Aged care peak bodies and providers in NSW have argued against expanding state laws to require RNs on site at all residential facilities 24/7, while GPs, nurse groups and seniors advocate for the measure.
A NSW parliamentary inquiry examining the adequacy of nursing staff levels in residential aged care has been told that state authorities need to play a role in regulating the sector’s workforce, as the national legislation is not prescriptive enough.
The inquiry was prompted by the impact of removing the high care/low care distinction in the federal Aged Care Act on existing NSW legislation, which required a registered nurse be in charge and on duty at all times in a high care facility. NSW was the only state in Australia with such a requirement.
Australian Ageing Agenda reported on Wednesday that veteran RNs have told the inquiry they were essential to quality aged care, while a regional provider said that mandating RNs 24/7 on site at all facilities would send them broke, written submissions to the inquiry showed.
In further stakeholder submissions, which have since been published by the inquiry, aged care providers and their peak bodies have argued against expanding the requirements on RNs to cover all facilities.
Leading Age Services Australia NSW-ACT told the inquiry that there was a comprehensive national system of aged care regulatory oversight, which overlapped the NSW requirement in question.
LASA’s submission said that care outcomes were best delivered by providers operating under the framework of regulation, funding and quality control provided for under the federal Aged Care Act.
Aged & Community Services NSW & ACT said that there had been “an alarmist campaign waged that asserts that without the ‘safety net’ of such a legislative requirement aged care providers would remove RN staff from their services. This is not the case.”
Providers recognised that more, not fewer RNs were needed in the sector, but they were needed in the right place to best support residents with complex clinical needs and were not always readily available, especially in the rural and regional areas, ACS said in its submission.
“No other state has this legislative imperative and there is ample evidence to show that aged care providers in the other states provide the same high standard of care and support to their residents as those in NSW,” it said.
NSW provider HammondCare recommended that policies and regulations about the staffing in residential aged care should recognise that residents with high level needs had diverse care requirements, “which are best met through flexible care and staffing models.”
“It is important to recognise that aged care residents with ‘high care’ needs can have vastly different care requirements that will be best met through a range of different staffing models. While some facilities with ‘high care’ residents will require an RN on duty at all times, others will not,” HammondCare said in its submission.
Presbyterian Aged Care NSW & ACT told the inquiry that if the requirement to have RNs was extended to cover all facilities it would have to consider removing other types of staff in order to find savings for the required RN cover, which would impact on the overall quality of care for residents. Further, it would potentially have to “transfer ‘high care’ residents, from what used to be a low care facility, to a hospital to avoid making the facility non-compliant.”
The requirement could also force Presbyterian Aged Care to stop looking for ways to provide short-term acute or palliative care in a facility, as there would not be enough RNs available to help with these short-term peaks and troughs in changing resident needs, the provider said in its submission.
Federal legislation ‘does not define’ appropriate staffing
The Australian College of Nursing dismissed the argument that the NSW requirement was superfluous to the national aged care framework, as it said the Aged Care Act did not stipulate nurse-to-resident ratios or minimum requirements for RNs to be on duty.
“The Act requires that residential care services are staffed by ‘appropriately skilled and qualified staff sufficient to ensure that services are delivered in accordance with these standards’ but does not define what constitutes appropriate staffing,” the ACN said in its submission.
It argued that the lack of clarity regarding appropriate staffing in the Commonwealth legislation put the onus on state regulation “to ensure appropriate nursing skill-mix in nursing homes at all times across the 24-hours of care.”
The Central Sydney General Practice Network (CSGPN) said it was “highly concerned” at the prospect of the removal of the NSW requirement. “The burden on GPs will increase if there is no RN on duty – less qualified staff will not have the same ability as an RN to adequately access and triage patient needs,” the CSGPN said in its submission.
The result would be increased phone calls to GPs or requests for visits, or calls for ambulances when care workers were unsure of a resident’s condition, it said.
Seniors advocate for requirment
The two major consumer lobby groups also backed the state requirements.
National Seniors called on the government to “maintain the provision for RNs to be on duty at all times within NSW aged care facilities.”
It said that childcare centres, schools and hospitals had mandated staffing ratios and staffing qualifications at national and state and territory levels, and older Australians should be afforded the same level of care and quality.
Council on the Ageing NSW argued that “there should in fact be more staffing requirements, not less, including standardised staff-to-resident ratios and the continuing requirement for registered nurses to be rostered on all shifts.”
This was fundamental to ensure a standardised quality of care could be delivered to residents with increasingly complex care needs, COTA NSW said.
The inquiry begins its public hearings next week. Its final report is due on 30 September.
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