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PUP Senate leader makes the case for ratios in aged care

The nursing union’s campaign for mandated nurse-to-resident ratios in aged care has gained a new Parliamentary ally, with Senator Glenn Lazarus, Leader of the Palmer United Party (PUP) in the Senate, set to lobby the federal health and social services ministers over the issue.

A spokesperson for Senator Lazarus confirmed to Australian Ageing Agenda that he would be raising the issue with Federal Health Minister Susan Ley at a meeting today, as well as with Assistant Minister for Social Services Mitch Fifield.

Senator Lazarus was in favour of mandated nurse ratios in various areas of the health system, including aged care, the spokesperson said.

The Australian Nursing and Midwifery Federation (ANMF) said yesterday it was “heartened by a commitment” by Senator Lazarus that he supported the union’s campaign for mandated staffing levels in aged care.

Lee Thomas

Lee Thomas

ANMF federal secretary Lee Thomas and assistant federal secretary Annie Butler met with Senator Lazarus on Monday to discuss the union’s concerns that “a lack of nurse-to-patient staffing ratios was compromising the amount of quality care being provided to elderly, vulnerable people living in nursing homes.”

In their meeting with Senator Lazarus the union had outlined “the staffing crisis in aged care and the urgent need to address this at a time when there is a current shortfall of 20,000 nurses in the sector,” Ms Thomas said.

“The senator appreciated these concerns and the lack of quality care in some nursing homes because of poor staffing, as these issues had also been raised by community members in his home state of Queensland,” she said.

Responding to the latest push for ratios, Leading Age Services Australia (LASA) restated its opposition to their use in aged care.

“LASA supports a qualified and skilled aged services workforce, with adequate numbers to address the growing and diverse needs of Australia’s ageing population,” CEO Patrick Reid told AAA.

“Just as the needs of residents differ, so do the size and structure of providers. LASA supports high quality care but does not support ratios as they are not responsive to the changing acuity of residents or the varied models of care provided across the industry. It is also important to remember that, based on consumer demand, the predominant future case setting will be home care, where a flexible, blended workforce will be required.”

Nurse ratios in aged care have been a long-standing debate in the sector. While unions have campaigned for their introduction, aged care providers have argued there is a lack of evidence to show they are effective in raising standards or outcomes.

The Productivity Commission decided against recommending ratios in its landmark 2011 report into aged care.

It found a staff ratio in aged care would be a “relatively blunt instrument”, given the resident profile would be ever changing. “Such ratios become particularly problematic for small facilities, and a rigid application of ratios could create operational difficulties for these facilities,” the PC found.

It further noted that the accreditation process provided a means for “encouraging providers to apply an appropriate skills mix and staffing level in the delivery of community and residential aged care services.”

Meantime, in Victoria, the recently elected Labor Government is set to become the first in Australia to legislate for ratios in public hospitals and state-owned aged care facilities.

HAVE YOUR SAY: What’s your view on the call for nurse-to-resident ratios in aged care? Comment below 

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20 Responses to PUP Senate leader makes the case for ratios in aged care

  1. Gerard Butler February 11, 2015 at 11:44 am #

    In an industry that generally accepts that access to a (single) registered nurse on night shift is adequate despite the size of the facility staff to client ratios are overdue. The issue is not about nurse to resident ratios it must also include nursing assistants and personal care staff the real but often much forgotten overworked and underpaid core workforce.

    Not sure that assistance from PUP is a helpful tactical move.

  2. Charmaine Crowe February 11, 2015 at 11:49 am #

    The call for ratios is based on there being systematic understaffing of facilities, which the industry has failed to address on its own. Yes, the care need profile of residents in facilities changes, but a sophisticated ratio system could be responsive to those changes, not least because ACFI would give a good indication of what kind of staffing was required to meet care need. In any case, it is well established that the overall acuity of residents is increasing, demanding a higher number of higher skilled staff. The evidence shows, however, that staffing is going the other way, with a decline in care hours delivered by registered and enrolled nurses, who are being replaced by assistants in nursing and care workers.

  3. Kevin Crank February 11, 2015 at 11:55 am #

    There is already a ratio between every person being cared for by a nurse and that nurse, because a nurse always has a particular number of persons in their care at any one time – the point is that a lot of those ratios are terrible, due to profits being put before care. Persons in care need those ratios to be limited by legislation to ensure each of them gets the amount and quality of care they need from their nurse/s.

