Aged Care

Aged Care information on COVID-19

June 1, 2020 by Gia Hayne 4 Comments

The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).

Ensure you’re covered at work by joining the NSWNMA.

If you’re working for a private aged care provider, please check this page for information around self-isolation and your workplace entitlements

The evolving nature of the novel coronavirus (COVID-19) outbreak means our public health advice will continue to change. One thing remaining consistent however, is the contribution frontline nurses and health sector professionals are making to address it.

The Commonwealth Department of Health website contains detailed guidance for health sector workers and is updated regularly.

Face to face assessments

From 25 May, Regional Assessment Services (RASs) and Aged Care Assessment Teams (ACATs) should offer face to face aged care assessments, where it is possible and safe to do so.

However, it is important to note that while COVID-19 circumstances continue, face to face assessments are not mandatory where this would be unsuitable or inappropriate for a client, service provider or assessment organisation. RAS and ACATs will continue to consider their local circumstances and client choice when determining whether aged care assessments are conducted face to face or by telephone or telehealth.

Outbreak management

When an Outbreak is Suspected: Providers must immediately notify their local Public Health Unit (PHU), and the Australian Government Department of Health.

The PHU manages the outbreak, for example testing, contact tracing and infection control.
The Department of Health will work with the provider to support them to identify whether an outbreak has occurred, and deliver additional support if required, such as in-reach pathology testing, access to PPE and workforce assistance.

Workforce Management: A critical aspect in the preparation phase is understanding the workforce impact and needs. It is essential providers put in place strategies to identify where and how they will get additional staff if there is an outbreak. Aged care providers must exhaust all possible avenues including contacting other providers for support; contacting recruitment agencies; reaching out to local and private district hospitals. The workforce surge measures that are in place are a last resort and work to complement the workforce that providers have sourced. They are not the full solution for a provider.

When an Outbreak is Confirmed: When an outbreak is confirmed, providers must establish an outbreak management team to direct, monitor and oversee the outbreak, confirm roles and responsibilities and liaise with their relevant Australian Government Department of Health state/territory officer. Providers will also need to put in place additional infection prevention and control measures, including:

- Isolation or cohorting of affected residents
- Maintaining hand hygiene
- Wearing appropriate PPE
- Practising cough and sneeze etiquette
- Enhanced environmental cleaning
- Placing signage at entrances and other locations in the facility
- Screening of staff and visitors.

The Department of Health’s guide to outbreak management outlines how to identify if there is an outbreak at your facility and the steps to take to manage the outbreak. Access the guide here.

Inform the Federal Department of Health of any confirmed COVID-19 cases via agedcareCOVIDcases@health.gov.au – this will facilitate Australian Government support for PPE and staff supplementation.

The Department can help with information on resources to manage an emergency or service delivery issues. If you need urgent assistance outside of normal business hours please contact the department on 1800 852 649.
This information is also available on the department’s website.

The Communicable Diseases Network of Australia also have National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia. This visual flowchart summarises the key steps aged care providers need to take around COVID-19 in an easy to read and understand format.

Influenza vaccine requirement for workers

New legislation now requires all aged care workers to be vaccinated against Influenza

from 1 May, you must have your influenza vaccination to work in or visit an aged care facility
if you’re a residential aged care worker, you must not go to work if you have a fever or symptoms of a respiratory illness

Your employer should be making sure all staff receive a vaccination as soon as possible and meet the cost.

An aged care worker who is unable (or their facility is unable) to access an influenza vaccination is able to continue employment beyond 1 May 2020 on the basis that the vaccination has not been available to the person (5(d)).

NSW Ministry of Health have stated those who have actively sought a flu vaccine before 1 May 2020 but have not yet received one because of shortage in supply may still attend work. However, they must have a vaccine as soon as one becomes available to them.

Aged care providers having trouble with supply can report this to the Department of Health at COVID-19FluVaccine@health.gov.au

The Commonwealth is currently seeking to improve access to the vaccine:

The Australian Government has secured three million additional doses of seasonal influenza vaccine bringing the total number of flu vaccines to 16.5 million
To assist access to the flu vaccine, Primary Health Networks (PHNs) have been contacting all residential aged care providers by region to undertake a needs assessment and coordinate influenza vaccination programs for those services with an identified need. The provisions may include sourcing vaccine supply and qualified vaccine administrators (see here for further details).

