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‘Staffing levels linked to quality of care’: aged care royal commission final report

‘Staffing levels linked to quality of care’: aged care royal commission final report

Aged care royal commission links care hours to quality of care

‘The evidence is compelling that overall staffing levels in aged care are linked to quality of care, and that registered nurse numbers are particularly important’, states the long-awaited aged care royal commission final report.

After two years of hearing evidence from aged care residents and their families, nurses, personal care workers and organisations such as ANMF, the royal commissioners, the Honourable Tony Pagone QC and Lynelle Briggs AO, released their 1000-page final report on 1 March.

ANMF called upon the Morrison Government to urgently respond to the Royal Commission into Aged Care Quality and Safety’s recognition that staffing levels in aged care homes are too low, and to introduce mandated ratios and skill mix.

The royal commission report says the 1997 Aged Care Act had removed the obligation of aged care providers to spend a dedicated portion of their government funding on direct care staffing. Despite increasing needs of people in care, the capacity and capability of the residential aged care workforce had since been eroded.

‘Since 1997, providers are free to judge for themselves what staffing numbers are ‘adequate’ and what skill levels are ‘appropriate’,’ the commissioners said.

‘The status quo is unacceptable. The current requirements have not prevented inadequate staffing nor substandard care and may in fact have encouraged these outcomes.’

The royal commissioners state they were ‘informed by a highly credentialed international nursing home expert that the most important policy measure for ensuring appropriate staffing levels is to adopt a regulatory requirement that establishes a minimum staffing level.’

‘We recommend that the Australian Government should require approved providers of residential aged care facilities to meet a minimum quality and safety standard for staff time.’

The following were among the commissioners’ 148 recommendations:


  • Minimum quality and safety standard for staff time and at least one registered nurse on-site at each aged care facility at all times
  • Registration for personal care workers, including a mandatory minimum qualification of a Certificate III, ongoing training requirements and a code of conduct
  • The government should establish an Aged Care Workforce Planning Division to prepare an interim workforce strategy and planning framework for 2022–25 and a 10-year strategy for 2025–35.

The commissioners’ report says modelling by Deloitte Access Economics estimated that the number of direct care workers needed by 2050 to maintain current staffing levels would be around 316,500 full-time equivalent, a 70 per cent increase on the 186,100 full-time equivalent workforce in 2020.

The Aged Care Workforce Planning Division should have access to a fund that can be used to support training, clinical placements, scholarships and other initiatives to respond to the workforce challenges.


  • A new Aged Care Act, which provides a clear statement of the basic responsibility of approved providers to ensure that the care provided to residents is safe and of high quality.

The Act should include a civil penalty on providers for a failure to provide quality, safe aged care services where the failure exposes residents to a risk of harm, as well as the possibility of compensation to residents.

  • Better governance of the existing system

The commissioners differed on what the governance system should be, with Commissioner Tony Pagone suggesting an independent regulatory body, the Australian Aged Care Commission, to be responsible for management and regulation.

Commissioner Lynelle Briggs recommended a ‘government leadership’ model, with management remaining in government hands, while quality regulation would continue to be overseen by a reconstituted Aged Care Safety and Quality Authority.

  • A new position of Inspector-General of Aged Care to identify and investigate systemic issues in the provision or regulation of aged care.
  • A review of the Aged Care Quality Standards.

The commissioners identified four areas for immediate improvement: food and nutrition, dementia care, the use of restrictive practices, and palliative care.

Regarding dementia care, the commissioners said residential aged care homes need to have ‘the right number and mix of staff who are trained in dementia care’, the right physical environment and the right model of care. The commissioners recommended that dementia training be mandatory in all forms of aged care.

The commissioners recommended that ‘a strong and effective’ regulatory framework be introduced to control the use of restrictive practices as a matter of priority.

Quality improvement

  • The existing health quality regulator, the Australian Commission for Safety and Quality in Health, should be expanded to encompass aged care.

The Australian Government should implement reporting and benchmarking of provider performance against quality indicators, with a star rating system to help people choose aged care homes.


  • A levy on taxable income to finance aged care.

ANMF Federal Secretary Annie Butler said the Morrison Government and many previous governments have done nothing to address ever-increasing shortages of registered nurses and qualified carers working in aged care.

‘Without adequate staffing and skills mix, with minimum standards for care workers, nursing home residents have suffered terribly, as a result of inadequate levels of care.

‘The Morrison Government must now act; every day the government delays taking action to address dangerous understaffing in nursing homes and community care, is another sad day, that vulnerable residents will continue to suffer.

Read the executive summary of the report, the full report or the list of recommendations.