  4. Simone I February 11, 2015 at 12:12 pm #

    Nurse to resident ratios is a poor argument, increasing the number of nurses in an aged care facility will not change the level of day to day care of residents in aged care. yes the residents nursing care needs will be met but what about the other needs? having more nursing will not equal better holistic care of older people living in aged care facilities. The only way to impove the total care of older people is to ensure there is enough care staff PCA’s to meet the needs of each individual in care, this is also a better optiopn to help smaller facilities becaues they cost less.
    I am a nurse I do work hard but I think residents would be better off with more carers than they would be with more nurses.

  5. Rhonda Nay February 11, 2015 at 12:35 pm #

    Having PUPS support ratios is sufficient evidence in my view to show them to be a shortsighted solution

  6. Tony Rolfe February 11, 2015 at 3:29 pm #

    Simone is right on point with her comments. The general gist of the long-standing call for nurse:resident ratios being applied in aged care always overlook the fact that these facilities are caring for frail older people. They are no longer the old notion of a nursing home where residents receive clinical care from a qualified nurse. Most of the residents are not sick – they are just frail and/or living with dementia. As such, they don’t need nursing they need care, assistance and support. The government subsidies and approved fees for residents are not sufficient to meet the higher cost of qualified nursing staff in the numbers ideally stated by the ANMA. The care needs and clinical needs across a resident spectrum on any given day will vary from one day to the next. I tis almost impossible to determine the precise number as a ratio for the number of nurses required for any number of residents. They might all be high care residents or those with lower care needs or require no clinical intervention at all. The Productivity Commission recognised this and Senator Lazarus would do well to consult with a range of informed people other than just the union representatives of the nursing industry.

  7. Dave February 11, 2015 at 9:13 pm #

    Sorry Tony, but you’ve got it the wrong way ’round.

    The ‘old notion of a nursing home’ provided zero clinical expertise (unless you you think an enema is hi-tech). Wizened and crumbly old folk lay in urine soaked draw sheets and plastic macintoshes, Stage 4 pressure ulcers were treated with daily saline-soaked gauze swabs, the TV room was full of people tied to their chairs with twisted sheets and matron spent the day embezzling money from spinsters with no relatives.

    The increasingly complex care needs of residents now demand a higher skill set than the model you describe. It’s disingenuous to say ‘they’re not sick…just frail …’ as that misguided perception is one of the main reasons we’re still battling with a low skill, low wage based workforce.

    Many residents ARE sick and their frailty increases the risk of a rapid and avoidable decline. Skilled clinical assessment and early intervention, along with the expertise to confidently and competently manage end of life care are in short supply and any move to address this should be applauded.

    Or we could do it your way. I’m sure all that ‘assistance and support’ will complement the steady stream of preventable, traumatic and unecessary hospital transfers that result from a dearth of skilled clinicians. Palliative care? Perhaps we can promote the Emergency Room corridor as the best place for granny to die?

    We should never undervalue the contribution of our carers; we’d grind to a halt without them…but when things go wrong (and they always will) I’d like to think we’re able to offer more than just hand holding.

  8. Jamie February 13, 2015 at 12:43 pm #

    Tony & Simone, if you’re going to try to make the employer’s case for them, at least admit that it isn’t based upon any quality-related data.

    The DHA data shows that age and morbidity is increasing in aged care. The extension of home care packages also means that when a care recipient enters a residential facility, they generally are even more frail and with more co-morbidities than ever before.

    The data also shows that the percentage of RNs working in aged care has steadily and alarmingly decreased over the past five years.

    So, we have frailty and co-morbidity increasing, while the qualified nursing hours per day are rapidly decreasing.

    All this while aged care providers nationally hold more than $10billion in bonds paid by low-care residents and can now charge bonds to high care residents as well.

    I’m sure the general public is unaware that there are 100+ bed facilities where overnight the only RN available is on-call and situated up to 100km away from the facility.

    Please tell me how that is quality aged care!

  9. Margaret March 17, 2015 at 1:09 pm #

    After forty years working in nursing the only thing that has changed is that providers are getting richer and people are dying alone, in pain and miserable. The government should be sacked!

