Staff Ratios – Royal Commission Research Paper

I have read with interest late last week the very freshly released Royal Commission research paper (1) into aged care staffing requirements, and the shortfall in funding needed to raise the staffing mix and levels to appropriately care for the average residential aged care service consumer.  

The following excerpt from the recommendations paints a picture of what residents, families, advocates, and indeed some providers have been saying for some time – the level of service provision (staffing) in residential aged care in Australia is substandard.  

My conclusion is that because that level of provision is so strongly associated with the operating funding mechanism, the funding mechanism for care is equally substandard:

“more than half (57.6%) of Australian residents receive care in aged care homes that have unacceptable levels of staffing (1 and 2 stars).

To bring staffing levels up to 3 stars would require an increase of 37.3% more staff hours in those facilities. This translates into an additional of 20% in total care staff hours across Australia.

We have not limited our analysis to determining the additional resources required to bring facilities up to an acceptable level. We have also provided an indication of the additional resource requirements that are required to deliver staffing levels consistent with good practice and best practice care.

For all residents to receive at least 4 stars (what we consider good practice) requires an overall increase of 37.2% in total care staffing while 5 stars (best practice) care would require an overall increase of 49.4% in total care staffing.” (2)

As you are probably well aware, I am the CEO of Braemar Presbyterian Care (“Braemar”). To put our services into perspective, since I joined Braemar in March 2017 we have been increasing hours per resident per day to a level that is close to the current national average as recorded by the StewartBrown benchmarking service (3) reporting.  And, as far as is reasonable, we have been improving our subsidy income to match the staffing.  But that recurrent income is not enough.  

According to this research paper, prepared for the Royal Commission into Aged Care Quality and Safety, less than 3 star level of staffing is unacceptable, while a 4 star staffing is good practice, and 5 star staffing is best practice.  Yet 57.6% of residents receive less than 3 star (unacceptable) staffing and only 1.4% receive best practice staffing.

How is this translated into the care of our elders? 

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Shaky Foundation: Where is residential care today? 

I have been tracking various residential aged care data and some interesting comparison figures for two decades now since the Aged Care Act came into being in 1997.Please allow me to say right upfront – collecting relevant and appropriate data from indices can be difficult and not always truly comparable.

The data represented below is purely to make us think, and perhaps identify for providers at least, why it seems to have become so much more difficult to maintain a high quality residential aged care service today to people with more pressing multiple morbidities than ever before.

Clearly, by comparison, our funding foundation has worsened over the past twenty or so years.

Residential Aged Care Comparators:

Some description of the various indices follows:

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Reflections

In late January and early February 2018 I had the privilege of joining the Global Conference on Integrated Care (“GCIC”) in Singapore.  I am delighted to say that for me this was the most beneficial conference that I have attended since my re-connection to the aged care sector in August 2016.

Every nation represented at the Conference shared information about their significantly growing healthcare budget and rapidly ageing population. All nations have health and aged care systems that were created for a previous generation. They are not designed for the massive ageing population growth that require more and more health, social and aged care services.

As often as I remind others of the difficulties aged care providers, their workforce and clients are confronted with, I remind myself that we belong to a bigger system of health and social care provision.

Many parts of that system attract what seems to us, by comparison, to be outrageous funding.  Maintenance care only in a hospital costs approximately $1,200 per day.  A day of care in an intensive care unit costs $6,000 plus per day.  That is not to say of course that these services are not important and desperately needed.

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Direction of Australian Aged Care?

Hi Folks,

I am about to board a plane for Singapore where this week I will be speaking at the GCIC 2018 conference on integrated care.

My topic will look at where the industry may go next in its clinical governance responsibilities. I thought this was interesting to look at twenty years on from the introduction of the Aged Care Act in 1997.

I will share my full paper next week and explore some further ideas following the conference. In the Essay, I have strived to briefly describe the history of residential aged care in Australia and show how economic drivers that largely determine the funding of care may also be diminishing the clinical appropriateness of care. This can place care recipients, providers, and program funders alike potentially at risk of failure of service in financially constrained times.

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Unfair Expectations?

I recently chaired an afternoon session for a “Law in Aged Care” seminar in Perth.  It was a very useful day’s focus on the myriad of interaction that aged care providers have with the law daily.  There can be matters associated with town planning, local government, occupational health and safety, fair work, accreditation and liability issues, and that might be just before morning tea …

In October 2017, the residential aged care sector reaches twenty years since the enactment of the Aged Care Act 1997 (Cth).  As I recall, for Western Australians it started on Monday 1 October being a public holiday Monday.  The then new Act was a mighty and useful change from the Aged and Disabled Persons Homes Act and the Health Act.  Whilst it has not all been plain sailing the Act pertaining specifically to aged care has, in my view, served Australia well.

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