Aged care providers and nursing unions in NSW are set to clash over whether to keep state legislation requiring aged care facilities to employ registered nurses at all times to oversee high care residents.
NSW Health Minister Jillian Skinner wrote to the sector on 13 June announcing the State Government’s decision to grandfather existing arrangements which require a registered nurse to be in charge and on duty 24/7 in high care facilities for the next 18 months.
During this time a consultation process will be conducted with stakeholders to work out future arrangements following the removal of the low/high care distinction in residential aged care from 1 July, Ms Skinner said.
Currently NSW is the only state with a legislative requirement to have a registered nurse on duty 24/7 in a high-level care facility.
NSW aged care providers have denied claims by unions that they are seeking to cut back on registered nurses in high care, but argue they need flexibility to determine their own staffing levels and to target RNs where they are needed most.
Aged and Community Services NSW & ACT CEO Illana Halliday told Australian Ageing Agenda that ratios and staffing requirements were a blunt measure that did not respond to the actual needs of clients and would contribute to unsustainable costs.
The peak body estimated the direct wage costs of employing an RN 24/7, for a current low care 70-bed facility would be $500,000.
Ms Halliday said a requirement to have an RN on duty at all times in every facility with a high care resident would also be impossible to manage due to a lack of available staff and would be a waste of limited resources.
She said while skilled RNs were necessary in the provision of palliative care or short-term acute care in a facility, not all high care residents would require an RN to meet their needs.
“It is probable that many residents with a high score in ACFI may still not need an RN, as the care they require is not acute or curative, it is about comfort and quality of life,” Ms Halliday wrote in a ACS NSW & ACT position paper.
She said that industry, unions and government needed to work together to develop new models of care to best utilise available staff. “Nurses are a precious resource, which means they have to be deployed in the right place at the right time according to the needs of the client.”
Brett Holmes, general secretary of the NSW Nurses and Midwives’ Association, said providers were having a bet two-ways.
“The providers are telling government constantly that the acuity level of their residents is rising and they need more money to fund that care and yet they are often proposing that they don’t want a requirement to have registered nurses,” he told AAA. “They can’t take the funding but not be prepared to employ the staff.”
Mr Holmes said the union would continue to argue for a registered nurse to be on duty on each shift.
“We believe that it remains in the best interests of the residents to have their care overseen by registered nurses and for the workers in aged care to have the benefit of that professional level of oversight.”