New staffing model posed for residential aged care

Aged care residents should be receiving an average of 4 hours and 18 minutes of care per day, according to a new staffing model for residential aged care developed by the Australian Nursing and Midwifery Federation (ANMF), Flinders University and the University of South Australia.

The model, which identifies how long residents should receive care per day and the breakdown of skills required, is based on findings from the National Aged Care Staffing and Skills Mix Project carried out by the three organisations.

Credit: Shutterstock 170076527
Credit: Shutterstock 170076527

The project is the first of its kind in Australia and comprised the development of an evidence-based complexity profile for residents, testing the elements of care associated with the resident profiles, and then determining any care interventions that were being missed.

The outcome was a clear need for a staffing model for residential care, which includes an average of 4 hours and 18 minutes of care per day for each resident (up from the current average of 2.84 hours per day) and a minimum skills mix of Registered Nurses (RN) 30 per cent, Enrolled Nurses (EN) 20 per cent and Personal Care Worker (PCA) 50 per cent, according to the ANMF.

ANMF Federal Secretary, Lee Thomas said the project was undertaken as a result of the “monumental failure” of governments to establish evidence based staffing levels and skills mix in the aged care sector.

“The report’s findings reflect feedback from ANMF members working on the ground in aged care and is consistent with the stories from members about the increasing difficulty they experience in providing decent care to residents, many with dementia and other high-complex needs,” Ms Thomas said.

“Whilst the number of people in residential aged care has nearly doubled from 1995 to 2014, consecutive governments have failed to legislate the minimum number of staff with necessary skills.  As the report shows, missed care is a regular occurrence in residential aged care.”

In the report foreword Ms Lee said there is a growing body of research that demonstrates inadequate levels of qualified nursing staff leads to an increase in negative outcomes for those in their care, which results in increased costs.

“In the acute setting, the implementation of safe mandated minimum staffing has been shown to prevent adverse incidents and outcomes, reduce mortality and prevent readmissions thereby cutting health care costs,” she said.

While two states have legislated staffing levels and skills mix; and other states have mandated staffing levels, there has been little focus on the impact of nurse and personal care staffing and mix in aged care, she said.

The report highlights studies that prove an increase in workload for residential aged care staff with higher resident acuity due to hospital avoidance strategies and later admission into care.

According to AIHW data, the number of patients rated high across all three ACFI care domains of activities of daily living (ADLs), behaviour, and complex health care needs increased from 18 per cent in June 2012 to 27 per cent by June 2015. In the same period, the proportion of people with dementia had increased from 52.1 per cent to 59 per cent.

The ANMF provided the report to the Chair of the Senate Enquiry into the aged care workforce with the hope the Committee will use the evidence and outcomes and make significant recommendations to legislate minimum staffing levels and skills mix in residential care.

Recommendations from the Committee are due in April 2017.

View the full report here


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