Federal government aged care reforms have led to improvements but there is a big gap between policy intent and the daily realities experienced by residents and staff.

A national survey of aged care workers reveals a workforce under severe strain despite government-mandated reforms such as mandatory care minutes and 24/7 registered nurse coverage.

A total of 3,552 aged care nurses and care workers (including AiNs) responded to the survey, which provides a frontline perspective on staffing, skills mix, and violence and aggression in the workplace.

The Australian Nursing and Midwifery Federation (ANMF) conducted the survey from October to December 2025.

Forty-nine per cent of respondents said they did not get enough time to deliver care, a figure that rose to over 55 per cent in for-profit facilities.

More than 47 per cent of respondents said the ratio of nursing staff to care staff was inadequate, increasing to 52 per cent in for-profit providers.

Almost 40 per cent of aged care workers surveyed described their workplace staffing levels as “poor” or “very poor”.

While the legislated 24/7 registered nurse requirement has improved RN numbers, staffing relating to enrolled nurses (ENs) and personal care workers (PCWs) is widely seen as inadequate.

More than 44 per cent of respondents rated the number of ENs as inadequate. About 41 per cent said the number of PCWs was inadequate.

Registered nurses

Respondents reported substantial adverse changes to staff roles, such as RNs being shifted from direct clinical care to administrative tasks.

More than 62 per cent of RNs said that their administrative duties had increased, partly due to new reporting and compliance measures resulting from Royal Commission reforms.

Almost 50 per cent of RNs also reported a decrease in direct clinical care.

Respondents were asked to rate the amount of time they spent completing paperwork or administrative tasks in the previous 12 months.

Just over half of RNs rated this as “poor” or “very poor”, compared to almost 46 per cent of ENs and 42 per cent of PCWs.

Enrolled nurses

The survey reveals a significant erosion of the enrolled nurse role, with reduced clinical responsibilities, reclassification from nursing to care staff positions, and, in some cases, redundancy.

The survey report says that because funding models lack specific EN targets, providers have an incentive to replace them with lower-cost PCWs, leading to EN redundancies and a dilution of clinical skills.

The report estimates this has resulted in the loss of about 1,840 full-time EN positions nationally.

The report says ENs “play a critical role in delivering safe, person-centred nursing care” and must be recognised and supported as integral members of the aged care team.

To support this, the ANMF recommends attracting ENs back to the sector through dedicated staffing targets and a range of workforce incentives that recognise and strengthen their role.

Personal care workers

The survey shows that “universal worker” models are diverting PCWs from direct care to hotel, food, and laundry services.

More than 67 per cent of PCWs reported increased expectations to complete hotel, food, or domestic duties.

This misallocation of skills contributes to burnout, unhappiness and compromised quality of care, the report says.

Violence and Aggression

The prevalence of workplace violence and aggression is alarmingly high, with more than 96 per cent of respondents reporting they had experienced or observed it in the previous 12 months.

The most common forms are verbal abuse (experienced by almost 77 per cent) and physical aggression (experienced by almost 70 per cent). While residents are the primary perpetrators, families, visitors, and other staff also contribute significantly.

The survey establishes a link between inadequate staffing and violence and aggression: staff who rated their workplace staffing as “very poor” were more likely to experience violence.

Understaffing leads to rushed care and unsupervised residents, increasing the risk of aggressive incidents, the report says.

The report also points to a culture of poor management of incidents of violence and aggression.

Many respondents felt that aggression was dismissed as inevitable and “part of the job,” and that reporting incidents often led to blame rather than support.

This has created a culture of under-reporting, as staff lose confidence that any meaningful action will be taken, the survey report says.