Personal Protective Equipment (PPE)

Where you require PPE to do your job safely, it is your employer’s obligation to provide it. If you are caring for a resident who is suspected or confirmed COVID positive you should be provided with a surgical mask, disposable gloves, a long sleeved gown and goggles or a face mask. This should be put on before entering the resident’s room and removed on exit. You shouldn’t reuse any PPE unless it is marked as reusable, and then only where it has been properly cleaned in line with the manufacturer’s instructions before you reuse it. If you don’t have the PPE that you need to do a task safely, then you should not do that task until the PPE is provided.

Read more about PPE here.

Request stock of PPE

Residential aged care providers can request PPE by sending an email to agedcareCOVIDPPE@health.gov.au

The Department will assess requests and may be in contact if additional information is required. Providers will be advised if their request has been successful. If so, state and territory governments will distribute the agreed PPE to the provider.

Priority will be given to aged care providers where there has been a confirmed case of COVID-19.

Guidance for Symptom Monitoring

This guidance was developed by the Communicable Disease Network of Australia (CDNA) and endorsed by the Australian Health Protection Principal Committee (AHPPC).

This guidance is intended for health and residential aged care settings considering monitoring for symptoms. Health screening for health and aged care workers for symptoms of COVID-19 in these settings may be used as one of a suite of measures to detect and prevent outbreaks.

You can find the guidance here.

Aged Care Visitor Access Code

A Visitor Access Code is being developed to ensure a nationally consistent visitation policy to residential aged care homes during the COVID-19 crisis.

Views are being sought on the draft code from aged care residents, families, families of choice, friends, along with aged care providers and staff, by 3pm on Thursday 7 May.

Aged care residents, families, families of choice, friends, consumers and carers wishing to comment on the draft code can email cota@cota.org.au

Screening

Recommendations on screening of people entering residential facilities from the Aged Care Quality and Safety Commission (22 April 2020):

Ideally, there should be a single point of entry to the facility, with someone tasked to continuously monitor that entry
Every staff member or visitor arriving at the facility should be asked, at the point of entry, to respond to a standard set of risk screening questions. Services may want to consider giving these questions to each staff member or visitor on a pre-printed form on arrival to assist with understanding and recording

The screening questions could include:

Have you been overseas or travelled on a cruise ship in the last 14 days?
Have you been in contact with a confirmed or suspected case of COVID-19 in the last 14 days?
Are you in close contact with or caring for someone who is currently unwell?
Have you currently or within the last 7 days been unwell or been aware of any of the following symptoms:

– fever, night sweats or chills
– cough
– runny nose
– sore or scratchy throat
– shortness of breath

The staff member or visitor’s accurate response to the question about fever can be supported through temperature testing on entry. If temperature testing is used in addition to the standard screening questions, it is recommended that a no-touch method is adopted such as an infra-red temperature detection “gun” device.

Visitations

States and territories have established directions giving effect to the AHPPC’s recommendation that visitors and staff (including visiting workers) should not be permitted to enter a residential aged care facility, if they have not been vaccinated against influenza (after 1 May 2020).

Residential aged care facilities may wish to display this poster at entrances, to alert anyone entering the facility of these flu vaccination requirements.

Infection prevention and control measures in residential aged care must be balanced with the well being and best interests of the residents. It is acknowledged that this balance is sometimes challenging to achieve. Aged care providers should assess the needs of both residents and their families, and be proportionate in their response to and application of the restrictions.

At its meeting on Tuesday (21 April), the National Cabinet discussed residential aged care facility (RACF) visitation restrictions and reaffirmed the visitation principles set out by the AHPPC and agreed by National Cabinet on March 18. The AHPPC also reinforced restricting visits and visitors that should be implemented by RACFs.

The National Cabinet has reconfirmed that RACFs should not permit visitors and staff to enter facilities, if they have:

returned from overseas in the last 14 days
been in contact with a confirmed case of COVID-19 in the last 14 days
a fever or any (even mild) symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath)
not been vaccinated against influenza (after 1 May).

