Aged care is in crisis, and the core of the problem is too few staff to cater for residents properly

Nurse Sharon Lawrence says staff cuts in aged care mean the elderly are being dehumanised. She says they need mandatory staffing levels –as childcare has.

When nurse Sharon Lawrence realised she no longer had time to give the human touch to her aged-care residents, there was only one solution: start early and create the Cackle Club.

The regular get-together, where elderly people shared laughs and reminiscences over cake and pots of tea, became one of the highlights of her career.

It ended with COVID-19, but had only started because the 53-year-old enrolled nurse wanted the home to feel more than just a place where people waited to die.

“Unless you take the time to talk to them, and many carers don’t, they don’t feel like they’re real people any more,” Ms Lawrence says of the elderly residents. “I didn’t mind giving up my time because it gave them a bit of normalcy.”

Aged care is in crisis. Residents are dissatisfied, there is not enough staff, overuse of medication, poor quality food, assaults and inadequate funding – all of which have been highlighted before the Royal Commission into Aged Care Quality and Safety, which reports on February 26.

Ms Lawrence, who gave evidence to the royal commission in Adelaide, argues the key problem is that there are too few staff and not enough time – and that the current mix, with far fewer nurses, is wrong and must be fixed.

Childcare has mandatory staff levels and so should aged care, she says.

“We used to have a resident, and every day we’d put make-up on her, and do her hair,” Ms Lawrence recalls.

“We don’t have the time now to take that 15 minutes because I’ve got people who need to be showered, people saying ‘I need to get up’. And the staff have all been cut.”

Aged care nurse Sharon Lawrence at Largs Bay jetty. Picture: Mark Brake

The 300,000-strong Australian Nursing and Midwifery Federation is planning a national campaign in the wake of the royal commission’s findings, stepping up pressure for mandatory staff levels and ratios of nurses to unqualified care workers.

The union’s federal secretary, Annie Butler, says the sector needs 80,000 more direct carers nationally, and a doubling in the ratio of nurses. Registered nurses should make up 30 per cent, and enrolled nurses 20 per cent.

But nursing homes say they have felt the squeeze of inadequate government funding, and they have scaled back heavily on specialised staff – especially nurses.

The royal commission has been told lack of qualified staff is one of the core problems with aged care. The commission is expected to recommend a big reversal of the trend to dispense with nurses.

Its lawyers have already cited evidence showing that the number of registered nurses, the highest qualified, fell by 25 per cent between 2003 and 2016, so they made up just under 15 per cent of staff.

Enrolled nurses also fell from 14 per cent to 9 per cent in that period, and the numbers of care staff overall fell significantly. But the proportion of general care workers, who are less trained, rocketed from 56 per cent to 71 per cent.

The royal commission’s counsel assisting has warned that work once performed by nurses, physiotherapists and speech pathologists is now done by unqualified, unregistered, and in many cases untrained personal care workers.

“The little things that make them who they are, they’re not being done any more,” Ms Lawrence says of residents.

“Even just one extra staff member for four hours in the morning can make the difference with how your residents are, because the staff get stressed out because they’ve got so much work put on them, and the residents pick up on the stress.”

In evidence to the royal commission, she pointed to the danger of relying on “medication competent carers” to give drugs. Such carers have only had training of between four hours and two days, and have little idea of how to monitor for side-effects, even if they know what they might be.

“They don’t know what they are,” she says of the drugs. “And they don’t know what they do.”

Yet these carers have replaced enrolled nurses in some places, she says.

“I have seen the position of enrolled nurses disappear from some facilities altogether. I have seen the loss of registered nurses, some replaced by (less qualified) enrolled nurses or not replaced at all”.

While staff have been cut, residents are sicker. The government has emphasised keeping people in their own homes for as long as possible, so those who do enter a nursing home – typically in their 80s – are more frail.

Only 15 per cent are independently mobile, a third can’t move by themselves, 90 per cent need help showering, two-thirds need help eating and communicating, and 80 per cent need help toileting, the commission says.

