Six in 10 aged care residents live in inadequately staffed facilities

Matt Woodley

3/06/2020 4:59:01 PM

The new data also reveals only 1.3% are in facilities with ‘best practice’ staffing levels.

Woman sitting by herself in a RACF.
RACFs are more likely to ‘experience quality concerns’ when staffing levels fall below three stars.

The research, commissioned by the Royal Commission into Aged Care Quality and Safety, utilised a ‘five-star rating system’ used in the US by the Centers for Medicare and Medicaid Services (CMS) to assess staffing levels.
When applied to Australian residential aged care facilities (RACFs), the authors found 57.6% of residents live in RACFs that have inadequate (one or two stars) staffing levels.
Slightly more than one quarter (27%) reside in RACFs that have three stars, while 14.1% of residents are in RACFs with four stars. Only 1.3% of Australian aged care residents live in facilities assessed to have five star, or ‘best practice’ staffing levels.
Dr Ken McCroary, a GP with a special interest in aged care, described some of the findings as ‘horrendous’ but conceded the study is ‘a really correct representation of what’s actually going on’.
‘This information needs to become widespread, seriously,’ he told newsGP.
‘I really support all of the recommendations related to encouraging staff numbers, both allied and nursing. But the deeper picture is that it’s probably even worse than what the star rating indicates, particularly with regard to the work nurses are actually given the opportunity to perform.
‘Most of it’s just paperwork and giving out medications and pills, so patients are lacking quality nursing time as well.’
Study co-author Professor Kathy Eagar, Director of the Australian Health Services Research Institute at the University of Wollongong, said the CMS rating system has a strong evidence base and been in widespread use for nearly 20 years.
‘Research into the CMS system found that homes are more likely to “experience quality concerns” when staffing levels fall below a certain level,’ she said.
‘This threshold is equivalent to the minimum requirement for a three-star rating – ie, 30 minutes of registered nurse time and 215 minutes of total time per resident, per day. Therefore, we determined that anything less than three stars is inadequate for Australian RACFs.’
According to Professor Eagar, it would take an average staffing increase of 37.3% in RACFs currently rated one or two stars to elevate them to ‘adequate’ staffing levels – equivalent to an overall increase of 20% in total care staffing across Australia. Achieving four stars would increase total staffing by 37.2%, while a near 50% increase would be needed to reach five stars.
‘The existing system has failed to ensure residents uniformly receive quality care. Some residents receive excellent care. Too many others don’t,’ Professor Eagar said.
‘It is no longer acceptable to describe RACFs simply as a person’s home or for advocates to argue that what is required is a social model of care delivered with a wellness philosophy.
‘While on the surface it sounds attractive and in line with what consumers want, the evidence from the Royal Commission is that these arguments are now being used as a justification for inadequate care.’
Dr McCroary said the high numbers of deaths – 60,000 per year from a total cohort of around 180,000 permanent residents – means RACFs should now almost be considered an extension of the hospital system.
‘Staff are underfunded, undereducated, under-resourced, and under-supported by their managers. That causes them to be demoralised and it decreases the attractiveness of a career in aged care,’ he said.
‘Which is so disappointing, because you see some RACFs and some nursing staff that are actually doing fantastic, really incredible and really worthwhile work.
‘Unfortunately from my anecdotal experience, what seems to be the most important thing for management is filling out the forms for funding, which is so distressing for human beings that are in these facilities that deserve a lot more than that sort of de-personalised quantification.’
However, with almost 200 Australian aged care providers experiencing financial distress, securing additional funding is vital for many RACFs to stay afloat. It also means increasing staff levels to ‘adequate’ numbers would likely be out of reach without an injection of funding.
‘There obviously needs to be an increase in funding and an increase in efficiency of funding, and then a directed concentration on patient and quality care, not paperwork and administrative tasks,’ Dr McCroary said.
‘If the RACF is assessed as requiring that sort of support then they should be just funded completely for all that support, rather than having the nurses and allied health people spending excess time applying to get it.
‘At the moment the best clinical performers are generally pinched off the floor straightaway and thrown into management roles in the office to use their medical knowledge to attract [funding] or to complete the forms.
‘It happens all the time, which is again, just the wrong way around.’
Professor Eagar and her colleagues believe aged care in Australia needs to be provided within a ‘non-institutional environment’ that is respectful of individual choices and affords every resident the opportunity to be meaningfully engaged.
‘Residents in Australian RACFs have a right to be safe and to receive clinically competent and adequate care,’ the authors wrote.
‘There does not need to be a trade-off between a social model of care and a clinically competent model. Aged care residents have a right to both and do not have the time to wait.’
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