The Australian College of Nursing (ACN) has welcomed the delivery of the final report of the Royal Commission into Aged Care Quality and Safety, saying that the Federal Government now has two clear roadmaps to reforming the sector.
The Chief Executive Officer of the Australian College of Nursing, Adjunct Professor Kylie Ward FACN, said the historic final report delivered real opportunities for reform.
“The Royal Commission has laid out two real templates for change, and it is now up to the Government to stand strong and deliver on one of these options,” Adjunct Professor Ward said.
“We must not use this historic split as an excuse to do nothing about a sector so badly in need of reform.”
The Royal Commission called for additional support for nurses as part of its changes to improve aged care, including minimum time with a nurse for residents, Medicare Benefits Scheme changes to support nurse practitioners in assessing the health of residents and greater transparency around staffing hours in aged care facilities, moves which were welcomed by Adjunct Professor Ward.
“These changes will contribute to a nursing workforce that is capable of supporting residents in aged care facilities,” Adjunct Professor Ward said.
“However, while minimum timeframes are welcome, we must demand that this does not become care by timesheet. Rather, nurses need time to provide holistic care to meet the individual needs of each person.”
Adjunct Professor Ward also welcomed calls for registration and mandatory minimum qualifications for personal care workers who currently provide the bulk of aged care.
“Unregulated workers have been able to go untracked and unchecked for far too long in aged care,” Adjunct Professor Ward said.
“These changes will protect care workers who provide exceptional care, while embedding accountability for those who perform badly and should be removed from the sector.”
Adjunct Professor Ward welcomed the Government’s initial response to the Royal Commission but said more needs to be done to ensure that the changes that are necessary for the system can occur.
“While we welcome the immediate funding rollout, we have real concerns about the lack of workforce data to understand how to deliver safe, appropriate care for those who choose to be supported in their homes,” Adjunct Professor Ward said.
“We call on the Government to support our call, outlined in our budget submission to Treasury, for a research program into understanding the long-term nursing workforce requirements for home care.”
The Royal Commission also called for a number of critical changes to the aged care system, including significant reform to the Aged Care Act, funding levels and the assessment system.
Adjunct Professor Ward said that these recommendations would be assessed in detail by an ACN-led Expert Advisory Group of nurses in the coming weeks.
“This is an extraordinary report which requires the appropriate attention to ensure that every aspect can be dealt with in its importance,” Adjunct Professor Ward said.
“It is crucial that the voices of nurses are heard in the response to this report to identify the best way to enact the Royal Commission’s recommendations.”
It is fantastic to read the many passionate comments about aged care nursing. However it is a little disheartening to see comments about the lack of access to the evidence base for care. Australia lead the world with evidence based guidelines for palliative care in both aged and community care. While these are now obsolete, they have been replaced by palliAGED and the palliaged app, freely available 24/7 at https://www.caresearch.com.au/caresearch/tabid/4143/Default.aspx. his site also includes evidence based, peer reviewed tip sheets for both nurses and care workers.
The CareSearch website also includes evidence based information about dementia care, this includes one click searches of the PubMed data base for latest evidence about dementia care.
These sites work to NHMRC guidelines and the pages are all based on the highest level evidence and peer reviewed. Unfortunately the evidence base for age care has many gaps and much of the evidence is not published, for example the evidence to support the many ‘commercial’ programs for dementia care.
To truly implement evidence based best practice we need to improve the education of undergraduate nurses. Australia is falling behind the standards of other countries. As a profession we must insist on a 4 year undergraduate degree, it is intolerable that nursing is the only health profession to accept a three year preparation, and this is one reason nursing has lost its voice and advocacy role for clients. We must insist that all students have met language, literacy and numeracy standards and be fit to practice before beginning their studies. This year for the first time I have a class of students who have all met the NMBA standard for English. This means that the whole class is productive and teaching and learning is so much more effective. It is also essential that we have some independent means of verifying students knowledge levels prior to registration. For as long as Universities are funded on number of students passing, not on knowledge or proficiency in applying that knowledge, we cannot have confidence in the abilities of nurses to provide excellent care.
I think the great, but unspoken, tragedy of the publicity about the aged care system, is that it gives a very skewed, view of aged care, and gives little recognition of the massive improvements in care since 1997, and the many facilities offering excellent care. This has not only negatively affected the reputation of aged care, it has increased the guilt felt by families, set up road blocks to effective communication with aged care staff, and negatively affected the development of relationship care. Aged care is about team work. Resident and families need to be part of that team, and in a meaningful way, not just token inclusion in committees.
The new standards, in their proper desire for resident centred care have entirely devalued the role of the health care professional, just as it has been relegated to occasional consultant in community care (mostly wound care and IDC change) and removed altogether from the NDIS.