The Royal Commission into Aged Care Quality and Safety reports on February 26. Pictured are Royal Commission Chair, the Honourable Tony Pagone QC, and Commissioner Lynelle Briggs AO. Picture: Arsineh Houspian

Ms Lawrence grew up with her grandparents and great-grandparents. Caring for elderly people has been “my passion”, she says. But it is not the passion of some of the for-profit businesses, she argues.

They are not driven by looking after older people, but making money, and “the less staff they have, the more money they make.” “There’s a lot of nursing homes who get away with saying, ‘we’ve got plenty of staff’,” she says. “But they’re top heavy with management staff who are clinical but don’t help out on the floor.”

She may be right: aged-care providers received $21.5bn from the Federal Government this financial year but do not, according to the royal commission, have to publicly account for what they spend it on. Ms Lawrence points out that aged-care facilities have no mandatory staff levels.

“We need mandated staffing levels in aged care; we need a mandated safe skills-mix in aged care,” she says.

It remains to be seen if the royal commissioners will agree.

Counsel assisting says there should be a requirement for registered nurses, enrolled nurses, and personal care workers to spend at least 215 minutes per resident per day on average, with at least 36 minutes from a registered nurse.

As well, there should be one registered nurse on-site every day for the main shifts, and by 2024, around the clock.

The Australian Nursing and Midwifery Federation is happy with the thrust but not the detail.

It proposes a five-year implementation plan with the workforce split into: 30 per cent registered nurses, 20 per cent enrolled nurses and 50 per cent other carers.

It also wants the average level of care in nursing homes to increase from what it says is an average of 2.8 hours per resident to 4.3 hours.

Factoring in a 10 per cent pay rise across the poorly paid sector, Ms Butler says the extra cost would be $5bn. But with offsets from fewer hospital admissions, more prod­uctivity and increased taxes. the actual cost would be $2.5bn.

But nursing homes insist they are already struggling to operate on current funding levels, with two-thirds this year claiming they are operating at a loss.

They insist that with the levels being pushed by the royal commission’s lawyers they will go broke without a big increase in federal funding.

 

Quality of care in decay, says MP

A wage rise for aged-care workers is desperately needed to fix the “broken” system and improve quality of care, says South Australian federal Labor MP Mark Butler.

Mr Butler said cutting wait times for home-care packages and improving nursing home standards, including through incentives to retain skilled staff, would be his top priorities as the Opposition’s new aged care and health spokesman.

SA has more than 10,500 people on the wait list for home-care packages, while wait times have blown out to about six months for a basic package and 31 months for a level 4 or high-care needs package.

“The workforce is the driver of quality,” Mr Butler said. “You need well-qualified people and you need enough of them.

“It is hard work, it’s physically hard, it’s emotionally taxing, people do it for the love of it, but it’s challenging work, it’s shift work. Being paid one of the lowest base rates in the community for some of the most important work is unsustainable.”

Mr Butler said it was vital to fix the system in the next few years before the demand for services skyrocketed when Baby Boomers began entering aged care.

Older South Australians were already languishing for months on wait lists because the Federal Government had “abjectly failed to keep up with the growing demand for quality home care,” he said.

The aged care royal commission is due to report its findings next week.

The sector already estimates it could cost $20bn to fix the system.

Mr Butler said he would wait for the report, but believed there needed to be more transparency and accountability in the system, reforms around skilling and retaining workers, and much more done to tackle wait lists and standards.

The COVID-19 vaccine rollout will be his other top priority for 2021.

Mr Butler said the public needed more details about the rollout from Prime Minister Scott Morrison and Health Minister Greg Hunt, although he backed the education campaign initially focusing on encouraging Australians to get the jab.

“There is a lot being asked of older Australians, who have been going to the same GP for decades and now will likely have to visit an unfamiliar doctor, and they don’t have answers,” he said.

“GPs who want the best for their patients have no answers. With the vaccine due to start on Monday we need clear and direct answers not a last minute scramble.”

– Claire Bickers