  10. Maria March 18, 2015 at 1:46 pm #

    Simple – aged care is not something that any person that I know; is looking forward too as it is run now
    We fail to care for them at home or at a facility and if there is no family member involved it is a worse and sad situation
    You pay your taxes all your working life and at the end of the day you are forgotten as the politicians are concerned with their own pockets

  11. Maria Cameron March 19, 2015 at 4:27 pm #

    I would just be happy if the nursing home hired more carers, when ever I visit my mum in a nursing home I am lucky to find one, then they tell me they are not short of staff, I do know they are not well paid, and are topped up by Centrelink, at this place, I was mum’s carer but I just couldn’t do it anymore, but I do know I can cook better than they do in there. the shame of it is they don’t even have a choice of a doctor, there is only the one that comes and visits, I could not even tell you what medication mum is on anymore.
    at the moment they are doing extensions in 3 different areas of this nursing home, and it is not fair on the residents because of the noise.
    I spoke to a friend last night he has left strict instruction not to be sent to this nursing home, I don’t want to go there either.
    Some of the residents even complain that it has run down, but I’m only a visitor and chat to them while I visit mum, this place is in Maryborough Victoria

  12. Jane S. April 5, 2015 at 12:32 pm #

    As a Registered Nurse in an aged care facility, I think it is very necessary to have a ratio, according to the acuity of the resident. Without a set number of nurses to resident ratio, the facility will hold on to their minimal (or undertaffed) staffing.
    I am working in a facilty with at least 120 residents (low care, high care, palliative, dementia). In every shift, we usually only have 2 RNs on the floor (except night shift, we only have one) with one AIN assisting with the medications. We would be very lucky if we get at least 3 nurses in the morning and afternoon shifts. In addition to all the medications we need to administer, we had to do all the wound dressings, liaise with allied health and doctors, do our care plans, deal with incidents and various needs of the resident in a big facility. I can say that quality of nursing care is very minimal as well because of the lack of time and staff we have in a shift. We usually do overtimes (without pay) just to finish our job.
    So it would be really helpful if we have a set number of nurses depending on the number/acuity of residents.

  13. John D. April 6, 2015 at 6:27 am #

    You are definitely right Jane S! Could not agree more..

  14. Mick June 27, 2015 at 4:02 pm #

    Definitely need ratios in aged care and they need to be responsive to changing needs of residents. And the residents are not just “frail”. They have many chronic illnesses as well as MIs, TIAs, pneumonia etc. not being uncommon. And when you have an acute illness to deal with on top of your regular workload (and sometimes someone else’s workload who has called in sick and cannot be replaced) it is close to impossible to provide a standard of care you are happy with. Plus there a lot of residents with significant mental health/emotional issues you do not have the time to properly address.

  15. Brett H October 3, 2015 at 10:14 am #

    Well said Jane S.
    My Step father is in permanent care and is a high care needs (medical not dementia). We are continually having the issue of dealing with lack of care issues and also once, had to call the doctor and ambulance ourselves when we came to visit and found him in a situation that should have been dealt with hours before. We nearly lost him. There are 32 patients in his pod and at times less than 4 on. If every resident needed just one then that may be okay, but many times we have been there, one resident is taking the time of all carers. At times we cannot even find a staff member.

    The thinking behind all those who are making decisions should be first and foremost the dignity of the resident over the financial. Also, I would love those making decisions to place themselves in the residents shoes and ask is this what I would want when I am at the age where I need to go into permanent care? I know personally what I am seeing in the facility that my stepfather is in, I would not want.

    My stepfather is fortunate enough to have us to advocate for him, whereas a large number of residents do not.

    I am now to go to the facility and discuss increase of care due to a medical turn where his vision now classifies my Stepfather legally blind. I have raised the issue of staffing before with the centre and they have admitted that it is not at optimum as it should.

