Aged care peak bodies have added in principle support for the minimum staff time standards Counsel Assisting proposed in final submissions to the royal commission but have voiced concerns over how it will be funded.
Among the 124 recommendations is a proposal for providers to meet a minimum staff time quality and safety standard, where providers can select an appropriate skills mix for delivering high quality care according to their care model.
The standard requires at least 215 minutes of care per resident per day provided by registered nurses, enrolled nurses and personal care workers with at least 36 of these minutes provided by a registered nurse.
In feedback submissions, aged care peak bodies gave their “in principle” support to the recommendation, which Counsel Assisting proposed to start from 1 July 2022, but also raised some concerns.
Leading Age Services Australia said highlighted an issue with how would be set for this measure.
“We are concerned that funding for this measure will be set on the basis of the lowest cost combination of staffing that can meet the requirement, preventing providers from employing more care staff when that is more appropriate for resident needs and preferences,” LASA said in its submission.
As some providers already comply with this standard, there should be funding mechanisms in place to support and reward these providers before it becomes mandatory, LASA said.
“Funding support for voluntary compliance will also be vital to providers being able to comply with the proposed requirements by the proposed deadline,” it said.
LASA said it was positive that Counsel Assisting suggested a mechanism for providers to apply to adjust staffing requirements. LASA called for a broader and more flexible test that allows variation where equal or better outcomes can be demonstrated.
Fellow aged care peak UnitingCare Australia echoed LASA’s call for greater variation of the mix.
“Consideration should be given to the range of staff classifications that can be considered for the purposes of meeting the minimum standard,” UnitingCare Australia said in its submission.
It provided the example of services with a greater need for peer support, psychological or other types of mental health expertise.
UnitingCare Australia said an uplift in staff time would require significantly more funding.
There needs to be a commitment to an appropriate funding model that covers the cost of the minimum in place before services can commit to employing, training and on-boarding staff, the peak said.
“Even with an additional $10 per bed per day, one of our facilities has estimated a shortfall of around $10,000 per bed per year if care time was uplifted from the current average to 215 minutes per person per day.”
ACSA says model needs Australian context
Aged and Community Services Australia said Quality care needed to be defined by government, quantified, priced and funded.
“Ultimately the introduction of an independent pricing authority will attend the role of setting an efficient price for staffing. Providers can then be held to staff to that level,” ACSA said in its submission.
ACSA said Counsel Assisting’s recommendation for a minimum of 215 staff minutes per resident per day is derived from the US Star-rating system introduced by Professor Kathy Eagar but focuses only on nursing and personal care staff.
“The original proposal included allied health and lifestyle staff taking into account care models. ACSA is supportive of the model as originally proposed, noting that the model would need some contextualisation to the Australian system,” it said.
Support for aged care system design
LASA said it supported the establishment of the Australian Aged Care Commission by 1 July 2023 while UnitingCare Australia and ACSA provided in principle support.
“Our position in terms of governance has never specified particular arrangements but has emphasised the importance of adequate funding and recruitment of appropriately skilled workforce to ensure that the regulation of aged care contributes to continuous improvement of the sector, enables a range of responses to performance measurement and risk-based approaches to external monitoring of outcomes for service users,” UnitingCare Australia said.
ACSA said the proposed commission achieved system governance aims of independence and transparency but was unclear on responsibility and accountability.
“The proposal picks up functions from the [health] department and the current regulator and creates a range of new bodies to support the system. Establishing these new bodies will require significant cost, effort and time required. There are pressing issues in aged care that need fixing now and the creation of new bodies, even with interim implementation arrangements suggested, runs the risk of slowing down the process,” ACSA said.
The royal commission is due to hand its final report on February 26.
View the full submissions here: