History: Ever since Bronwyn Bishop and our politicians met the US con man Andrew Turner politicians and industry leaders, none of whom have had actual experience in the wards, have been enticed by the possibility of reducing the major cost of care - nurses. They have clung to the illusion that the aged are not ill -- they are simply getting old so don't need nursing and medical care.
Our leaders and businessmen keep coming back to it over and over again. They have steadily been eroding care by reducing the number of properly trained nurses year by year. Because they don't collect and publish accurate information, they can continue believing and claiming "no evidence".
Registered nurses in nursing homes
Adequate staffing is critically important in aged care and yet providers and government have connived over the years to steadily reduce staffing numbers and skills. Unlike the rest of Australia, NSW still had some regulations requiring registered nurses and an opportunity to get rid of that requirement presented itself.
Recent debate reignited in NSW
The debate has been reignited in NSW where the industry has urged government to consider removing the requirement that there be a registered nurse on duty in nursing homes at all times. There has been an outcry from everyone who has anything to do with care - except for those who make money out of aged care - those whose success on the share market depends on their making even more and of course the politicians who support them. The nurses union states the obvious, but stops short of saying that we can't trust the providers.
"The loss of this legislation would simply mean that we would rely on the 'good will' of aged care providers, who in many cases are there to make a profit – we know it and they know it."
Source: NSW Government shuts down debate on RNs in aged care - NSW Nurses & Midwives Association, 11 Sep 2015
I addressed the current conflict about staffing in NSW on the webpage Risks in the marketplace. I quoted the responses of those caring for the aged when faced by the proposal to no longer require nursing homes to have a nurse on duty at all times. This page is simply to highlight the widely differing views between those who actually deal with the aged and those who make decisions about aged care. The latter are deaf to what they are being told.
Arguing against registered nurses
Industry argued that nurses were often not necessary for 24 hours and that this would create problems for many nursing homes.
Those who don't think we need registered nurses legislation
But Charles Wurf, the chief executive officer of Leading Age Services Australia NSW-ACT, the peak body for high-care operators, said the law was a hangover from the days when aged care facilities were primarily regulated by the states, but were not relevant now the system had shifted towards federal regulation.
He said it was flatly wrong that removing the law would negatively impact elderly residents.
Source: Plan to remove nurses from nursing homes - Sydney Morning Herald, 21 May 2015
Aged care providers and nursing unions in NSW are set to clash over whether to keep state legislation requiring aged care facilities to employ registered nurses at all times to oversee high care residents.
Aged and Community Services NSW & ACT CEO Illana Halliday told Australian Ageing Agenda that ratios and staffing requirements were a blunt measure that did not respond to the actual needs of clients and would contribute to unsustainable costs.
The peak body estimated the direct wage costs of employing an RN 24/7, for a current low care 70-bed facility would be $500,000.
Ms Halliday said a requirement to have an RN on duty at all times in every facility with a high care resident would also be impossible to manage due to a lack of available staff and would be a waste of limited resources.
She said while skilled RNs were necessary in the provision of palliative care or short-term acute care in a facility, not all high care residents would require an RN to meet their needs.
“It is probable that many residents with a high score in ACFI may still not need an RN, as the care they require is not acute or curative, it is about comfort and quality of life,” Ms Halliday wrote in a ACS NSW & ACT position paper.
Source: Providers push to review RN staffing requirement Australian Ageing Agenda, 25 Jun 2014
if you need to refresh your memories, you can see the incredulous responses by linking to the press reports and reading the comments at the foot of the Australian Ageing Agenda page. Coming from an industry leader, the suggestion that registereed nurses are only needed for acute and palliative care is weird. The industry is promoting the illusion that they are bound by professional codes and would not understaff.
Unopposed corporate interests are not and have never been restrained by professional codes of any sort. Pressures within them seek to undermine or sidestep them.
CPSA highlighted the views of one opponent who acknowledged one consequence.
Phil Belletty, the CEO of Clarence Village, a not-for-profit aged care facility in Grafton, told The Daily Examiner that full time RNs could reduce the number of clients requiring hospitalisation, but this 'did not help the aged care facility’s bottom line.'
Source: Registered nurses reduce hospitalisations, but don’t help nursing homes’ bottom line – nursing home operator CPSA, 31 Jul 2015
The risks of doing without registered nurses
It means trusting the providers who exploit any loophole their can find to keep prices down. But they are the problem and have been the offenders.
What will happen
Below is an example of the sort of thing that is happening. How many will behave similarly and, as in the explanations offered above, try to rationalise and explain it away.
If the industry wants us to trust them, then they need to earn that trust. If the proposed Community Aged Care Hub was in place, with an accurate data base recording standards of care and nurses on duty then a more flexible and risk free approach to staffing might be possible. The market might then work. But until then, we do require laws and staffing levels.
Note in the extract below, that it is a not-for-profit operator that is doing this. They are increasingly copying for-profit providers:
The NSW Nurses Association (NSWNA) met with Fair Work Australia in Sydney yesterday to ask the independent body to step in and quiz the aged-care facility's owners on a number of redundancies and working conditions.
Waratah Village was owned and operated by Bland Shire Council until January 31, when council handed the reins over to the Royal Freemasons Benevolent Institution (RFBI).
The NSWNA says since the takeover, nine registered nurses have been made redundant and up to six enrolled nurses have resigned as a result.
The NSWNA says the two registered nurses left are co-managing Waratah Village and neither are rostered to work outside 8.30am and 5pm, Monday to Friday.
-- The village previously provided 24-hour registered nurse coverage.
- - the two registered nurses do not have the time to provide direct resident care or supervise the care service employees.
Source: Fair Work looks at aged-care sacking - Daily Advertiser, 28 Mar 2012
What we need to consider is the management culture in the nursing homes -- the way they think about this. We get a glimpse into this from the Royal Australian College of GP's answers to questions they were asked, by the NSW senate inquiry. They responded in writing.
The nursing home referred to are unable to balance their need to restrict staff numbers against the importance of giving medication. In the mind of at least one manager, staff restriction came before medication needs. While the memo referred to below was withdrawn, the cultural significance remains. Someone thought this was OK and someone in authority must have authorised it.
A GP from northern NSW advised that in June 2015, local GPs who have patients at a (de-identified) nursing home were memo-ed:
"... As you are aware, we have 80 beds in our (redacted) facility. Presently we have about 65 residents and of these we have 63 residents on 9 or more medications...
We have a large number of residents receiving Panadol t.d.s. and q.i.d. Unfortunately our staff are not able to administer the large volume of medication inc. the Panadols within the required time frame & as such the lunch time Panadols are usually not given... "
The GP advised that this memo was officially withdrawn by the nursing home management when they learnt of it. The situation described in the memo is:
- Not uncommon in nursing homes
- Indicates the increasing treatment complexity of the elderly residents in aged care homes
- Indicates that RN staffing ratio is both inadequate and not keeping up with increasing complexity of care.
Source: Answers to Questions on Notice: Royal Australian College of General Practitioners NSW Inquiry into Registered Nurses, 2015
A Government Inquiry in NSW
The Labour and the Greens held a majority in the NSW upper house. They initiated an inquiry that received many submissions. This inquiry advised that registered nurses 24/7 should continue to be mandatory. But this was really an exercise in futility. The providers had the ear of government and the Labour party had been so corrupt that it was unelectable. The important recommendations by the committee were rejected by government.