In relation to visits the following measures the AHPPC reinforced:

Limiting visits to a short duration
Limiting visits to a maximum of two visitors at one time per day. These may be immediate social supports (family members, close friends) or professional service or advocacy
Visits should be conducted in a resident’s room, outdoors, or in a specific area designated by the RACF, rather than communal areas where the risk of transmission to residents is greater
No large group visits or gatherings, including social activities or entertainment, should be permitted at this time
No school groups of any size should be allowed to visit RACFs
Children aged 16 years or less must be permitted to visit only by exception, as they are generally unable to comply with hygiene measures.

Visitors should also be encouraged to practise social distancing practices where possible, including maintaining a distance of 1.5 metres.

Measures such as phone or video calls must be accessible to all residents to enable more regular communication with family members. Family and friends should be encouraged to maintain contact with residents by phone and other social communication apps, as appropriate.

The AHPPC recommendations also state any staff with symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath) should be excluded from the workplace and tested for COVID-19. Staff must report their symptoms to the RACF. Sick leave policies must also enable employees to stay home, if they have symptoms of respiratory infection.

Read the legislation here.

Important processes

A reminder on some important processes that should be followed at all aged care facilities:

If there is an outbreak in your facility, all staff and residents should be tested for COVID-19. An outbreak is when there is two or more confirmed cases in three days.
Facilities should be recording if any of their staff work at multiple facilities or across services, whether for the same employer or another. This is important to contact trace if there is a suspected or confirmed case of COVID-19.

Discharging new and returning residents during COVID-19

The NSW Ministry of Health has developed advice for the safe and efficient discharge from hospital of new and returning residents of residential aged care facilities (RACFs). The advice includes a screening process and a discharge summary template.

A consistent approach will provide confidence that all new and returning residents at the time of discharge from hospital to RACFs have been screened by an appropriate medical officer and:

were not experiencing acute respiratory symptoms or fevers compatible with COVID-19 and
had not had any close contact with a confirmed COVID-19 patient in hospital.

NSW Health will now include a letter in the discharge paper work signed by the treating team confirming the person has been screened for COVID-19 symptoms. A template can be found here.

Workers in RACF admitting residents returning from hospital should ensure they receive a copy of the discharge paperwork as part of their infection control management arrangements.

Royal Commission seeking submissions

The Royal Commission into Aged Care Quality and Safety is calling for submissions from the general public and organisations relating to the impact of the coronavirus (COVID-19) on the aged care sector.

The deadline for submissions is 30 June 2020, but that deadline is also subject to ongoing review, given the effects of COVID-19.

Read the full media release on the website and visit the submissions page for more information.

International Student Nurses

On 18 March, the Commonwealth Government announced it will relax international student nurse visa work conditions to provide workforce continuity for aged care facilities, home care providers and other health care workers.

This will allow international student nurses and other aged care workers to work more than the 40 hours a fortnight that they are currently. This measure will be examined on an ongoing basis. There are currently around 900 approved providers of residential aged care employers and around 1,000 approved providers of Home Care Packages. There are currently around 20,000 international student nurses studying in Australia.

Online COVID-19 Training

The Department of Health has developed a free 30-minute online education course for workers in the aged care, health and disability sectors

After completing the course, course participants should be able to:

understand the basics about the COVID-19 virus, including how it is spread
describe what you can do to protect yourself and others
know what to do if you develop symptoms
know what to do if the person you are caring for develops symptoms
tell the difference between myths and facts of COVID-19.

COVID-19 support package

On 1 May, the Prime Minister announced an additional COVID-19 specific support package for residential aged care providers, totalling $205 million. This translates to around $900 per resident in major metropolitan areas and around $1350 per resident in all other areas.

The funds are “aimed at ensuring aged care providers can offer reinforced levels of safety and care for those who need it most”.

The Australian Nursing and Midwifery Federation (ANMF) says the Federal Government must guarantee the funding is fully and directly used to employ more nurses and suitably-qualified care staff and ensure the availability of appropriate personal protective equipment (PPE) to combat the COVID-19 pandemic.

Aged care providers must address chronic understaffing and the ongoing shortages of PPE as a matter of urgency if Australia is to ensure the safety and protection of all residents.

