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Missed care worse in private sector, study finds


Nurses and personal care workers in government owned aged care facilities report lower levels of  missed care than their counterparts in the private sector, a study finds.

The research, published in the latest edition of Australian Journal of Social Issues and funded by the Australian Nurses and Midwifery Federation, aimed to identify the frequency of missed care by staff in private-not-profit, for-profit and government facilities.

Missed care refers to required resident care that is omitted or delayed because of multiple demands, inadequate staffing, lack of materials and resources or communication breakdown. It includes answering call bells, attending to toileting or moving patients who can’t walk.

A total of 3,206 nurses and personal care workers completed the MISSCARE survey, a two-part tool that measures the reasons for missed care.

The survey, which was available online between 15 December 2015 and 5 February 2016, was made up of 68 questions, 28 related to demographic and workplace factors and 37 on care tasks that may have been missed.

The level of missed care was found to be higher in privately owned facilities.

Employees working in government owned facilities reported lower levels of missed care than privately owned facilities in the following 6 activities:

  • moving patients who cannot walk
  • assisting residents’ toileting within 5 mins of request
  • assisting resident mouth care
  • assessing skin integrity
  • answering call bells within 5 minutes
  • wound care

The most commonly missed tasks among all facilities was responding to call bells and to toileting needs within five minutes.

Lead researcher and Flinders University research associate at the Southgate Institute for Health, Society and Equity Dr Julie Henderson said unscheduled tasks were most likely to be missed.

“This may be due to workload as care workers have set tasks to complete each shift, leaving limited time for other tasks and few staff available to undertake unscheduled tasks,” Ms Henderson told Australian Ageing Agenda.

In the survey, staff cited lack of staff, complexity of resident needs, inadequate skill mix of nursing and care work staff and unbalanced resident allocations as reasons care was missed.

Staff members were delivering care to more residents, which meant they had less time with each resident to complete care tasks, she said.

Another reason for missed care was changes in staff at the facilities, she said.

Ms Henderson said privately owned facilities were replacing enrolled nurses with care workers and employing recently graduated registered nurses over more experienced registered nurses.

The levels of missed care may also be affected by funding changes, she said.

“Recent changes to aged care funding have shifted some burden of funding aged care to the user of services,” Ms Henderson said.

Implementing mandated staffing levels may assist with the issue of missed care among aged care residents across all facilities, she said.

“At the moment there are no mandated staffing levels for residential aged care with the standards only stipulating that adequate staffing be provided. This allows aged care facilities to reduce running costs through cutting staffing levels.

“Given that lack of staff was the most commonly cited reason for missed care, the establishment of mandated staff levels may counter this,” Ms Henderson said.

Access the paper, The impact of facility ownership on nurses’ and care workers’ perceptions of missed care in Australian residential aged care here.

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5 Responses to Missed care worse in private sector, study finds

  1. Pam September 14, 2018 at 11:51 am #

    Aged care facilities owned and operated by the Queensland Government receive the same ACFI funding and client contributions as all not-for-profit and for-profit RACFs elsewhere in Australia BUT they then receive tens of millions of Queensland taxpayer dollars EXTRA to pay for the increased staffing levels due to their ‘mandated levels’. Other States do the same, none of their RACFs operate just of the funding available under the Aged Care Act which the ‘private’ sector has to. Mandated staff levels of the kind that exist in state government run Residential Aged Care Facilities can happen because state taxpayers unknowingly pay for a services that is the Federal Government’s responsibility, and the client’s responsibility.

  2. Bemused September 14, 2018 at 11:52 am #

    A survey of staff does not seem to be a valid scientifically based study – simply a perception

  3. Kelly September 16, 2018 at 7:36 pm #

    How many studies need to be done to get any changes to staff levels This study is saying the same old thing. No one is listening.

  4. Gail Miller September 17, 2018 at 11:33 am #

    “… no mandated staffing levels for residential aged care … standards stipulating that adequate staffing be provided … allows aged care facilities to reduce running costs through cutting staffing levels.”

    Precisely the reason we saw the quality of care declinein my parents very reputable Aged Care Home in Adelaide.

    Have the decision makers ever watched what a Carer does on an shift in an Aged Care Home? Aged Care staff need to be paid and valued more than a person in a ‘white collar’ role for what they do.

  5. Dismayed September 19, 2018 at 10:31 am #

    Mandated ratios in aged care have been touted for as long as can be remembered. To have mandated ratios there needs to be an availability of trained and competent workers. Many training organisations, including TAFEs are churning out workers who do not understand the vulnerability of the people that they care for nor the need to follow the care needs and schedules of residents. Many short cuts are implemented as better care and yet devalue to dignity and individuality of residents eg continence aids where the person is “put in a pad” and left without intervention for various reasons including excuses such as “she has an eight hour pad it isn’t time for her to be checked yet”. Funding methods incentivise this and mandated ratios will not fix it. there are many other examples that can be cited.

    Government needs to examine the draw off of funds to the Corporate layers of the aged care sector. Most facilities have four or five layers of corporate duplication drawing hundreds of thousands of dollars away from the resident care which forms the base layer of funding. A simple solution may be to cap the Corporate draw off at a percentage and stop the duplication of layers of compliance and force funding back to where it should be in resident services.

    Carers work extremely hard to meet the ongoing needs of residents. They are often fatigued due to the demands of the meeting service funding requirements, compliance and (often) lastly, the needs of the resident.

    It is time to put the resident and their care and support needs first, limit the corporate funding updraft, reassess the funding model ( align it to a goal based model as available to NDIS participants) and move aged care to a meaningful model

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