The Royal Commission into Aged Care Quality and Safety resumes hearings in Adelaide today.
Last month’s hearings, held in the same city, heard about a residential aged care sector in crisis – underfunded, understaffed, poorly regulated and justifiably feared by many Australians.
The Australian College of Nursing (ACN) was one of the professional bodies that provided evidence at the hearings, and it wasn’t the first time the ACN has contributed to such an inquiry.
In the post below, ACN CEO, Kylie Ward, summarises the College’s advice on what is needed to assemble, train and maintain a residential aged care workforce that is fit for purpose.
Kylie Ward writes:
Reports of abuse and neglect of residents at residential aged care facilities (RACFs) across the country have brought scrutiny to the aged care sector. The current Royal Commission into Aged Care Quality and Safety is the latest review, adding to more than 20 inquiries over the past 20 years into the sector.
As a community, we cannot afford to ignore the issues facing aged care – hoping for the best until it is ourselves, or our loved ones, who need residential care.
The aged care workforce needs to almost triple in number, from 366,000 to 980,000 by 2050 to meet demand. It is therefore imperative that we establish a new industry-wide approach, that will attract the best health care professionals to aged care for a sustainable workforce into the future.
The Australian College of Nursing (ACN) recognises that a large proportion of nurses work in aged care, and that these nurses are central to providing invaluable care and support to older Australians. The nursing profession has been saying for some time that nurses are expected to do many non-clinical tasks in aged care that take them away from spending quality time with people – meaning that residents do not get the care they deserve.
Former Senator Bernard Cooney, who lived his last days in a RACF, insisted on submitting an account of his experience to the Royal Commission before his death to explain that, “the very process stripped the elderly of their dignity and left them to die miserably.”
We hope that with the nursing profession’s contributions, the Royal Commission’s findings will make a real difference in ensuring all Australians can age with dignity.
The ACN has made the following recommendations to numerous inquiries, including the Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse and poor practices, and ensuring proper clinical and medical care standards are maintained and practised inquiry, and the Royal Commission, as a result of considerable input and consultation from nurse leaders across the country.
Unregulated health workers (however titled) need to be regulated.
Last month, ACN Ageing Policy Chapter Chair Professor Deborah Parker MACN, presented evidence at the Royal Commission on behalf of the ACN.
Unregulated health care workers (UCHWs), Professor Parker explained, lack the training, level of assessment and planning skills that are required to meet residents’ increasingly complex needs in aged care.
In 2016, the National Aged Care Workforce Census and Survey (NACWCS) found personal care attendants (PCAs) made up 70 per cent of the residential aged care workforce, while the number of registered nurses (RNs) had fallen from 21 per cent in 2003 to approximately 14.9 per cent.
UHCWs’ frontline role needs to be recognised and valued in service delivery across all health sectors however, as they are increasingly undertaking activities that fall under nursing work, this leads to a blurring of scope and accountability.
ACN’s Position Statement, Assistants in Nursing [AIN] (however titled)* released in 2016, notes:
The introduction of AINs* into nursing care teams must never be as a substitution for registered or enrolled nurses. ACN believes that AINs’ contribution to nursing care should be underpinned by participation in the National Registration and Accreditation Scheme (NRAS) with the aim of providing a nationally consistent practice framework that clearly defines the AIN scope of practice, practice standards, and codes of ethics and conduct and a minimum formal education requirement.”
ACN’s Policy Chapter for Workforce Sustainability has reiterated the call for regulation of UHCWs (however named) to improve patient safety. A White Paper is in development which will make recommendations on how this should be introduced and implemented.
It is imperative that nation-wide inconsistencies regarding the UHCW role and UHCW regulation are addressed promptly.
ACN believes an adequately regulated workforce enables quality care and safe environments.
A Registered Nurse (RN) needs to be on-site and available in the resident area at all times in RACFs, to promote safety and wellbeing for residents.
RNs are typically the clinical leaders in RACFs. Nursing care in aged care must be led by RNs, as they possess the nursing surveillance and intervention skills required to care for older adults with complex care needs.
If quality and safety in residential aged care is to be assured, their role cannot be substituted by any other category of health care worker.
Having at least one RN on-site at all times in every RACF in this country can improve the care provided to residents and decrease the risk of mistreatment.
Skills, and skills-mix, modelling needs to be implemented in aged care.
ACN has called for nurse leaders to be able to exercise their professional judgement and clinical management expertise to determine the appropriate staffing levels, skills and skills-mix requirements in aged care.
Mandating staffing levels alone does not address all issues. Patient care is very complex and unpredictable. ACN endorsed the ICN Position Statement of Evidence-based safe nurse staffing in 2018, which thoroughly explains the importance of flexibility and a sound methodology to provide a safe and appropriate workforce.
The ACN’s call for the regulation of the unlicensed health worker includes minimum levels of professional development and education, with end of life care and dementia care among other priority education needs.
ACN supports the report, A matter of care, released in 2018 by the Aged Care Workforce Strategy Taskforce. This report recommends a strategic approach to reforming the aged care system, in skills-mix modelling and workforce planning.
Aged care in this country must continue to be a priority. As a profession, nurses want safe and appropriate care for all vulnerable communities, including the elderly living in RACFs.
ACN advocates for tougher sanctions on providers who do not meet standards, and closure of facilities that continue to fail to provide acceptable standards of care.
ACN is continuing to influence and put forward recommendations that will shape the future of health and aged care so all Australians, including our most vulnerable populations, receive the care they deserve.
*unregulated health care workers (however titled)
Adjunct Professor Kylie Ward is CEO of the Australian College of Nursing. On Twitter @kylieward