aged care nurses
An expanded resource has been developed by nurses, doctors, industry experts, and consumer groups to help people navigate the complexities across the aged care sector.
The 10 Questions to Ask series was launched at Parliament House in Canberra by Federal Assistant Minister for Health and Aged Care, Ged Kearney.
Ged said she welcomed the translated resources for people seeking residential and in-home aged care, which was developed by the NSW Aged Care Roundtable in collaboration with the NSWNMA.
The NSW Aged Care Roundtable includes medical, clinical, and consumer representatives, who used their expertise to collaborate on a series of 10 Questions to Ask leaflets, each providing a ‘top 10’ of suggested aged care-related questions and answers.
The information series have been endorsed by credible professional and advocacy organizations.
Each leaflet focuses on an individual aspect of aged care to increase consumer knowledge and make the journey into residential or in-home aged care simpler.
Following input from the Department of Health and Aged Care translation service, the leaflets have also been translated into 15 different languages, as well as six Aboriginal and Torres Strait Islander languages, with support from the Multicultural Communities Council of Illawarra, and the Partners in Culturally Appropriate Care (PICAC) NSW & ACT.
The information is targeted at consumers searching for a high-quality residential aged care facility, or reviewing the quality of a current residential aged care facility, or deciding between similar service providers, in order to provide them with the tools to find the best service available.
More information: The leaflets can be found at: www.10questions.org.au
Australia’s subsidised aged care services now help around 1.5 million older people to receive care and support. Taxpayers contributed A$28 billion to the various programs in 2022-23. And yet the system is governed by an act that was first passed in 1997.
A lot has changed over the past two and a half decades – more people are living longer with chronic conditions and impairments that necessitate care, more of that care helps people stay in their own home, older people have more choice and control, and quality and safety are subject to tighter regulation and improved enforcement.
These and many other reforms are welcome. But as a result, the 1997 Aged Care Act has become a patchwork of change upon change. So when is the new act due, and what does it aim to achieve?
What we know so far
Following the report of the Royal Commission into Aged Care Quality and Safety, the government is rewriting the act with a view to it commencing on July 1 2024 – less than five months from now.
Parts of an initial draft of the act have been released for public consultation. The proposed act adopts a rights-based approach to caring for older Australians, and consolidates and simplifies multiple pieces of existing legislation.
Some of the improvements will include:
- establishing a complaints commissioner to increase the independence and transparency of investigating aged care complaints
- increasing whistleblower protections so older people, their families and aged care workers feel comfortable about exposing unacceptable treatment from a provider
- streamlining access to aged care through a single-assessment process, rather than older people having to be assessed by different organisations depending on their particular care needs.
But several significant issues have yet to be addressed. The partial draft of the act lacks any provision relating to the proposed fees, payments and subsidies, or about how people with different needs will be prioritised and how aged care places will be allocated to them.
The act also makes many references to the government making rules about how the aged care system will actually operate. As always, the devil is in the detail but the rules have not yet been made public.
The new act also attempts to address the fundamental concern that Australia’s Constitution doesn’t provide the federal government with powers to make laws specifically for “aged care”. This is unlike the government’s powers over banking, marriage, the age pension and many other matters.
Instead, the act attempts to patch together a range of other powers, such as for providing sickness and hospital benefits and making binding international treaties (including disability support) under its external affairs powers.
It is unclear whether this approach will make the system too complex, compared with seeking agreement from the states to refer their powers to the federal government, or to enact a common set of laws on which both levels of government agree.
Federal Parliament will have the final say on what the act will contain and when it is passed.
How does this fit with other recent changes?
The new act aims to provide an enduring structure that brings the current aged care system, including recent reforms, into a single consistent regulatory regime.
The newly introduced residential care workforce standards, for instance, will be carried over to the new act. They include the requirement for 24/7 cover by registered nurses so nurses are always available to care for a resident when needed, at any time of the day or night.
The new levels of care minutes that nurses and other personal care workers must provide to residents will also be part of the new act.
The act will also include the Star Ratings for individual aged care homes. These help inform residents about the quality of the care their homes provide.
Will this be it for a while?
The recent changes to aged care are not the end of the decade-long reform journey.
In the immediate future there will be changes to payment arrangements for care as the government responds to the – yet to be released – report of the Aged Care Task Force.
Following that, a new Support at Home program is being designed to consolidate and streamline the current home care packages, short-term restorative care and respite care. Having already been deferred twice in recent years, the current proposed start date is July 1 2025.
The drafting of a modern, simplified act is an important opportunity to provide the best legislative regime for caring for older Australians.
But such an opportunity comes only once every decade or two. While the new legislation needs to put older people at its centre, it must also facilitate a system that is sustainable and sufficiently robust to support them to access subsidised care when they need it.
