Reconceptualising residential aged care from an institution to a home has inadvertently led to today’s less clinically skilled and oriented workforce, an expert tells the aged care royal commission.
This week’s hearing of the Royal Commission into Aged Care Quality and Safety, which kicked off in Melbourne on Monday, is focusing on the most popular issue raised so far – workforce.
In opening statements Senior Counsel Assisting Peter Rozen told the hearing that more than half of the 6,631 submissions the commission has received raised concerns about workforce related issues.
Around 85 per cent of the 296 witnesses who have appeared during the commission’s 55 days of hearings to date gave evidence about workforce issues, he said.
Mr Rozen said that included 113 witnesses providing their perspectives of working in aged care and whose evidence identified the following challenges:
- inadequate numbers and continuity of staff
- adequacy and relevance of training and education
- low pay and limited career paths.
Professor Kathy Eager, director of the Australian Health Services Research Institute at the University of Wollongong, which has been undertaking the government-commissioned Resource Utilisation and Classification Study and related work and trials (read more here).
Professor Eager said the philosophical repositioning to describe residential aged care as a person’s home with a wellness and social approach, which came with the Aged Care Act 1997, has inadvertently encouraged the development of a less-skilled workforce.
“If I go back 20 years, homes were criticised because they were institutional, and this was a whole policy shift to say let’s move away from an institutional model and feel and make them more homely.
“But I don’t think anyone ever intended that you would move away from a clinically competent model towards more of an unskilled model, but that is actually what’s happened,” Professor Eager told the hearing.
Professor Eager said it was possible to have – and residents had a right to – an environmentally friendly place for residents to receive socially engaged and clinically competent care at the same time.
Australian staffing levels compare poorly
Professor Eager also gave evidence about how poorly Australian residential aged care staffing levels compared with international and national benchmarks, drawing on the findings of a research report commissioned by the royal commission that she co-authored.
The research found that the United States’ five-star rating scheme is the best system available to evaluate staffing levels. It is based on the amount of nurse and personal carer time per resident and adjusted for differences in residents’ care needs so that homes can be compared against each other.
Professor Eager and her fellow authors found that one or two stars represent unacceptable levels of staffing, three stars is acceptable and the bare minimum, four stars is good, and five stars is best practice.
Professor Eager told the hearing that Australian homes were clustered much more into 1, 2 and three-star ratings compared to the Americans, which were much more evenly spread.
They found that 58 per cent of all aged care residents are in facilities with staffing levels that would be rated one or two stars in the US system (read more here).
She told the hearing that an important feature of the system is that there are different combinations to get to each rating.
“We have said that three stars is the bare minimum for adequate care. There are actually nine combinations that get you to three-star and this is really important because one of the arguments against ratios has been that this is a blunt instrument with a one-size-fits all approach.
“This sort of system, which is more sophisticated, allows for homes to have a quite different mix of staff in each home, depending on the unique needs of their resident,” she said.
Read also from this week’s hearing
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