The federal government’s introduction of new workforce requirements for residential aged care was “largely effective”, says an independent report.
Published Monday by the office of the Auditor-General, the report, Design and Early Implementation of Residential Aged Care Reforms, aimed to assess whether the Australian Government’s response to recommendation 86 of the royal commission – which called for minimum care time provided by registered nurses and personal care workers – was effective. The Auditor-General’s report found, generally, it was.
Indeed, as the report’s authors acknowledge, the government implemented the royal commission’s workforce recommendation 12 months earlier than called for.
From 1 July this year, aged care facilities have been required to have an RN onsite and on duty around-the-clock. As well, facilities are required to provide a minimum average of 200 care minutes per resident per day – including 40 minutes of RN time.
The report’s authors note – as of September 2023 – 88 per cent of aged care homes reported 24/7 RNs. During July to September, residents received an average of 199 care minutes per day – 39 minutes from an RN.
“The [Department of Health and Aged Care’s] implementation of the requirements through operational arrangements, legislation and IT systems was largely consistent with the government’s policy intent,” say the audit report’s authors.
They add: “Project management and governance arrangements for the new workforce measures were largely fit-for purpose.”
Nonetheless, while the 24/7 RN exemption process was found to be “consistent with government requirements” – RN exemptions apply to facilities located in rural or remote areas of the country and for sites with fewer than 30 beds – the assessment procedure was delayed. Meaning no exemption applications were approved prior to the mandatory deadline of 1 July 2023. Exemptions were only granted “over subsequent months” after the RN start date.
As well as designing and implementing 24/7 nursing and the mandatory care minute requirement effectively, the report found that the department provided “largely robust policy advice” on the staffing reforms.
The report also found that –“after initial delays” – the department and the Aged Care Quality and Safety Commission “were largely prepared” to monitor and enforce compliance with the new requirements.
However, the 87-page report lists some “minor non-conformances”. These include:
- the threshold for payment of the 24/7 RN supplement being lower than that agreed by government
- reporting of the 24/7 RN compliance not being integrated into facilities’ star ratings
- some care minute targets being lower than the royal commission recommended
- a slight delay in the deployment of IT systems to support public transparency
- inaccuracies in the calculation of care minute targets.
The audit report contains two recommendations for the department:
- ensure Risk Potential Assessment Tools are completed in accordance with government policy – particularly for policy proposals with a financial impact of $30 million
- establish evaluation plans for mandatory care minutes and 24/7 RNs.
Two recommendations were also directed at the commission:
- improve documentation of processes for preparing and disseminating intelligence briefs
- identify a method to assess the impact of care minute and 24/7 RN regulation on aged care quality outcomes.
Both the department and the commission agreed to the recommendations.
In response to the Auditor-General’s findings, the department replied: “It was pleasing to note that the design and early implementation of the Australian Government’s response to recommendation 86 of the Royal Commission into Aged Care Quality and Safety has been found to be largely effective, and that the department was largely effective at introducing new workforce requirements.”
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