Back To The Future With Aged Care Ratios
In a recent survey by the Australian Nursing and Midwifery Federation (ANMF), 92% of respondents said they are being asked to care for the same number of residents with less staff or less hours rostered care hours. 71% didn’t think the ratio of registered nurses to other care staff is adequate. Has it always been this bad or have things gotten considerably worse over the years? Industry research officer, Ben investigates.
Ratios in aged care are not impossible, in fact we had them for 10 years until 1997. It gets better, they covered all nursing homes in the for-profit sector too.
Back in 1986, the Labor Hawke government formed a joint working party to formulate standards of care and uniform staffing standards in nursing homes throughout Australia. In July 1987 the new funding arrangements commenced.
For those who are too young to remember, these funding arrangements were:
- The Care Aggregated Module (CAM) funding for personal care
- The Standard Aggregated Module (SAM) funding for food, laundry, even a profit margin etc
- Other Cost Reimbursed Expenditure (OCRE) funding for payroll tax, workers compensation etc
The CAM funding component in this funding model was paid to provide nursing and personal care for each resident according to their dependency level. It’s allocated for nursing and personal care hours only, and if it wasn’t spent, it was returned to the Government. That’s right, money for just the care and not for the profit!
This was significant because nurses/carers wages are the largest aged care expense and an easy target for employers seeking to increase profit.
What are these ratios you speak of?
|Resident Categories (based on care needs)||Nursing hours per patient week|
The Application for Resident Classifications, Resident Classification Instrument, (1989), Hospitals and Residential Programs Division, Department of Community Services, pg 5
How did it get to this?
There are two main reasons I believe made these ratios a possible. Government’s favourite word “efficiency” and the providers tendency to over-service.
Prior to 1987 there were different funding systems for different sectors of the nursing home industry. These systems had no efficiency incentives as providers were paid the total amount the provider submitted for providing care. If their expenses “increased”, the fee would then be increased to cover any additional costs. This system led to providers over-servicing and an increase (over supply) in private for-profit facilities.
Over-servicing and exploitation of residents by providers seems to be a common business strategy in the history of the aged care industry and continues to this day. This funding for care arrangements held providers to account by providing transparency and accountability of taxpayer’s money.
Sadly, after intensive lobbying by aged care providers, the Howard Government, sided with providers and introduced the Aged Care Act 1997. This legislation gave in to employer demands and finally removed the requirement for some aged care funding to be quarantined for specifically nursing care. The ANF/NSWNA raised concerns at the time that this legislation would threaten safe staffing levels within nursing homes and also reduce the quality of life for residents. Even members of parliament reviewing the introduction of this legislation had concerns.
Since then, providers receive all funding and have full discretion to spend it as they want. Now when presented with the opportunity to either spend on adequate staffing and quality care (nurses/carers wages are the largest expense in aged care) or higher dividends for shareholders, it doesn’t take a rocket scientist to figure out why aged care staff are feeling overworked. Maybe the increase in scandals popping up in the news recently is a symptom of an industry in need of greater accountability and regulation in regards to staffing.