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Australian-first survey shows sector in crisis


Residential aged care staff are still struggling to manage clients with dementia, despite increased research available on the subject, due to a simple lack of time and resources.

The three most pressing issues facing residential aged care services in Australia remain the same as they have for decades: workforce inadequacies, lack of funding and challenges managing residents with dementia, revealed a survey among services in Victoria, which authors say reflects literature on the country as a whole.

The overwhelming issues around workforce were not a surprise for survey co-author Jo-Anne Rayner, but she told Australian Ageing Agenda she did not expect the management of responsive behaviours to be such a pressing clinical issue.

Jo-Anne Rayner

“I was surprised at this one because there is a lot of information and research out there on dementia at both a state and federal level and through organisations such as Dementia Australia,” said Dr Rayner, a senior research fellow at La Trobe University’s Australian Centre for Evidenced Based Aged Care.

“But I think the translation of that research is the problem. I don’t think nurses and personal care workers in aged care have the time to actually read this information and see what evidence is out there.

“And that’s down to a lack of staff and a lack of funding, so all three issues highlighted in the survey are inter-related.”

The survey was the first in Australia to look at research priorities in residential aged care. All 754 Victorian residential aged care facilities were invited to list the three most important areas where they would like more research, with 162 participating.

Findings highlight the urgent need for workforce reform, including improved nurse-to-resident ratios and wage parity with other sectors, and adequate funding to ensure this happens.

Ms Rayner said while residential aged care is becoming more complex and challenging, the proportion of registered nurses is falling and personal care workers, who provide the bulk of direct care, are inadequately trained.

“If we’re not committed to providing people with the ongoing education and training to look after people who have complex needs then we’re going to end up with problems continuing,” she said.

“Residents are older, they’re frailer and more of them have dementia. I think we need to acknowledge that aged care is a specialist area these days; most residents require 24-hour care and support.”

In this high-pressure environment, it is little wonder responsive behaviours among residents with dementia are problematic, she said.

“If you’re trying to look after elderly people who have multiple chronic diseases, including dementia, you’d can’t rush them; you need time. But staff are continually stretched to get the work done. They can’t sit down and talk with residents.”

Additional funding could provide meaningful activities for those with dementia, as well as higher numbers of experienced staff, the research found.

Even if they could afford more experienced staff, the sector is having trouble attracting them, particularly in regional areas. This, according to the survey, was down to the poor image of a sector blighted by low wages, an ageing workforce, and less-than-glamorous tasks, demanding workloads and high stress levels.

“We really are an ageist society,” said Ms Rayner. “Childcare services is much more emotive. What is being done to entice younger nurses to aged care?”

Access the research, which was published in the Australasian Journal on Ageing, here.

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9 Responses to Australian-first survey shows sector in crisis

  1. Adrienne June 14, 2019 at 2:22 pm #

    Hello, good research. But it is up to boards and CEOs to review the research, accept it and commit to spending on the strategies that we know work to care for people with dementia.

  2. Janet Pearce June 15, 2019 at 8:08 am #

    As a dementia consultant I wrote recommendations with evidence based strategies to assist staff to manage and modify challenging behavior for people living with dementia in residential care. When seeking feedback on the effectiveness of individualised recommendations the reply from staff was often “I’m sorry, I just haven’t had time to read it yet!”

  3. Annabelle June 15, 2019 at 8:58 am #

    I have worked in aged care for years and have witnessed the crisis in aged care expanding. The residents are living longer, have complex needs, fewer staff to care for them, not enough registered nurses and staff under paid. No matter what is said the organisations want to make money. Be them private or not for profit. It is very hard work and stressful as not enough time for staff to provide the care required.

  4. wendy June 16, 2019 at 6:11 am #

    We really are struggling; as a RN in Aged Care, I feel like we are on the stormy seas without a life boat.