Additional Commonwealth Funding

On 20 March, an additional $444.6 million in funding, including a retention bonus for workers, was announced for the aged care sector:

$234.9 million for a COVID-19 ‘retention bonus’ to ensure the continuity of the workforce for staff in both residential and home care. This means:

– Full-time direct care workers in residential care facilities will receive a payment of up to $800 after tax per quarter, paid for two quarters.
– Full-time home care workers will receive payments of up to $600 after tax per quarter, paid for two quarters.
– Part-time direct care workers receive a pro-rata payment for the amount of time you work. For example, if you work two days a week, you’ll receive 40 per cent of the payment.
– Payments will be made via your employer with the first payment expected in June (for the preceding quarter). The second payment will be paid in September.

The Australian Government Department of Health has been working on the mechanisms, processes and guidelines in order to release these funds for workers and providers.

In addition:

$78.3 million in additional funding for residential care to support continuity of workforce supply.
$26.9 million to increase the residential and home care Viability Supplements and the Homeless Supplement (including increased viability payments for National Aboriginal and Torres Strait Islander Flexible Aged Care Program providers and Multi-Purpose Services).
$92.2 million in additional support to home care providers and organisations which deliver the Commonwealth Home Support Programme, including for services such as meals on wheels.
An extra $12.3 million to support the My Aged Care call centre to respond to the needs of older Australia.

Prior to this, the Commonwealth Government announced a $2.4 billion health care package, with $101.2 million dedicated to the aged care sector to:

educate and train more aged care workers in infection control;
enable aged care providers to hire extra nurses and aged care workers for both residential and home care; and
bolster the Aged Care Quality and Safety Commission’s capacity to ensure providers are stepping up infection control measures.

Other useful resources

This document outlines special precautions when entering COVID-19 designated zones.
COVID-19 factsheet for aged care workers. This is a 4 page document with information on things like visit restrictions, changes to work visa hours arrangements, when people should or shouldn’t come to work etc.
Cleaning – the Health Department has provided guidance on Environmental cleaning for residential aged care facilities.
Information for in-home care clients – “Its OK to have home care” – is designed so carers can print off and distribute before entering their clients home to reassure them that it is OK to continue to receive care
Flowchart/poster on when to use PPE in aged care settings
This document provides more detail on what kind of PPE to wear when treating suspected or confirmed cases of COVID-19 and how to wear it
PPE video from Australia’s Chief Nursing and Midwifery Officer, which provides a demonstration on how to appropriately use PPE

NSWNMA Support

If members are concerned their employer is not following the appropriate guidelines, the NSWNMA can provide assistance to ensure appropriate measures are in place. Contact us here.

Further information on PPE

Further information for private health nurses and midwives

The NSWNMA will continue to provide further updates for members as we receive them. Information contained on this page is current as of 18 March 2020. Contact us here.

Aged care workers inspiring efforts to keep residents safe despite COVID-19

May 8, 2020 by Gia Hayne Leave a Comment

In presenting the findings of its national Aged Care COVID-19 Survey, the Australian Nursing and Midwifery Federation (ANMF) is today acknowledging the inspiring efforts of aged care workers across the country to keep older Australians, especially those living in nursing homes, safe, despite experiencing significant challenges presented by the COVID-19 outbreak in Australia.

The survey, conducted from 15 April to 6 May, aimed to assess aged care workers’ sense of their employer’s preparedness to deal with the COVID-19 pandemic and the strategies that had been put in place as well as identify the key challenges and major gaps in the aged care sector’s response to COVID-19 from the perspective of those providing direct care to older Australians.

A total of 1,980 registered and enrolled nurses, personal care workers and ancillary staff, from a range of employment areas, including for-profit, not-for-profit and government aged care providers, participated in the national survey, with the highest participation rate coming from the not-for-profit sector (44%).

ANMF Federal Secretary, Annie Butler, acknowledged that Australia has done an excellent job to date in containing the COVID-19 pandemic across states and territories, but said the ANMF continues to have concerns about the preparedness of the aged care sector to deal with outbreaks of the disease.

“Our concern is due both to the chronic understaffing and widespread lack of skills in the sector, so clearly identified by the Aged Care Royal Commission and the increasingly well-known risks for older people from COVID-19,” Ms Butler said today.

“We recognise that the Government has provided considerable assistance to the sector since the beginning of the COVID-19 outbreak in Australia but we have been unsure as to whether this assistance has converted to the additional staff, skills and resources required to prepare for, and deal with, an outbreak of COVID-19. So, we conducted this survey to find out what’s happening on the ground.”