The broad framework is there, but there are less than five months to get the details right.
After my mother passed away, I turned my full attention towards aged care, becoming an assistant in nursing.
I wanted to help older Australians, and by help, I meant all the way. I knew there had to be a way to make a difference not just to individual people’s lives, but also to fix things and make the latter stage of life more dignified and supportive.
Fast forward 10 years and wow … what a difference we truly have made.
In 2017, I was asked to join other union members to stand up and fight for our rights, and the rights of all affected by the appalling conditions in aged care.
We were in crisis. We were a small handful of very passionate and very angry nurses who truly wanted to make a difference. Our targets were in line with what the Royal Commission handed down, and make a difference we did!
So far aged care nurses have won:
- labour agreements
- an RN 24/7
- pay increases
- care minutes and a voice for workers.
These are incredible wins and will make a real difference in the lives of aged care nurses and the residents we care for! But there is so much more that still needs to change.
We all need to stand together and fight for our basic human rights and for the rights of those we care for: the residents – people whose voice is often forgotten, neglected and overlooked.
Janine Quinn, AiN
Mandatory care minutes for aged care residents are now law, but some employers are dodging their responsibilities. Aged care workers can help to make sure providers obey the rules.
“Nothing has changed at my workplace. It is even worse than before. Not sure where all the budget is going. Past few weeks have been very difficult due to the workload, understaffing, and absolutely no support from the management team.”
So wrote a registered nurse (RN) at an aged care facility in Sydney’s southwest recently.
The RN added, “We are getting more residents with very difficult behaviours; more incidents to report; new admissions with no paperwork; the pressure to complete assessments and care plans while minding all residents, resident/family complaints, medication administration, doctors’ rounds; it just goes on and on. I’ve never felt so burnt out.”
The nurse is one of dozens of aged care workers who have told similar stories in answer to an NSWNMA written survey.
The stories show that some facilities are failing to meet new mandatory care minutes for residents, despite receiving extra government funding for that purpose.
Since 1 October 2023, residents must receive, on average, 200 minutes of care each day – including at least 40 minutes from an RN.
From 1 October 2024, this will be boosted to 215 minutes of care, including 44 minutes delivered by an RN.
Under the new law, the government sets quarterly care-minute targets for every aged care facility, based on the needs of residents living in the home over the previous three months.
Staff, residents and their families are able to track the requirements via the federal Department of Health and Aged Care website.
Aged Care Watch website
NSWNMA General Secretary, Shaye Candish, urged members to help the NSWNMA make providers stick to the new legal standards.
“Aged care workers now have an opportunity to help monitor and enforce the new care standards,” she said.
“An updated ‘Aged Care Watch’ website will allow staff, residents and families to publish their stories about the state of care in their facilities, while remaining anonymous.
“By telling us their experiences, members can help us to put pressure on providers to do the right thing.”
The website was set up by the NSWNMA in partnership with the Queensland Nurses’ and Midwives’ Union and the United Workers Union.
“It is essential members speak up and let us know if they suspect their employer is failing to meet their obligations,” Shaye said.
She pointed out that mandatory care minutes and other important changes, such as requiring RNs to be employed in facilities 24/7, came about as a result of a long campaign by NSWNMA members and others.
The campaign forced the former federal government to establish the Royal Commission into Aged Care Quality and Safety, which recommended every aged care facility follow care-time targets that reflect the needs of their residents.
“The NSWNMA will continue to campaign for greater transparency and accountability measures to ensure care minutes are delivered as intended,” Shaye said.
“We will also continue to push for aged care workers to have greater power in enforcing the delivery of these reforms.” n
Stories of understaffing and neglect
Staff doing unpaid work and missing their breaks. Residents left soiled for long periods because workers are too busy to answer the bell. Staff required to perform tasks outside the scope of their role. Residents not receiving adequate care, and medication incidents.
These are just some of the consequences of understaffing reported to the NSWNMA in response to a written survey.
“We are constantly short of AiNs, as there is a limited staff pool to pull from to fill shifts,” wrote an RN at a NSW North Coast nursing home.
“ENs are doing care staff tasks and duties, RNs are doing routine medication rounds, and often there is no functional in-charge nurse role.
“Even RNs sometimes are doing personal care due to lack of staffing. There is minimal use of agency staff for AiNs, when there is a high demand for it.”
In a typical response, an assistant in nursing at a facility in Sydney’s northwest wrote, “We always have to work understaffed. We have to attend double-assist by one staff only. No replacement for first sick call. No kitchen staff, and staff have to handle medication, residents and kitchen when we are understaffed.”
An RN at a nursing home south-west of Sydney reported that some RNs were being replaced with Certificate IV-qualified staff, leaving the remaining RNs covering their floor to cope the best they could.