  5. Robyn D June 18, 2019 at 11:08 am #

    Well done , great research, those on the front line and managers know all of this struggle daily. The quality agency staff need to read this, as some of the people they churn out have no idea on these issues in my experience, often deer in the headlights. Let’s hope studies like these get to the Royal Commission and form some reform for change, it will come from government decisions on funding, not CEOs and Boards who already struggle to make any profits at the moment, most RNs are being enticed into the hospitals which are expanding, are well funded and staffed and have nowhere near the workloads, the care workers are becoming more and more from overseas, as a means to an end for permanent residency, lovely gentle people of course, who come from a non ageist society where the elderly are the wise and respected ones.

  6. Anonymous June 20, 2019 at 5:51 pm #

    Great article, very factual in capturing the true picture on the front line of care in the sector. The answer always is money, to provide higher staffing levels, resources such as outside people coming in to run sessions, equipment to assist in the lifestyle domain. The number of people with dementia is increasing, and the hospitals expect the care homes to manage their aggressive residents, not offload them to the hospitals, but often there is no choice and the safety of staff and residents is paramount, as is covering yourself and the company from litigation or complaints from family, which can bog you down and red flag you. There are some wonderful people working in this industry, and doing their best every day across the country, you don’t get to hear much about them. The burn and churn rate in residential aged care is worrying, the amount of overseas workers now filling roles is massive, often the majority of RNs are 457 visa holders. Managers move on after a year or two due often to burnout and exhaustion from being bogged down in complaints management and compliance burdens. Often the expectations from families and residents is 5 star, but the reality is that you can only offer 3 star due to underfunding from Govt. You only need to look at job sites such as SEEK in aged care roles across the country to see the amount of jobs available, Nursing Agencies thankfully are filling the void, which is getting larger. Where will the money come from? The studies show that many providers are not making a profit. You wouldn’t run a fish n chip shop and not make a profit, not for too long anyway. Let’s hope some change comes soon, as the ship is certainly on stormy seas without a lifeboat in sight.

  7. Ruth A Wagstaff June 21, 2019 at 11:06 am #

    A good deal of the issue is the length of time it takes research to filter to the providers. I have heard of figure such as 17 years from the initial publication of information to the front line.

    Why so long?
    Some research topics need to come from the client and services who are the primary target groups of research.
    Doing a literature search and researching to fill a gap of knowledge in the literature may satisfy academic question but stakeholders may not get the connection between the gap and their own questions.
    Perhaps the issue is that the stakeholder has a distrust of science and researchers.

    I have no doubt that there must be more dialogue between science and stakeholders. Collaboration that builds trust is a must. Another often overlooked issue is learning the language of each other to ensure that scientist and stakeholder has a genuine understanding of each others motives, goals, and concerns. Without this understanding, the research will continue to expand, but the industry as a whole will remain distant from research findings and not apply the findings to the all important coal front of care.

  8. Jane Rankin June 24, 2019 at 4:02 pm #

    The challenges of attracting nurses, especially young nurses into aged care is a big challenge, wage parity and being able to sell a career in aged care are big factors. Recently in Victoria there were third year student nurses criticised in nursing homes by Aged Care auditors while on placement during spot audits for doing general observations on residents without an RN looking over their shoulders. They explained that all of their hospital placements involved taking obs on their own and reporting the results back to their RN, to no avail, the Agency was of the opinion that this should not occur in aged care. This sort of backward attitude just puts young nurses off, they all just head to the hospitals, or aged care until they get the call up for a hospital position. The Quality Agency needs to be on the same page if it is ever going to work.

  9. Liz Turner July 3, 2019 at 11:50 am #

    I didn’t want five star care for my mother, just good care. I have moved her three times and have finally found a wonderful facility, so it is possible

    Too few staff, corners being cut to save money, and poor management was what we experienced. I had nothing but praise for direct care staff though, as anyone could see they were underqualified, undervalued and overworked.

    Hopefully the Royal Commission results in some change, but I have my doubts.

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