A snapshot of COVID-19 survey found:

• Up to 80% reported no increases in care staff at their aged care facility to prepare for a COVID-19 outbreak;
• 19% working in for-profit, 17% in not-for-profit and 13% in government-run aged care facilities reported staff cuts since the beginning of March;
• 77% reported their employers had recently updated or implemented infection control procedures for staff;
• Less than 40% said their aged care facility was prepared for a COVID-19 outbreak;
• Less than 30% said their aged care facility had enough supplies of PPE;
• 53% said they were willing to work more shifts at their aged care facility during the COVID-19 pandemic.

“A concerning element of these results is the reports that staffing has not been increased and, in some cases, has actually been reduced since the beginning of the COVID-19 outbreak in Australia, across the aged care sector, despite a majority of workers reporting that they would be willing to work additional hours to help out during the pandemic,” Ms Butler said.

“Perhaps even more concerning is that once again, aged care workers are reporting significant levels of stress, pressure and a lack of support as the sector grapples to combat COVID-19. This is while they continue to be the ‘glue’ that is holding the system together. A fact that has been unacknowledged by the government and the sector since the pandemic began.”

The major issues of concern are captured in comments from the survey’s participants:

1. “I TRULY, TRULY hope it doesn’t make it into the facility. I fear short staffing. It occurs anyway (working short), as [we] can’t get replacements. Carers not allowed to have bottles of sanitiser on trolleys during pad/continence night rounds. Means only hand washing and a wall sanitiser left. Not as used as time poor. So infection control is now compromised.”
2. “They stated that if we suspect [COVID-19] in the facility, that we would ask for a test but not put precautions in place until we have a positive result which I feel vulnerable being exposed to the risk of Coronavirus …[W]hy should staff have to be asked to attend to residents as normal without being provided with adequate PPE or told off if we use PPE without a Coronavirus confirmed case? I understand there is limited supplies on PPE, but I still believe that we aren’t being given a fair opportunity to protect ourselves and our other residents that we have to care for.”
3. “We are working short staffed now. My concern is if we have an outbreak, the staffing numbers will be reduced even more and our residents are going to suffer.”
4. “I don’t think employers are being adequately advised by the government. They’ll take minimum measures required by government rather than look at overseas trends. The main issue with aged care from a carer’s perspective is a lack of staffing. This guarantees that carers will not be able to provide perfect care. Standards inevitably slide. This is why there’s so much hidden neglect in Aged Care.”
5. “I would want to help out in any way to nurse any patients and ease the pressure on permanent staff.”
6. “We don’t feel valued. Feel like they don’t care about our safety. Poor communication and lack of direction on how things need to be put in place More and more responsibility assigned every day, day-by-day workload increasing, high chance of forgetting things/making mistakes. It’s overwhelming.”
7. “Exhausting when you are working short, not only registered staff hours but also care staff hours. We are compromising our health, our ability to complete workload which is horrendous at any time. We have extra workload with COVID-19 and residents emotional needs – sad and missing families.”
8. “I work by myself with forty residents on a night shift. Not only do I care for my residents, I am expected to do their laundry, clean my area, cook for the residents and many other tasks.”
9. “Since March I’ve been told I wasn’t allowed to come to work and haven’t been offered any shifts as I’m a casual and also work at another institution. They said that it’s their policy to not allow staff that work elsewhere to work there. I had all my upcoming shifts cancelled and haven’t had any work since March.”
10. “We have been in total lockdown for months now. No family or visitors. Only if family bypass management and go higher up to CEO. We have palliative residents and family can only come in for a couple of hours. They are so grief stricken not being able to be with loved ones. When staff complain they are disciplined very harshly.”

8 May 2020

ANMF media release authorised by Annie Butler, ANMF Federal Secretary. 1/365 Queen St, Melbourne.

ANMF says aged care funding must guarantee safety of all residents

May 1, 2020 by Gia Hayne Leave a Comment

The Australian Nursing and Midwifery Federation (ANMF) says the Federal Government must guarantee the additional $205 million COVID-19 funding for aged care providers is fully and directly used to employ more nurses and suitably-qualified care staff and ensure the availability of appropriate personal protective equipment (PPE) to combat the COVID-19 pandemic.

