The Hive 2019The Hive - calling for more nurses in aged care aged care

By Professor Deborah Parker MACN

As we grow older, the more our health care needs get increasingly complex. In order to adequately meet these needs, we require a sustainable health system which will ensure that those who are most vulnerable in our communities are not slipping through the cracks.

The Royal Commission into Aged Care Quality and Safety is Australia’s latest review to address the allegations of abuse, neglect and mistreatment of our vulnerable elderly in aged care.

In over 20 years, we have seen more than 20 inquiries conducted (Phillips 2018) in order to address the issues within the sector. These reviews are aimed to ensuring Older Australians are provided with the care that they deserve and expect.

When I received an invitation to present at the Royal Commission into Aged Care Quality and Safety earlier this year, I was highly aware of the gravity of the opportunity. As Chair of ACN’s (formerly known) Healthy Ageing Policy Chapter — and thus in representation for ACN — I explained that nurses are essential to the delivery of care to our Senior Australians.

Nurses provide care holistically — meaning they take into account a patient’s emotional, social, psychological and physical wellbeing. This is a factor which cannot be measured and easily defined, especially in aged care.

In 2003, Registered Nurses (RNs) working in residential aged care facilities made up as much as 21 per cent of the workforce, however that number has fallen now to approximately 14.9 per cent; while personal care attendants (PCAs) in 2016 made up 70 per cent (Mavromaras et al. 2017, p.10).

PCAs are one of the many titles which are given to unregulated health workers. Within residential aged care facilities, they are supervised by a small number of RNs. These workers are exceptionally valuable to the workforce and their contributions are to be suitably recognised. However, unregulated health workers working in aged care lack the training, level of assessment or planning skills to appropriately provide care to residents with complex care needs.

At the Royal Commission’s hearing, I reiterated the significant role that the RN has in residential aged care facilities, as well as reinforcing the commitment that such unregulated workers should be regulated. This position will be an essential focus for the Workforce Sustainability Policy Chapter as they work towards launching their White Paper.

There are still challenges yet to be uncovered throughout the Royal Commission’s process and I am eager to see how we as nurses and the Ageing Policy Chapter will respond to ensure that our Senior Australians receive safe and high-quality care. For 2019, the Chapter has already decided that the Quality Indicators for Aged Care Services will be closely monitored. By drawing on current national and international evidence for these and broader quality indicators, the Chapter will collate this evidence and work toward a discussion paper.

With the focus on aged care at present, I am conscious that our topic for the chapter while important is only one aspect that we need to draw attention to.

The aged care workforce needs to almost triple from 366,000 to 980,000 by 2050 to meet demand (Department of Health 2017). This means that we must ensure the aged care sector is a sustainable and attractive career for those starting nursing careers, but to also retain those currently in the workforce. Prioritising adequate remuneration as well as a promising career structure will contribute to enticing enthusiastic and dedicated professionals to aged care.

Within residential aged care facilities, RNs provide leadership and coordination of care. By applying models which focus on the skills and skills-mix of staff will mean that the complex care needs of residents’ will be appropriately met. Being so well-equipped, RNs must also be empowered to utilise their experience and training in such settings. As a profession, we must ensure that at least one RN is available in residential aged care at a minimum 24 hours a day, 7 days a week.

In this current environment, the expertise and knowledge of the collective Ageing Policy Chapter — and the nursing profession — is well-placed to influence, inform and be consulted on to reform national aged care policy.

Department of Health 2017, Strengthening Aged Care — developing an aged care workforce strategy, viewed 19 February, http://www.health.gov.au/internet/budget/publishing.nsf/Content/budget2017-factsheet56.htm

Mavromaras, K., Knight, G., Isherwood, L., Crettenden, A., Flavel, J., Karmel, T., Moskos, M., Smith, L., Walton, H. &Wei, Z. 2017, The Aged Care Workforce, 2016, Department of Health, viewed 18 February 2019, https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/03_2017/nacwcs_final_report_290317.pdf

Phillips, J, Parker, D & Woods, M 2018, ‘We’ve had 20 aged care reviews in 20 years — will the royal commission be any different?’, The Conversation, 20 September, viewed 10 March 2019, https://theconversation.com/weve-had-20-aged-care-reviews-in-20-years-will-the-royal-commission-be-any-different-103347

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