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.