The Australian Greens believe that the federal government must play a central role in the funding, regulation and support of high quality aged care services, and that older people should be able to access health and aged care services as soon as they need it.
We want to see a high-quality, affordable, aged care system characterised by quality support, nursing and personal care whether in own home, residential care or hospital, that is provided on a not-for-profit basis.
The Australian Greens welcome the Aged Care Amendment (Implementing Care Reform) Bill 2022, and support the majority Committee recommendation that the Bill be passed. As a number of stakeholders noted in submissions to the inquiry, a requirement for on-site nurses is an important and overdue reform. We also want to see improvements in workforce conditions for aged care workers, supported by staffing ratios, improved award wages and conditions, and access to training.
The Australian Greens welcome the changes in this Bill, and support the recommendation in the main committee report that the Bill be passed. We particularly welcome the implementation of 24/7 nursing support, to provide the care and support that older Australians need and deserve in residential care. This change was supported by a number of submissions to the inquiry.
The Older Persons Advocacy Network stated:
OPAN strongly supports the requirement that Registered Nurses must be on site and on duty at all times (that is, 24 hours each day, 7 days each week).
While we acknowledge that the Royal Commission into Aged Care Quality and Safety recommended one registered nurse be on staff for both morning and afternoon shifts (16 hours per day), increasing to all day from 2024. OPAN believes a registered nurse should be available 24 hours per day as soon as possible rather than delaying implementation. The increasing health complexity and comorbidities of older people entering residential aged care requires a corresponding need for staff with the right health and medical skills to provide support. We know that health related incidents don’t just happen in the day time.
Similarly, the Australian Nursing and Midwifery Federation stated:
The ANMF welcomes the introduction of a requirement for 24 hour, on‑site and on duty registered nurse presence in every Australian nursing home. Along with mandated care minutes, this requirement will strengthen overall staffing standards in nursing homes across the country and will significantly contribute to improved safety and quality in care for older Australians. The ANMF is therefore also pleased to see the Government has committed to the ensuring a minimum of 215 care minutes (including 44 registered nurse minutes) by October 2024 as recommended by the Royal Commission.
Council on the Ageing also stated:
This measure strengthens national minimum staffing standards in residential aged care and brings Australia into line with similar regulations in other countries. Nurses play a vital role in aged care in partnership with allied health professionals, lifestyle coordinators and well-trained personal care workers. COTA Australia has long supported the principle of ensuring the right skills are available in the right setting and at the right time, within each staff member’s professional scope of practice.
The Aged & Community Care Providers Association also stated:
ACCPA supports 24/7 registered nurse coverage in aged care facilities in‑principle, but the implementation of this measure needs to account for chronic workforce shortages, noting that even the RIS “anticipates a reasonable proportion of services will be non-compliant”.
The 24/7 nursing requirement also needs to be considered together with implementation of care minute targets, which require a significant increase in overall residential care staffing (including 45% increase in RN levels by October 2023).
While welcoming the implementation of 24/7 nurses, the Australian Greens note the concerns raised by physiotherapists and other allied health providers about the impact of changes to funding models. As Allied Health Professions Australia noted:
We support the purpose of the Bill and its place in a suite of recent and forthcoming reforms to implement the Government’s response to the recommendations of the Royal Commission into Aged Care Quality and Safety.
However, we endorse the submission of our member the Australian Physiotherapy Association that genuine implementation of essential care reform in residential aged care, including the Royal Commission’s recommendations, requires more than the introduction of the Australian National Aged Care Classification (AN-ACC) funding model and average carer and nursing care minutes per resident.
The Bill before the Committee is silent concerning allied health services in residential aged care; nor are we aware of any proposed legislation to address this gap.
Similarly, the Australian Physiotherapy Association noted that:
The APA supports Schedule 1—the introduction of 24/7 registered nurses to individual facilities—as a first step in addressing the inadequacies of current healthcare provision to aged care residents. Numbers alone will not guarantee high quality care. As well as the right number of staff, there needs to be the right skill mix to meet the complex care needs of older whether at home or in residential aged care.
This amendment, along with the introduction of the Australian National Aged Care Classification (AN-ACC) and average carer and nursing care minutes per resident, should not be considered the completion of residential aged care reform as it relates to healthcare.
These measures do not provide certainty about ongoing access to allied health care such as physiotherapy…
In evidence to the Committee, Mr Alwyn Blayse stated:
We're facing a generational loss of some experienced aged-care physios, and that is an absolute tragedy. You just heard Scott say that, about 50 per cent of a major provider. Well, I've had my team, and, through the skin of my teeth, I'm managing to keep everybody's jobs, and I will continue fighting for that, but it's not been easy. I promised everyone a year ago we'd keep their jobs, and I still keep that, because we can go and work in another area and make more money, but we want to work in aged care; we want to stay in residential nursing homes, and we can't, the way this is playing out right now. And that's absolutely a tragedy.
Recommendation
That the Australian Government consult closely with aged care residents, providers, and allied health specialists, to ensure that allied health services are appropriately funded and available to all who need them.
Senator Janet Rice
Deputy Chair