An article published on The Conversation has called for nurse practitioners to be ‘an additional tier’ of clinical support in aged care facilities.
The article by Professors from four faculties at The University of Technology Sydney (UTS) – Palliative Nursing, Law, Nursing Aged Care and Palliative Medicine – weighs into the debate about 24/7 nursing staff and the evolution of residential care since the Aged Care Act came into effect.
“Since 2008, the number of older Australians admitted to a residential aged care facility has remained steady, but the proportion of people with high-care needs has progressively increased,” the authors wrote.
“Currently, around half of people living in aged care have dementia, depression, or another mental health or behavioural condition. The proportion of older people requiring high care for complex needs, which includes assistance with all activities of daily living such as eating and bathing, has quadrupled from 13 per cent in 2009 to 61 per cent in 2016.”
“When the [Aged Care 1997] Act was introduced, more emphasis was placed on supporting older people to remain at home for as long as possible. Now, the transition to permanent care only occurs once all options have been exhausted.”
“…As a result, our aged care facilities are increasingly functioning as hospices for the frail elderly with complex care needs.
The authors argue the biggest flaw of the 1997 Act was “to repeal the legal requirement for all aged-care facilities to provide 24-hour registered nursing care to assess and manage resident’s changing clinical needs, wounds and unrelieved pain.”
“Too few have access to the necessary help from a geriatric medicine specialist (doctor), psychologist or social worker. And their families have minimal access to psychological and social support, and bereavement follow-up.”
They note the Act has achieved the amalgamation of hostels and nursing homes into a single, user-pays, regulated system and the low interest bonds have fuelled much-needed capital works but argue the social model of care was idealistic.
“The act’s repeal of the legal requirement for 24-hour nursing care reflected the social model of care underpinning the legislation. The idealistic yet impractical philosophy took the focus away from nursing and medical care. So now, the bulk of personal care is provided by a pool of untrained and unregulated aged-care workers supervised by a very small number of registered nurses.
“Registered nurses employed in aged care are central to assessing, planning, monitoring and delivering complex care to older people living in these facilities.”
“But there are too few registered nurses (and they are often managing the facility) so they have limited capacity to ensure the older person’s function, comfort and dignity is optimised, their mobility maintained and dependence minimised.”
“Aged care facilities lack the clinical infrastructure of our hospitals. So, if a registered nurse is not on duty, there are few people the unskilled care workers can call for timely clinical review.”
“If the GP can’t be contacted and the registered nurse is not on duty, an ambulance will be called and the frail older person will be transferred to hospital for assessment.”
“A new nursing skill mix model is urgently required in aged care to address the level of unmet health care needs.”
“At a minimum, the act should be amended to stipulate appropriate staffing requirements for the delivery of direct clinical care, including the presence of at least one registered nurse at all times.”
“As part of the skill mix, a higher ratio of registered nurses and enrolled nurses supported by a team of care workers is required.”
“The availability of a nurse practitioner, with advanced training and prescribing rights, and a geriatrician to all aged care facilities would do much to improve timely access to medical care.”
“It’s also likely the addition of this tier of health professionals into aged care would reduce the need for unnecessary emergency department presentations.”