aged care ratios
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.”
The aged care sector has taken two historic steps towards better staffing and decent wages for nurses and other employees.
Federal legislation to make residential aged care facilities roster registered nurses on duty 24/7 came into effect on 1 July.
Some facilities had been operating without a single RN on site, despite a general rise in the clinical needs of residents.
Also on or after 30 June, a 15 per cent increase in award wages started to flow through to nurses and carers in the residential and home care sectors.
Approved by the Fair Work Commission and funded by the federal Labor government, it is the biggest wage increase ever achieved in aged care.
And there are more improvements to come, including mandatory minimum care minutes starting in October this year.
These significant reforms are the fruit of years of hard campaigning by members of the NSWNMA and other aged care unions.
“Tirelessly, our members collected signatures on petitions, held street stalls and public forums, contributed to state parliamentary inquiries, met with politicians and stakeholders, and gave evidence at the historic aged care royal commission,” NSWNMA General Secretary, Shaye Candish, said.
“The 15 per cent award increase goes a long way towards recognising the value of a historically underpaid workforce and will help the industry to attract and keep staff – thereby delivering much-improved care for elderly residents.
“In addition, some assistants in nursing will also be entitled to a 5.75 per cent increase to minimum award rates. This will be a significant boost for some of our lowest-paid workers in the aged care sector.
“It is great to finally see a federal government brave enough to promise reform of the aged care sector and subsequently deliver it.”
Shaye said nursing unions are working with the government to make sure employers are accountable for implementing the 15 per cent award wage increase in full, as the government intends.
The government is giving $11.3 billion to providers to cover the 15 per cent increase for RNs, ENs, AiNs, personal care workers and lifestyle workers.
Employers must pass on all additional funding
Guidelines published by the Federal Department of Health and Aged Care show what the 15 per cent increase is worth in dollar terms for all classifications. See tables here.
“It is vitally important that [aged care workers] receive the full benefit of this funding so the aged care sector can attract and retain a skilled workforce,” says the department’s guidance document.
By law, members who are paid award rates should have received the new higher award rates from the first full pay period on or after 30 June.
The government also expects providers to pass the increase on to workers who are paid above-minimum award rates, in line with the published tables.
The tables show that if you earn above-award wages (usually via an enterprise agreement) you should get the same increase in dollar terms as workers on the award.
Workers should not expect to receive a full 15 per cent on top of enterprise agreement rates, the guidance document warns.
It also says, “Providers must pass on all additional funding allocated to wage increases to their workers in the form of an increase in wages.”
“Funding should not be used for short-term localised incentives, which apply to only some staff in a particular area/s of labour shortage.
“Any short-term incentives should be funded from the provider’s own resources.”
The 15 per cent increase is fully funded with taxpayer dollars and the department’s guidelines make it clear this increase should not be used as an excuse to restrict enterprise bargaining.
The guidance document says, “Providers can pay over and above the amounts set out in this guidance and the government expects the usual enterprise bargaining to occur, with periodic wage increases drawn from the provider’s funding as in past years.”
Employers must be accountable
The document states providers will need to tell individual workers their old and new wage rates via letter or email.
“The government also urges providers, as far as possible, to undertake workforce communications in consultation with unions and other employee representatives,” it says.
“Where appropriate this should involve joint communications, including paid workplace meetings.”
For-profit and not-for-profit providers of residential care and home care packages will need to state in their quarterly financial report that all funding provided to implement the 15 per cent wage increase is passed on to workers.
“Providers are required by law to provide accurate information to the government,” the guidance document warns.
“The department will work with the employer peaks and unions to follow up worker complaints.”
From the fourth quarter of the current financial year (April to June 2024), the quarterly financial report will also collect additional information about wages, including the minimum and maximum wage rates for direct care workers, as well as information on the primary way workers are being paid (i.e., award, enterprise agreement, individual agreement).
“The department will closely monitor providers’ expenditure on labour costs and identify trends in this spending over time,” the document says.
The difference in dollar terms between the old Nurses Award rate and the new award rate:
|Classification under the Nurses Award 2020
|Old hourly award rate
(From the first full pay period on or after 1 July 2022)
|New hourly award rate (From the first full pay period on or after 30 June 2023)
Additional amount payable from the first full pay period on or after 30 June 2023
(Difference between the old and new hourly award rates)
Assistant in nursing 3rd year and thereafter
Pay point 5
|Registered nurse – Level 5
|Nurse practitioner 2nd year
Members say the true value of aged care work is finally being recognised.
Requiring nursing homes to roster RNs on all shifts from 1 July will contribute to safer and higher quality care for all residents, says Western Sydney RN Angelin Maharaj.
Her own facility has always had RNs on duty 24/7, but other homes run by the same provider have been using ENs on night duty.
“We are so happy, because having RNs 24/7 means there will be reduced risk of harm to residents across all our facilities,” said Angelin, who is a delegate for her NSWNMA workplace branch.
“Qualified and experienced RNs will be available on all shifts, to identify potential risks and give residents better access to care, and it will allow us to manage issues as first responders.
“This will improve resident safety and prevent unnecessary trips to ED.
“An RN on site 24/7 will also mean we will keep and recruit new RNs who join the aged care workforce.
As a NSWNMA member in aged care, Angelin has been a part of union efforts to publicise the needs of the sector and lobby for reform.
She has attended rallies, collected signatures on petitions and joined fellow members in delegations to meet members of parliament.
As she told The Lamp in 2021, “We are all going to be old one day. We all need to raise our voices to protect vulnerable residents.”
In that article she described how her workplace had suffered a steady decline in staff hours.
“Staff are burning out from overwork. If they call in and can’t be replaced, it then puts more pressure on everyone else. We have been seeing it even more during the pandemic,” she said.
Staff are “overjoyed”
Angelin said staff were “overjoyed” to be getting a significant pay increase from 1 July.
“Nurses in aged care have been working harder and longer with little to no recognition. We are the workforce who has always been undervalued and underpaid, and it has gone on for far too long.
“Now, staff are satisfied that finally we are being heard, and that the crucial work we do is being recognised and valued.”
Angelin sees the pay rise as the start of a process towards “a decent wage, getting paid what we deserve, and having a pay packet that will be able to cover the cost of living, with money left over to save and invest for the future.”
A wage that reflects the social value of aged care work “will make it possible for aged care nurses to be able to get ahead and plan financially.”
At first, her employer wrongly advised that the 1 July pay increase would not apply to RNs on the grounds they were already paid more than AiNs.
“Our union officials assured us it doesn’t matter what anyone (from management) says, we will get the pay increases we are entitled to. We were very happy to hear that.
“With the union by our side supporting us all the way, we secured the 15 per cent award increase for all AiNs and RNs in all facilities.”
Angelin said the 1 July union gains had prompted “a significant number” of staff members to join the NSWNMA.
“Some are new members while others are rejoining after a period of absence. Many of them say the pay rise means they can more easily afford to pay union fees.”