ANMF Federal Secretary Annie Butler said with funding provided to the aged care sector to manage COVID-19 now amounting to more than $850 million, aged care providers must address chronic understaffing and the ongoing shortages of PPE as a matter of urgency if Australia is to ensure the safety and protection of all residents.

“The Prime Minister said today that the new COVID-19 payment for aged care is aimed at reinforcing levels of safety and care for those who need it most but he provided no guarantee to the Australian public that this will actually happen. Without clear transparent requirements of providers to publicly account for how they spend these funds, we cannot be confident that the money will be used to implement the safety measures that are urgently needed,” Ms Butler said today.

“The most important measure to defeat the COVID-19 outbreak is to guarantee that the right numbers of staff with the right level of skills are available to meet all needs of residents. This will require every facility to have: registered nurses on duty on every shift; sufficient numbers of experienced care-workers; and, sufficient additional staff to undertake screening procedures and any other safety measures required.

“Aged care nurses and care-workers are stretched to their limits and are giving their all to provide the best care for their residents in these difficult times, a fact which went unacknowledged by both the Prime Minister and the Minister in today’s announcement, leaving our members feeling not only undervalued and unappreciated, but also uncertain.

“Unless processes, which require transparency and accountability for the use of these additional funds, are implemented, our members cannot be sure that the funds will be used to address the problems at the core of the sector’s lack of capacity to deal with the pandemic. They are concerned that frail, vulnerable residents, and the nurses and care-workers caring for them, will remain at increased risk from COVID-19. We are therefore asking the Government to require aged care providers to publicly demonstrate that the additional resources provided to them are being spent directly on increasing nursing and care skills in their facilities.”

1 May 2020

ANMF media release authorised by Annie Butler, ANMF Federal Secretary. 1/365 Queen St, Melbourne.

Which aged care services near you weren’t up to scratch in 2019?

April 30, 2020 by Rayan Calimlim Leave a Comment

In July 2019, the government introduced new aged care standards to “raise the bar” in an aged care system where some nursing home residents have experienced care that is neglectful, depersonalised, uncaring, unsafe and of poor quality.

We took a close look at breaches of aged care standards from 2019 to see what effect the new aged care standards are having, and where aged care providers are falling short.

In the interactive map below you can see aged care providers that were non-compliant in 2019.

Map created by data visualisation company Small Multiples

What are aged care standards?

Aged care standards are the minimum standard of care the government expects nursing homes to provide.

They are supposed to ensure people in aged care have access to quality care including competent staff who listen, best-practice clinical care and nutritious and tasty food.

Nursing homes that don’t meet standards are given a notice of non-compliance. If the provider doesn’t fix the problems that made it non-compliant, then it will be sanctioned.

If assessors decide there is an immediate and severe risk to residents, nursing homes can also be immediately sanctioned. The nursing home provider must then bring the care up to standard before they can take new residents.

The new aged care standards

From 2014 until the new standards were introduced in July 2019, the number of non-compliance notices and sanctions increased steadily as can be seen in the chart below.

This was likely due to a combination of increasing scrutiny of the quality of residential care as a result of the unsafe care revealed at Oakden in 2017, and the establishment of the aged care royal commission in October 2018. A 2018 policy change meant providers were no longer warned about upcoming accreditation visits.

The new standards, introduced in July 2019, focus on “personal dignity and choice”.

They were designed to support the provision of care based on what residents want, rather than penalising providers when they let residents do something that could be considered “risky”, such as allowing someone with mild dementia to walk to the shops, or having a pet in the nursing home.

The number of non-compliance notices and sanctions in the first six months of the new standards decreased. This is likely because assessors visited fewer nursing homes in this period, and may still be learning how to interpret the new standards.

Aged care providers and industry bodies have criticised the new standards for being subjective and vague. They do not measure objective resident outcomes like depression or number of infections.

For-profit companies had a higher rate of non-compliance in 2019

Some 6% of for-profit residential care facilities failed aged care standards in 2019, some of them multiple times. In comparison 5% of not-for-profit and 4% of government facilities failed standards.

The rate of non-compliance in for-profit facilities was 27% higher than not-for-profits, and 54% higher than government facilities.

This suggests for-profit providers in Australia are more likely to provide lower quality care. An international review has noted similar trends in other countries.

