Call for skills and skills-mix modelling in aged care

Staffing levels and a skills mix that allow for time to be spent on clinical and care tasks that respect the holistic needs of aged care residents must be prioritised, writes Adjunct Professor Kylie Ward.

The care we expect for our loved ones as they grow older may not always be the care they receive within aged care settings, including residential aged care facilities.

The Australian public has recently been exposed to a raft of stories of less than acceptable care practices and the Royal Commission into Aged Care Quality and Safety is now leading an investigation into these claims.

One of the key issues raised during the royal commission has been how restricted nurses are in the time they can spend providing clinical care to residents due to other demands. Having spent a considerable amount of time in the aged care sector as a nurse, I can certainly attest to this.

As a nurse early in my career, I was honoured to work in aged care and spend time with older people from different backgrounds. I valued the time I spent with each resident, not to mention the immense fulfilment I felt after each shift.

However, on a daily basis I was frustrated by the many tasks such as paperwork that took me away from those who needed my clinical expertise and attention.

Recent research released by the quality agency, now called the Aged Care Quality and Safety Commission, found the top concern for aged care residents is not having staff available to talk to when feeling sad or worried.

Nurses are highly skilled and proficient at delivering care, however it is the quality of humanness – how we as nurses humanise the health system by listening, advising and treating people with dignity and kindness – that we must be able to provide to the most vulnerable in our community.

This humanness makes time with patients the most precious resource within our health system. Above any other health professional, nurses spend the most time with residents and their families. To give a nurse and a patient a few extra moments will ensure that care is provided holistically, that we can focus on an individual’s physical, mental and emotional health.

In 2016, the National Aged Care Workforce Census and Survey (NACWCS) found that 70 per cent of the residential aged care workforce was made up of personal care attendants, while the number of registered nurses had fallen from 21 per cent in 2003 to approximately 14.9 per cent.

As much as personal care workers must be valued and recognised for their delivery of care across all health sectors, they should not be asked to replace our registered and regulated clinical workforce.

The Australian College of Nursing supports the Aged Care Workforce Strategy Taskforce’s report A matter of care – a strategy for Australia’s aged care workforce, which was released last year. Instead of recommending quick fixes, the taskforce focused on a strategic approach to workforce planning and skills-mix modelling.

Across the country, nurses have told us that appropriate staffing levels, skills and skills-mix requirements must be addressed to ensure that residents in aged care are protected.

Patient care is very complex and unpredictable, especially for our vulnerable elderly. Best practice does not simply require three nurses on a shift, but the right three nurses who have the appropriate knowledge and skills to ensure safe and high-quality care.

If we are serious about solving these systemic issues, providing staffing levels that allow for time to be spent on clinical and care tasks that respect the whole-person needs of older Australians must be prioritised.

Adjunct Professor Kylie Ward is the CEO of the Australian College of Nursing (ACN).

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