Lack of staff – both total nurses and carers on a shift and staffing skill mix – is the number one issue that aged care members bring to ANMF (Vic Branch), Assistant Secretary Paul Gilbert told the aged care royal commission.
In his testimony to the royal commission’s 16 October hearing on workforce issues, Mr Gilbert said nurses have a professional obligations to delegate care only to people they have assessed as being competent.
But registered nurses often don’t have the staff numbers or the right staffing skill mix for safe delegation to occur.
Over 85 per cent of facilities operated by aged care networks have enterprise agreements requiring 24/7 registered nurse staffing, usually with a requirement for a director of nursing. But as facilities have grown larger, having a sole registered nurse on hand is ‘clearly insufficient’, Mr Gilbert said.
Only about 60 per cent of stand-alone aged care facility agreements included a requirement for 24/7 registered nurse staffing.
Staffing ratios in Victorian public aged care homes are fixed under the Safe Patient Care Act 2015 but are not within private aged care. However, ANMF had been successful in negotiating staffing ratios with three aged care homes across the large private and not-for-profit aged care sector. These are TLC and Benetas aged care providers, and the stand-alone Ballan and District Health and Care.
Staff to resident ratios with other private aged care providers had been ‘an impossible thing to achieve in bargaining’, Mr Gilbert said.
Private aged care already has ‘blunt’ ratios
In a written statement to the royal commission, Mr Gilbert said he was familiar with the employer line that ‘ratios are a blunt instrument’. But the reality was that most employers already operate staff to resident ratios.
Rather than offer flexibility for adjustment to suit residents’ needs, the staff to resident ratios within the private sector only vary to suit the employer, Mr Gilbert said.
‘There is no science to the number of staff that employers provide now, in my opinion,’ Mr Gilbert added. ‘Rather it is at best informed by industry comparisons, or at worst, the least that they can survive with, without coming to grief in the media or with the regulator.’ In his verbal evidence Mr Gilbert referred to the Stewart Brown report that providers use to compare how much they spend on direct care, and cut hours if they are above an industry average.
Staffing shifts were also formulated to suit the employer rather than residents, Mr Gilbert said. A staff of five on a day shift could drop to three by 1pm, which also makes it hard for personal care workers to make a decent wage.
Mr Gilbert’s evidence is available in transcript or video formats at the Royal Commission into Aged Care Quality and Safety website.