 85 is 6.4 days from a potentially preventable admission, compared to 4.9 days for non-preventable conditions.
- Experienced nurses can provide appropriate and skilled care within the nursing home, which in conjunction with GP oversight, can prevent transfers to hospitals.
- Clinical care in aged care is of crucial importance as older people have multiple and complex medical conditions and require ongoing clinical care.