While nurses in aged care are paid significantly less than those in acute care, and their role is so disrespected by nurses in other sectors, the media and the legislation, it will be difficult to attract the brightest and the best to aged care. Employers will be forced to take the graduates who can’t get a position in a formal graduate program, but with out the budget or other resources to give them the support they need to transition from student to competent (let alone exemplary) aged care nurse. Even as a nurse with 25 years experience, I found it hard to adapt my knowledge and skills to the aged care environment. We cannot expect new graduates, who may have language or cultural barriers to overcome, and may have struggled to learn during their studies (financial, language, work other commitments) to do this successfully.
As a profession we need to offer mentoring and nurture to nurses entering aged care, as well as to the brightest and through ENL. We need to promote the excellent nurse leaders in aged care, as ACN promoted the excellent men in nursing. We need to do this also as a public campaign. Last year the local ABC radio station In Adelaide asked callers to nominate aged care services providing excellent care. They were inundated with great stories. We need to improve morale and give all nurses in aged care positive goals to aim for.
I became a passionate aged care nurse in my hospital trained student days when I witnessed appalling care and treatment of the most vulnerable sick older people where community expectations were steeped in ageism and low expectations. I have had many health management positions since and most of my career including post graduate study has been in gerontology. I have focused my work on bringing evidence based practice to the experience of the older person in care everyday. Aged care nursing – I hate that description as it does not represent or foster the specialised skills that all nurses should bring to their practice. Nurse practitioners have a role for sure but what is the ACN doing to support young grads finding themselves in “aged care” because there are jobs – or the nurses that have been slogging hard for years with little reward and no recognition- (as well as not taking responsibility for advocating for at times appalling care) – often because no one has told them or shown them what “ good care” is! – and they have failed to understand their own role and be accountable! Why isn’t the ACN advocating for a digitalised evidence based care management system fully funded by the government, with compulsory funded training including evidence based interventions for care of dementia, frailty, heart failure! You can do all the research you want and we should, but academics and peak bodies need to come and understand the frontline experience – no older chronically ill person should be waiting! That’s where I have gained my professional satisfaction- knowing on my watch I can make a difference in a broken system where the unions and peak bodies and academics do little to support their colleagues who are subject to low expectations, no funding or time for training, working with unskilled GP’s in geriatric care. At work these days I say “ don’t call the geriatrician just yet” (there not as good as they used to be) – Nurse Practitioners will be great at assessing and recommending – we do that well in some places – but it is the Implementation and capability of evaluation after the NP that nurse leaders need to do – who is going to do the do and lead the carers, And I can’t emphasise enough how important it is for nurses to have skills to impart knowledge to families of the ageing process when living with chronic disease. A contributing factor to family distress is the health service response across all sectors to end stage dementia and frailty – where is that conversation? Lastly when are we going to do something about the racism that is so transparent in the “aged care system” and how do we support the marginalised disempowered workforce who have to cope with this everyday on top of everything else? We need our own voice – voices that touch the skin of the frail everyday! And we need support and awareness – when is that going to come!
Here, here!
I agree that the perception of aged care is not seen as a specialised area of nursing. Can we not say – gerontological care, or, and the one I am using more and more to increase understanding – chronic comorbidity health care. I use this term with other health professionals so that I am not dismissed. I am lucky enough to work in an organisation where we have graduate nurses. I am passionate about my industry, like Jenny above, knowing that I have educated new nurses to the residential aged care system in a way that they can recognise their importance in health and wellbeing of those under their care. We need to find a way to retain those working in aged care who want to also study. Often, those who want to increase their skills are required to walk away to study. There needs to be a way that those who have the passion are retained and trained to obtain further qualifications.
The Australian College of Nursings CEO’s response to the findings of the Commission into Aged Care Quality and Safety addresses several crucial issues which require attention if anything is to change . It is obvious that professional nurses had lost control of the essential matters of care for our elderly population. Where we once played a major role in caring for those who are ageing somehow privatisation and profit became the key features of this sector.
We now have an opportunity as Kylie so wisely suggests to turn back the clock, to reclaim our territory ,to ensure that no longer are our elderly citizens cared for by untrained and unprofessional staff whatever their ‘good’ intentions. The elderly in our society are our most vulnerable with diseases from living a long life and often co morbidities. Of all our society , they deserve and need expert diagnosis and respectful care . Nurse Practitioners are in an ideal position to be the pivots around which care is organised and delivered . Let us join together is ensuring this essential role is not hijacked again.
I am not sure how it could be implemented but wouldn’t it be great if it was mandatory for every aged care facility to employ a nurse practioner as the CEO, Care Supervisor, Head Nurse or whatever title they want, in charge. I know it would be difficult in the outback towns, having worked in these areas, I know how hard it is to attract staff. Some of the places where I have worked the only RN was the Nursing Supervisor who worked Monday to Friday and was then on call when she went home at 5pm . She lived on a property 20 or 30 kilometres out of town. So whenever the carer on duty was worried about a patient she would simply phone the ambulance and have the resident taken off to hospital unnecessarily.