Main Content

Understaffing is underlying cause of aged care ‘neglect’

Understaffing is underlying cause of aged care ‘neglect’

Nurses and personal care workers have responded to the aged care royal commission’s interim report on social media saying they are at ‘breaking point’.

The three-volume report, titled Neglect, found the aged care system was ‘cruel and harmful’ and must be changed.

The report, by commissioners Richard Tracey and Lynelle Briggs, was published on 31 October 2019. It is based on much of the work of the Royal Commission into Aged Care Safety and Quality between January and September 2019.

The royal commission described the many problems that older people and their families have in trying to access aged care services, service shortfalls, the dispiriting nature of residential care, serious substandard care and unsafe practice, an underpaid, undervalued and insufficiently trained workforce, and isolation of young people with disabilities.

About 1000 providers, who responded to the royal commission’s service provider survey, self-reported 274,409 instances of substandard care over the five-year period to June 2019.

The royal commission reflected on an aged care workforce under pressure and observed that ‘intense, task-driven regimes govern the lives of both those receiving care and those delivering it’.

‘While there are exceptions, most nurses, carer workers and allied health practitioners delivering care are doing their best in extremely trying circumstances where there are constraints on their time and on the resources available to them. This has been vividly described by the former and current aged care staff who have given evidence.’

Federal Aged Care Minister Richard Colbeck said he was ‘shocked’ by the report despite 18 previous reports and reviews into the aged care system since 1997 and thousands of official complaints about aged care providers.

Federal ANMF Secretary Annie Butler called for the immediate introduction of nurse/carer-to-resident ratios.

The Morrison Government must not continue to be ‘missing in action’ when aged care workforce reform was so urgently needed to ensure safe, quality care for residents, Ms Butler said.

‘Mandated minimum staffing levels and skills mixes in residential in aged care is not the only solution required to fix the crisis in aged care, but it is the centrepiece – many other solutions and improvements required are dependent on proper, safe and quality staffing in order to be effective,’ Ms Butler said.

Prime Minister Scott Morrison said the government would respond to the urgent issues raised in the report – waiting lists for home care packages, over-reliance on chemical restraint and finding alternatives for younger people living in aged care – by the end of the year.

Aged care staff under pressure

The royal commission received extensive evidence showing aged are workers often experience ‘excessive work demands and time pressure to deliver care’.

‘The evidence suggests that the adequacy and consistency of staffing is an underlying cause of these pressures and a barrier to the capacity of workers to deliver person-centred care.

‘Basic standards are often not met,’ the royal commission found, ‘For care workers, inadequate staffing levels mean that they are overworked, rushed and generally under pressure.’

Understaffing also meant serious implications for the health and safety of those who worked in aged care.

The royal commission said its final report, due in November 2020, would ‘give close consideration to options to ensure staffing levels and the mix of staffing, are sufficient to ensure quality and safe care’.

Time for ‘aged care industry’ reality check

The royal commission said some aged care providers who have given evidence were ‘defensive and occasionally belligerent in their ignorance of what is happening in the facilities for which they are responsible’.

The system lacked ‘fundamental transparency’ and there was little useful information available to the public about providers’ performance.

Evidence suggested ‘that the regulatory regime that is intended to ensure safety and quality services is unfit for purpose and does not adequately deter poor practices,’ the royal commission said, ‘Indeed, it often fails to detect them.’

It was time for a ‘reality check’ for the aged care sector which prided itself on being an ‘industry’ despite the federal government providing 80 per cent of its funding.

‘Australian taxpayers have every right to expect that a sector so heavily funded by them should be open and fully accountable to the public and seen as a ‘service’ to them,’ the royal commission said.

Only preliminary observations were included in relation to workforce which included a finding that employers must provide ‘high quality training and development opportunities’, but also importantly increase staff ‘sense of empowerment to do their jobs well.’

Still waiting on wages

The royal commission highlighted a previous review in 2017, conducted by David Tune, which had proposed the aged care sector develop a strategy itself to transition personal care workers and nurses to ‘pay rates that better reflect their value and contribution’.

‘In many ways, the wages and conditions in the aged care sector are a mirror which reflects the community’s attitudes towards older people and ageing.’