  16. Nick Sam November 25, 2015 at 3:04 am #

    my 55 yo wife has been in high care for the past 18 months in a privately owned & runa aged care home in Melb
    The home looks pretty enough & clean is about all the good things I can say about it.
    Staffing levels are a complete joke, the only times they seem to have full staffing is morning to 3pm shift or they have been given notice of an inspection.
    I visit & stay late so the afternoon staff finish and the night shift starts at 10.15. People who have loved ones in this home would be shocked to find out that many nights there is only 2 staff members working ( nurse & pa ) for over 150 residents as staff have phoned in unwell and not been replaced for that shift…why haven’t they been replaced? More $$ to the owner as less wages to pay? At full night staff levels there is supposed to be 1 nurse & 4 pa, The owner seems to think that 5 staff is more than adequate for the night shift. There’s over 150 residents, both low & high care combined with many bed ridden like my wife that can’t do a thing for herself.
    When I first placed Helen in this home I was told that the resident ratio was 5-1 day and 7-1 night. Believe me these ratios aren’t even being close to meet as the staff turnover is high also due to the managerial demands forcing some staff to leave. I am there every night and I see it for myself, resident to carer ratio of 55-1 many times during the year.
    All except when there is a Certificate Renewal coming up

  17. stevie January 31, 2016 at 8:13 pm #

    I work in agedcare and staff ratio needs to be looked out ASAP We are losing good staff as they are burning out trying to keep a top level of care .
    Please help us
    I dont know how much longer I can work as im burning out.
    Most of us maybe be future residents but at this point i would not like to go to a nursing home

  18. Debra February 11, 2016 at 10:50 pm #

    I am an RN & have worked in aged care for 30 years. For the past 14 years I worked in management, (DDON, DON/ Facility Manager). I am now working as an RN ( Aged Care).
    Residents coming into Aged Care facilities now have much greater and complex care needs. This is because elderly people have the opportunity to stay at home longer due to Community packages to assist them.Unfortunately, when they arrive into Aged Care homes, their needs are great, psychologically, physically and medically.
    And its not just elderly anymore; younger people are being admitted which creates a more complex environment.
    Expectations for documentation on a computer program that is so time consuming.
    Assessments, 3 month care reviews, Care Plans, Complex Wound dressings, 2 hour medication rounds, BGLs, Insulin injections. How do you do it and get off on time. Well you don’t get off on time. I work 1-2 hours overtime my shifts and don’t get paid for it. I am not the only one.
    The Care Staff/ AINs are wonderful and work extremely hard under demanding conditions. They cannot toilet residents and attend 2 hourly PAC/ repositioning as their “assessed needs” and care plans state.
    I say a review is desperately needed.
    Mistakes will happen more an more and who will suffer – Our Residents.

  19. Giesela November 1, 2016 at 9:28 pm #

    I am an Endorsed Enrolled Nurse in Aged Care.
    Just me to 30 residents.
    My staff are pushed to the limit as I only have 4 staff.
    We are a high care unit.
    What is happening on a daily basis now is when staff are sick, they are not replaced.
    Also I argue with the hospitals continually as my residents will usually get sent back within hours still in an acute phase. I don’t have the equipment, staff or MET Call button to assist me when thingsvgo wrong.
    I have noticed alot of residents coming in who are predominantly Psych which we are not equiped for.
    Then we are told that we are not managing our time.
    Us nurses don’t know what a morning tea or lunch break is.
    I love being a nurse and caring for people but now seriously considering leaving the aged care sector.
    It is a disgrace and a shame that the government and politicians really don’t care.
    Get them to come and spend a week with us doing what we do and then you might see an attitude change.
    Sad part is, I am losing great staff as they are exhausted and I have realised that I can’t keep up with these delusional expectations and demands.
    How sad has it become.

  20. Gustave Eiffel November 27, 2016 at 10:02 am #

    “Sad part is, I am losing great staff as they are exhausted and I have realised that I can’t keep up with these delusional expectations and demands.
    How sad has it become.”

    But, we still go in, do what we can, take the flack and turn up again. Why? Because of the residents. Bullying is endemic in this industry and it is centred at low staff numbers and ridiculously high expectations of staff.

    I am left to shower (fully) 6 people who are unsteady on their feet and I’m given 1.5 hours to do this so they’re all out for breakfast. In this time I am also expected to assist with dressing for another 10 residents and have them ready for breakfast. This never happens. Then, with sabotage from another co-worker – it makes the demands impossible to fill.

    Residents are upset, confused and frightened because their needs are not being met. I’ve found residents in bed with faeces all over them on a clean Conni sheet, but faecal matter smeared on the sheet underneath. For how long? How long does it take faeces to become like concrete?

    That’s why I turn up even though I know I have an impossible task at hand.

    I find it’s not a skill of mine to split myself into two, which is what one would need to do in order to get the work done.

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