Profit margins are slim in aged care, and for-profit providers are under pressure to make profits by cutting costs. This could lead to a lower standard of care compared with not-for-profit or government providers.

Reasons for non-compliance in 2019

The most common reasons for non-compliance in 2019 were in the area of personal and clinical care and the area of governance.

An example of a nursing home breaching the personal and clinical care standard could be if the home’s practices mean it isn’t giving medication correctly, isn’t managing wounds properly, or isn’t providing dignified help for residents using the toilet.

Homes might also breach the personal and clinical care standards if they don’t have sufficiently skilled staff such as registered nurses to care for residents with complex health needs.

A nursing home might be non-compliant in governance when it doesn’t have the right systems in place to monitor and improve its clinical care, for example in the areas of infection control or restraints. It might also be non-compliant if residents and families don’t have enough of a say in how the facility is run.

The new standards were supposed to place an increased focus on dignity and choice, supporting the identity of a person, and increasing their say in the care they receive. This means catering for residents who want to have showers in the evening, stay up late, or make their own lunch. Previously there was much less emphasis on these aspects of aged care.

It is somewhat promising that more breaches of non-compliance in the “dignity and choice” standard have been picked up since the new standards came in. But given we know care is often poor in this area and there is an increased focus on this standard, we could have expected a more significant change.

Based on the first six months of non-compliance and sanctions data for the new aged care standards, we cannot be confident the new standards are ensuring nursing homes provide higher quality care. We await more data.

Until then, aged care residents and their families should monitor the quality of care they receive, know their aged care rights, and complain if they think there is an issue.

If you or a family member are considering using an aged care provider, you can check whether the provider has breached standards via the My Aged Care non-compliance checker.

Lee-Fay Low, Associate Professor in Ageing and Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Aged Care needs more support to tackle COVID-19

April 29, 2020 by Rayan Calimlim Leave a Comment

The NSW Nurses and Midwives’ Association (NSWNMA) has called on the Federal Government to urgently strengthen the level of support being provided to the aged care sector, in light of the ongoing coronavirus (COVID-19) pandemic.

As one of the most vulnerable sectors to COVID-19, NSWNMA General Secretary, Brett Holmes, said aged care required further intervention to ensure additional resources were prioritised, including extra nursing staff and adequate Personal Protective Equipment (PPE).

“If the Prime Minister and National Cabinet want residential aged care facilities to continue relaxing restrictions to visitors, it must facilitate extra support to these providers and insist they improve their efforts,” said Mr Holmes.

“We’ve got a situation where many aged care providers have struggled to implement enough infection control precautions to tackle COVID-19, while others are doing the best they can, in the hope the virus doesn’t emerge. There are genuine concerns that visitors will bring COVID-19 into the facilities.

“This has been exacerbated by an inability or unwillingness to ensure these facilities have enough basic PPE for staff, but also enough qualified staff rostered to continue the dedicated care to residents, as well as carry out the necessary screening of visitors. The Royal Commission has clearly heard undisputed testimony that there is inadequate numbers of qualified staff in aged care let alone during a pandemic.

“At a minimum, additional PPE and nurses are essential to allow the required screening to be undertaken, in the same way our public hospitals are responding to the risk of people inadvertently spreading the virus.

“Yes, some sites are practicing individual risk assessments within their facilities and allowing family visits to resume however, this is not consistent across the aged care sector and is ad hoc at best.

“In addition, many of our aged care members have indicated a heightened level of fear with regard to their own personal safety in the workplace, including anxieties about placing their own families at risk.

“They are increasingly worried about the risks to the residents. Many are also fearful of becoming sick themselves, given access to any special leave provisions is inconsistent between aged care employers.

“Aged care nurses and carers are compassionate, hardworking individuals who take pride in their work, their facilities and often develop great relationships with residents’ families. They want to keep everyone safe.

“In light of COVID-19, all aged care nurses require the best support possible to manage and defeat the pandemic. That support starts at the top, under further Federal Government intervention to support a sector that was already struggling under a myriad of issues prior to COVID-19.”

Royal commission counsel recommends ratios

April 1, 2020 by Rayan Calimlim 2 Comments

The legal team assisting the aged care royal commission has proposed sweeping changes to raise the numbers, skills and pay of the aged care workforce.

Lawyers assisting the aged care royal commission have called for mandatory staff-to-resident ratios in aged care facilities with a registered nurse on every shift.