“We RNs have to administer medications. If there is any incident during the round, we have to leave the meds trolley to attend it. Meds rounds are interrupted and many times we don’t finish it on time.
“We are understaffed. We need more staff for difficult residents, behaviourally unstable residents, for high falls-risk residents, for full-care/high-care residents. Call bells are still not answered on time due to staff being busy with other residents.”
An endorsed enrolled nurse (EEN) reported that a facility southwest of Sydney was even more understaffed than before the introduction of mandatory care minutes.
“A ratio of 32-to-1 RN/EEN is bonkers. I don’t get a break and if I do, it is interrupted by phone calls or management,” the EEN wrote.
An RN at a Blue Mountains facility reported their workload had increased as a result of a cut in hours for night-shift carers.
“I continue to work through my unpaid meal break. Meanwhile, management emails us about unacceptably high call-bell response times,” the member noted.
We have accomplished a great deal in the last 12 months, but there is much more to do, says NSWNMA General Secretary, Shaye Candish.
Nurses and midwives have achieved significant wins in the public health system, private hospitals and aged care over the last 12 months, and these gains have created opportunities for even more improvements, Shaye Candish told Annual Conference.
In the public sector, “after more than a decade of campaigning for nurse-to-patient ratios, it was no small feat to finally secure a commitment, in the lead-up to the state election, to introduce safe staffing ratios in five key areas of our Public Health System Award”.
“Achieving this has been testament to the unwavering resolve of public sector nurses and midwives to keep fighting day and night for patient safety, better patient outcomes, safety in the workplace, more support in the workplace, long-lasting changes to workforce planning, and investment in the future workforce.”
But, she said, the NSWNMA remains “committed to fighting for as long as it takes to achieve our full Award claim, covering all specialty areas, as endorsed by public sector members”.
The union will also continue to fight for better pay.
“The previous government’s arbitrary wages policy contributed to falling real wages, made it more difficult to attract and retain vital workers, and undermined wage growth across the broader labour market. These caps were also a violation of workers’ basic collective bargaining rights, and we look forward to them being abandoned for good in NSW.”
Great ratio wins in the private sector
There have been terrific wins in the private sector too, Shaye said.
“Thanks to the valiant efforts of members, we now have a commitment for minimum staffing ratios to be embedded in all wards, maternity, perioperative units, and the emergency department at Sydney Adventist Hospital (SAN), under a new enterprise agreement.
“Buoyed by the courage of their SAN comrades, and the high-profile public sector strikes, members embarked on historic protected industrial actions at St Vincent’s Private Hospital in Darlinghurst and The Mater Hospital in North Sydney over a seven-month period.
“These led to an agreement that delivers ratios on most wards at St Vincent’s and the Mater, the improvement of staffing in all perioperative areas and improved wage increases over three years.”
Historic achievements in aged care
In aged care, massive strides have been made thanks to the perseverance, determination, and a willingness to win by our courageous aged care members, Shaye said.
Members have won a 15 per cent pay rise in a work value case heard by the Fair Work Commission, which has flowed through to all registered nurses, enrolled nurses, and assistants in nursing.
Importantly, she said, we convinced the federal government to commit funding for this pay increase to flow on to nurses on enterprise agreements too.
“This means, that for the first time in years, many aged care nurses will be earning wages competitive with the public and private hospital system. In some workplaces, aged care will even be paid more.
“In the May budget, the federal government announced a $11.3 billion taxpayer-funded commitment to cover the cost of the pay increase.”
Going forward, “we will be campaigning and lobbying for a worker voice to be developed into the legislation, undertaking a key regulatory role in this sector, through the enforce- ment of care minutes, which will be implemented from October this year”.
“We also achieved success in our campaign to secure a legal requirement for residential aged care facilities to have at least one registered nurse on duty, 24 hours a day, seven days a week.”
The challenges of COVID-19
During the pandemic our efforts to protect our members and patients led NSW Health to implement better PPE and fit testing, Shaye told conference.
This led to the NSWNMA winning the SafeWork Award for Outstanding Work Health and Safety support to members in the changed working environment due to COVID-19.
“Although the World Health Organization determined COVID-19 is now an established and ongoing health issue that no longer constitutes an international health emergency, its impacts are still being felt – particularly in the mental health and wellbeing of the workforce.
“Rather than pushing a destructive ‘individual resilience’ approach, which places the burden of a broken health system onto nurses or midwives, solutions-driven and system-wide reform is needed.
“We must see improvements in working conditions, as well as urgent investment in available services such as robust physical and mental health supports, more job control, and access to childcare.
“Our state government and the majority of employers need to understand that better conditions at work, lead to better conditions of care.”