Webinar outlines providers’ RN responsibilities

Residential aged care providers who are genuinely struggling to recruit registered nurses but are doing their best to comply with the mandatory ruling of having an RN onsite 24/7 will not face “enforcement action”, the head of the sector’s regulatory body has said. 

Aged Care Quality and Safety Commissioner Janet Anderson was speaking during last week’s webinar hosted by the Aged Care Quality and Safety Commission to assist providers in understanding their new workforce responsibilities, which include – from 1 July – having an RN on the ground at all times.

Ms Anderson opened the hour-long webinar by addressing the “alarmist commentary” that has surrounded the issue of 24/7 nurses and reassuring providers that if they could demonstrate that “genuine ongoing efforts” were being made to recruit RNs while still delivering safe, quality care that meets residents’ clinical needs, “it is unlikely we would take enforcement action,” she said.

Instead, the commission would monitor providers’ recruitment efforts. The commission would only engage with a service provider, added Ms Anderson, if residents were found to be at risk of harm.

While the commissioner told providers “they are expected to strive for compliance,” she acknowledged concerns about what would happen if they failed to recruit enough registered nurses and were not eligible for exemption.

“If a non-exempt service is struggling to achieve around-the-clock cover, then the commission will look at your particular situation before deciding what to do. And in all circumstances our approach to regulating these responsibilities will be fair and sensible.”

She asked providers to “take a deep breath” and approach the new regulations “as people with good intent who share the same goal: ensuring that older people in this country receive safe, quality aged care that meets their needs and enables them to experience the best possible quality of life.”

Ms Anderson told the online audience that 24/7 nurses was a key recommendation of the aged care royal commission. “The royal commission enforced the importance of having the right number and mix and qualifications of staff to deliver safe, quality care. So this is all about boosting people’s trust and confidence in the performance of the aged care system,” she said.

Ms Anderson was joined on the webinar – entitled Regulation of workforce responsibilities – by Mark Richardson, assistant secretary, residential aged care reform at the Department of Health and Aged Care; Peter Edwards, executive director, compliance and financial and prudential regulation at the Aged Care Quality and Safety Commission; and Dr Melanie Worth, the commission’s chief clinical advisor. 

Exemptions, available funding, ENs

Mr Richardson said, while all aged care homes were obliged to have an RN on site 24/7 by 1 July, the department “also recognise that external pressures can present challenges to providers in attracting and retaining a suitably skilled and competent workforce – particularly in rural and remote areas.”

Outlining the facilities that can claim exemption status –  those located in MMM 5 to 7 areas of the country under the Modified Monash Model – Mr Richardson said: “We expect that around 5 per cent of residential aged care facilities may be able to receive an exemption if they meet the legislated criteria.”

These include facilities that have fewer than 30 beds and have alternative clinical care arrangements in place.

Facilities that fit the criteria have already been contacted by government, said Mr Richardson. Providers whose sites are eligible for exemption, but have not been contacted by the department, are encouraged to email exemptions@health.gov.au. 

The exemption criteria applies only to the 2023-24 financial year. “Government will use experiences from this exemption process to inform any future potential exemption framework,” said Mr Richardson. 

He also said there was a funding pot of $473 million to support aged care homes with up to 60 residents meet the cost of providing 24/7 RN care.

Mr Richardson also told providers that, while only RNs could fill the 24/7 responsibility, “an experienced [enrolled nurse] to cover RN absences may make up a valuable part of a provider’s strategy to ensure the clinical care needs of their residents when an RN is not onsite and on duty.”

Care minutes, care needs, gap prediction

As well as 24/7 RNs, from 1 October, residential aged care providers will also be mandated to provide an average of 200 minutes of care per resident per day – including 40 minutes from a registered nurse.

The commission will decide whether the legislated clinical care needs are being met and each provider will be judged by its individual circumstances, said Mr Richardson. 

Mr Edwards told providers that the commission’s focus is to ensure that they deliver good quality, safe care that meets their residents’ needs. “So it goes without saying that having the right staff who can deliver the right type of care that is needed is what all these responsibilities are designed to deliver.”

The commission will know whether providers are delivering the appropriate care through their own reporting, said Mr Edwards. “You’re already reporting information about care minutes being delivered, and you’ll soon be required to report about 24/7 RN coverage gaps.”

Providers are expected to predict – where possible – gaps in RN coverage, said Dr Worth. “While you may not know that somebody is going to resign or become ill, you can anticipate that it might happen. It’s important to consider as many of the possible things that might happen as you can and to have a range of strategies that you can use to make sure that the clinical care needs of residents are met at all times.”

Following a Q and A session, Ms Anderson concluded the webinar by saying that the commission was conscious of the workforce pressures aged care providers faced, “particularly the further away you get from metropolitan areas – we’re not blind to those issues.”

However, Ms Anderson told providers they were expected to undertake and refine their workforce plans “in that context” so as to optimise opportunities to attract and retain RNs.

The webinar finished with Ms Anderson saying that, from 1 July the commission will seek to understand what providers are doing in order to meet their new responsibilities “and how you are doing everything possible to deliver a standard of care that your residents expect and deserve.”

Government will work with sector

Minister for Aged Care Anika Wells recently met with Ms Anderson to seek assurances about how the commission will be regulating 24/7 nursing and care minutes.

In a letter – posted on Twitter – Ms Wells said she welcomed the commission’s commitment to taking a fair and sensible approach to regulating the new requirements.

“In particular, I look forward to the commission implementing its stated approach that it will not initiate enforceable regulatory action where a provider can prove it is making ongoing efforts to comply and is effectively managing risks and providing safe and quality care to residents.”

The government will work with providers to implement the reforms, said Ms Wells, adding: “I am confident that providers, encouraged by the commission, will make utmost efforts to meet these new responsibilities and ensure the safety, dignity and wellbeing of older Australians living in residential aged care.”

In response, the CEO of the Aged & Community Care Providers Association Tom Symondson also took to Twitter, saying: “Glad to see a very clear message from both Anika Wells and the commission that providers will not be shut down for failing to meet 24/7 nursing where they can prove they are doing everything they can to comply but just can’t find the staff due to the workforce crisis.”

A shipshape transition

Meanwhile, Minister for Health and Aged Care Mark Butler addressed 24/7 RNs at a press conference at Parliament House in Canberra on Wednesday. Mr Butler told journalists he was unapologetic for taking a strong stance on the importance of nurses in aged care homes.

“When I talk to members of the public and point out to them there is no legal requirement for our nursing homes to have a nurse in it 24/7, people are shocked.”

The government, he said, is committed to the policy “and the vast bulk of aged care facilities will be able to comply, or already have an arrangement in place to have a registered nurse 24/7.”

Acknowledging that some of the sector may have difficulty complying with the requirement, Mr Butler said the government would be reasonable in its dealings with those providers who were struggling.

“We won’t be heavy-handed about it. We want to see all these facilities come through this wave of reforms that are designed to improve the care provided to our most vulnerable Australians well. We want to see them come through in shipshape.”

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