They recommended ratios that should give each resident at least three hours of high-quality care a day.

Senior counsel assisting the commission, Peter Rozen QC, outlined the legal team’s recommendations to the commissioners.

They include mandatory minimum qualifications and minimum levels of English for personal care workers.

The recommendations cover residential care only. The home care workforce will be covered in separate recommendations later this year.

Mr Rozen said the residential care workforce should be “better remunerated and should work in safe workplaces”.

“The staff in our aged care homes are not well paid,” he said.

“There are all too often not enough of them to provide the care they would like to – for example, to sit and have a chat over a cup of tea.

“Many work in stressful and sometimes unsafe workplaces. Some are untrained; others have inadequate training.

“As a community we owe these workers a lot.

“These submissions are aimed at improving their working lives so that our elderly citizens can receive safe care of the quality that they should receive in a country as rich as ours.”

Improvements needed to attract and retain staff

He said the legal team’s recommendations would, over time, make aged care a more attractive sector in which to work.

“This will help to retain the current workforce and attract new workers to the sector.”

Mr Rozen said a minimum staffing ratio should be set at a level necessary to achieve a 4-star rating under the United States CMS system as adjusted for Australian conditions.

On average, that would require care of between 186 and 265 minutes per resident per day from a trained workforce comprising registered and enrolled nurses and personal care workers.

Currently, only 15.8 per cent of Australian aged care residents are in homes staffed to this level, he said.

He said he agreed with Victorian nursing union official Paul Gilbert, who said that when it comes to staffing numbers in aged care, it is “time to stop kicking the can down the road”.

Mr Rozen said commission hearings had “revealed the disturbing extent of the substandard care, that there are not enough staff, that there’s never enough time to do the work, that aged-care workers work in poor and sometimes unsafe conditions and lack the training they need to do the work required of them”.

“Any redesign of the aged care system that does not remove the incentive that presently exists for providers to reduce the number of nurses they employ to cut their costs, will necessarily fail.

“If the goal of this royal commission is to make recommendations to achieve high- quality, safe and person-centred aged care services,” he went on, “as it must be under the terms of reference, then the time for real action on staffing numbers and mix, skill levels, remuneration, conditions of work, and registration of the unregulated portion of the aged care workforce is now.”

Major workforce recommendations

Major recommendations from the royal commission legal team’s 160-page workforce submission include:

Mandatory minimum staffing ratios

Average total care per resident should be between 186 and 265 minutes a day, and include “a minimum of 30 minutes of registered nurse time per resident per day and at least 22 minutes of allied healthcare per resident per day”.

Providers must provide the Department of Health and Ageing with quarterly staffing levels for registered and enrolled nurses, allied health and other care staff by shift in residential care.

The department must publish this information with clear explanatory material to allow the public to compare services.

Registered nurses 24/7

An RN should be present on each shift and available to direct or provide care subject to limited exceptions.

More nurse practitioners

To increase the supply of nurse practitioners, the Australian government should introduce scholarship programs (with aged care return-of-service obligations) for nurse practitioner training and advanced skill nursing.

Registration for personal care workers

A registration scheme for personal care workers should be established, with:

mandatory minimum qualifications
ongoing training and continuing professional development requirements
minimum levels of English
criminal history screening requirements
a code of conduct and power for the registering body to investigate complaints about breaches of the code.

ANMF welcomes minimum staffing call

The Federal Secretary of the Australian Nursing and Midwifery Federation (ANMF), Annie Butler, welcomed Peter Rozen QC’s “practical recommendations” to the aged care royal commission.

She said the ANMF supported Mr Rozen’s recommendations to mandate the minimum numbers of nurses and qualified care staff to be rostered.

She said better wages, training and regulation, would improve the quality of care and help to retain and recruit more staff.

“The ANMF will continue to contribute to the commission’s proceedings as it works towards completing its final report and recommendations to government later in the year,” Annie said.

Commission suspends hearings

The Royal Commission has suspended all hearings and workshops for the time being, subject to ongoing review. This decision is a consequence of the evolving coronavirus (COVID-19) pandemic, and affects all hearings and workshops scheduled until at least the end of May 2020.

The deadline for submissions to the Royal Commission into Aged Care Quality and Safety will also be extended by two months to 30 June 2020.