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RC recommends 4-star staffing model


Aged care providers should be required to meet a prescribed amount of daily care, registered nurse and allied health time per resident under a minimum staff-to-resident ratio model, say Counsel Assisting the royal commission.

Senior Counsel Assisting Peter Rozen presented 10 workforce recommendations in a submission to the aged care royal commissioners at a hearing in Adelaide on Friday proposing a registered nurse on site at all times and more RNs and nurse practitioners (read our backgrounder here).

In addition to mandated staffing in residential aged care, the recommendations cover quarterly publishing of facility staffing levels, a registration scheme for personal care workers and funding to implement the workforce taskforce recommendations.

Counsel Assisting have proposed mandated staff ratios to address staffing and skills mix in aged care facilities.

“The ratio should be set at the level that is necessary to provide high-quality and safe care to the residents in its facility,” Mr Rozen said in the submission.

The proposal is based on:

  • achieving a 4-star rating under an adjusted US-staffing model outlined in the Australian Health Services Research Institute report produced for the royal commission
  • an average case-mixed total of between 186 and 265 care minutes per resident per day from registered and enrolled nurses and personal care workers
  • a daily minimum of 30 minutes of registered nurse care time per resident
  • at least 22 minutes of allied health care per resident per day.

High quality needs 4 stars

The AHSRI report found that most Australian aged care homes currently provided a two-star level of staffing under the US system (58 per cent), which translates to unacceptable levels of staffing.

Peter Rozen

Under the research-based system, several different combinations of nursing and care staff can achieve a particular star rating.

Mr Rozen said they have recommended 4 stars because that is the staffing level recommended to achieve high-quality care.

Under the model, there are six combinations of registered nurse minutes and total care minutes that will achieve 4 stars, which gives providers a level of flexibility in how they reach the mandatory minimum staffing levels, he said.

For example, a home could achieve a 4-star staffing rating with enough staff to provide each resident with 31 minutes of care from a registered nurse and at least 3 hours and 53 minutes of care by other staff, such as personal care workers, every day.

Alternatively a home could achieve 4 stars by decreasing the total daily care time to 3 hours and 6 minutes provided at least 63 minutes is provided by registered nurses, according to the submission.

The additional requirement for minimum levels of allied health care addresses an identified weakness of the US system.

Implement transparency, taskforce recommendations

Counsel Assisting have also recommended aged care providers be required to provide quarterly staffing levels for registered and enrolled nurses, allied health and other care staff by shift, which the Department of Health should publish at a service level.

They have also called for the Australian Government work in partnership with the Aged Care Workforce Industry Council to implement the workforce taskforce recommendation in the report A Matter of Care (read more here).

They recommend the government provide the financial and practical support necessary to implement the recommendations.

Counsel Assisting have recommended personal care workers hold a Certificate III in Individual Support (Ageing) as minimum mandatory qualification required for performing paid work in residential and home aged care and respite, restorative and palliative care.

As AAA reported on Friday, Counsel Assisting have also called for a registration scheme for personal care workers that includes mandatory minimum qualifications, scope to require qualifications be obtained from certain approved training providers and ongoing training and continuing professional development requirements.

The registration scheme should also ensure minimum levels of English language proficiency, criminal history screening requirements and a code of conduct and power for the registering body to investigate complaints, according to the submission.

Other recommendations

  • establish Australian government-funded scholarship programs to increase the supply of nurse practitioners
  • review the skills needed by general practitioner to enable them to meet the anticipated future aged care needs of Australians
  • make geriatric medicine a core element of undergraduate medical curriculum and placement in a geriatric setting a requirement of registration
  • include geriatric medicine and gerontology care in nursing accreditation standards
  • ongoing research funded by the Department of Health to estimate the short, medium and long term demand for geriatric services
  • the Commonwealth should lead aged care sector workforce planning including:
    • long-term workforce modelling on the supply and demand of the workforce
    • overall management of the training pipeline
    • improvements in labour productivity
    • appropriate national distribution of the workforce
    • facilitating the migration of workers.

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7 Responses to RC recommends 4-star staffing model

  1. Pam February 26, 2020 at 3:01 pm #

    Where do the billions of extra dollars come from to pay for this staffing model?

  2. Anne February 26, 2020 at 6:16 pm #

    There is no way nursing homes will pay for registered nurses to spend 31 minutes with each resident. My mother is in bupa, they have 101 residents. They have minimal RN cover.

  3. Carolyn Tranter March 3, 2020 at 12:02 pm #

    Are there sufficient RNs out there who want to work in aged care and what programs are available to support those new to the industry?

  4. Helen March 3, 2020 at 3:30 pm #

    There needs to be a total review of MBS items, collaborative agreements, continuing care medication arrangements and review of what tests a NP can arrange for Nurse Practitioners to be viable

  5. Bronwyn baker March 5, 2020 at 7:03 pm #

    It’s not nursing care that most aged care people need …. it is care from people who care, staff who know them , staff who see them regularly and are happy to chat and engage them in things they like to do. Nursing care is overrated …. We need staff educated in person centred care and it’s not rocket science. Allow staff to have the time they need with their residents and the quality of care easily goes up as most workers are very caring.

  6. Cheryl March 5, 2020 at 11:25 pm #

    Where are all these RNs going to come from? Will they be specialised in Aged Care?

  7. J March 8, 2020 at 3:12 pm #

    Who is going to pay for all this extra staff. I roughly calculate 1 extra RN per shift and 1 extra PCA per 15 residents for 3 hours of care per resident.

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