The Royal Commission into Aged Care Quality and Safety has delivered its verdict – Australia’s nursing homes cannot provide decent care without mandatory minimum staffing levels.

In a win for aged care workers, the royal commission has recommended mandatory minimum staffing hours for all residential facilities.

The commission recommends that a minimum staff time per resident be set to improve the quality and safety of care, and attract and keep workers in the sector.

The recommendation represents a win for NSWNMA members and others who have campaigned for minimum staffing for many years.

Prime Minister Scott Morrison said the government would respond to the commission’s report in full by 31 May.

If the government accepts the commission’s recommendations, staffing will increase in two stages.

By 1 July 2022, providers will have to engage enough staff for at least 200 minutes per average resident per day, adjusted for the needs of each resident.

“Staff” includes registered nurses, enrolled nurses, AiNs and personal care workers. At least 40 minutes of that time must be provided by an RN.

In addition, at least one RN must be on site for the morning and afternoon shifts (16 hours per day).

From 1 July 2024, the minimum increases to at least 215 minutes per resident per day on average, with at least 44 minutes provided by an RN.

At least one RN is to be on site at all times.

To meet the 2024 targets, staffing will have to increase by more than one-third, the commission says.

It describes this objective as “challenging but achievable”.

Currently, on average, each resident receives 180 minutes of care per day, of which 36 minutes are provided by RNs, according to research done for the royal commission.

The commission says, “High quality and safe” care… “cannot be achieved without the sector having enough staff with the skills and time to care.”

A system to rate quality of care recommended

The commission recognises that the current Aged Care Act 1997 has failed residents by allowing providers to judge for themselves what staffing levels are “adequate” and what skill levels are “appropriate”.

This has not prevented inadequate staffing and substandard care “and may have in fact have encouraged those outcomes,” the commission says.

The commission also recommends more transparent reporting of staffing levels linked 
to a five-star system to rate quality of care.

This would be modelled on a United States government quality rating system known as Nursing Home Compare.

If the government accepts the commission’s recommendations, the whole sector will be brought up to at least a three-star rating by 1 July 2022.

Currently, almost 60 per cent of facilities have the equivalent of one or two-star staffing, which the commission calls “unacceptable”.

According to research done for the commission by the University of Wollongong’s Centre for Health Service Development, these “unacceptable” facilities would experience an increase in staffing hours of about 37 per cent in stage one.

In the second phase, to be implemented by 1 July 2024, the entire sector will be brought up to a minimum of four-star staffing.

Only 15.5 per cent of facilities are currently staffed to this level, with the remaining 84.5 per cent at three stars or lower.

The University of Wollongong report estimates an average 37.2 per cent increase in total care staffing is needed to bring all facilities with three stars or lower, up to four stars.

The amount of care time provided by RNs would go up by 22 per cent on average to meet the 2024 requirement.