Despite the federal government’s legislative reforms, Australia’s aged care sector continues to struggle with chronic understaffing, rising workplace violence and a lack of transparency over how providers are spending billions of dollars in taxpayer funding meant for resident care, a new national survey of the aged care workforce has revealed.
The findings have prompted the Australian Nursing and Midwifery Federation (ANMF) to call for a range of measures to address systemic problems across the sector, including replacing care minutes with mandated staffing ratios, risk assessments and person-centred care planning to prevent and manage workplace violence and aggression, and greater transparency and accountability over the use of government aged care funding.
Conducted by the ANMF, the ‘Aged Care Pulse Check – The Real Impact of Reforms’ surveyed more than 3,550 frontline nurses and care workers.
The findings uncovered three main areas of concern for registered nurses, enrolled nurses and care workers.
Inadequate Staffing and Skills Mix:
- Almost half (49.03%) of the staff surveyed had insufficient time to deliver care, increasing to 55.75% for staff from for-profit providers;
- 47.52% of all respondents said the ratio of nursing staff to care staff was inadequate, increasing to 52.09% in for-profit providers;
- Nearly two in five respondents (39.71%) rated the level of staffing at their workplace as ‘inadequate’, ‘poor’ or ‘very poor’; while
- 43.47 % of those working in private for-profits providers were more likely to rate the staffing levels as inadequate.
Escalation in Workplace Violence and Aggression:
- Almost all staff (96.43%) experienced and/or observed one or more instances of violence and aggression at their workplace in the past 12 months, with most identifying residents as the perpetrators;
- 76.69% experienced verbal aggression;
- 69.68% experienced physical violence;
- 49.01% reported property damage or thrown objects;
- 36.44% experienced racism;
- 35.55% experienced sexual harassment.
- Workers who rated the overall level of staffing at their workplace as “very poor” were more likely to report experiencing violence and aggression, suggesting that inadequate staffing levels contribute to the likelihood of experiencing it.
Cost-cutting and Lack of Financial Transparency:
- 20.22% of staff said a lack of funding/budget meant residents didn’t receive the services they need;
- 35.74% said it happens ‘some of the time’, whilst 20.22% indicated it happens ‘most of the time’;
- Staff reported providers frequently failed to replace sick staff or hire agency workers, which was perceived as a measure to control costs;
- Other cost-saving measures included rationing essential supplies such as wound dressings or updating equipment.
ANMF Federal Secretary Annie Butler said the findings provided a damning assessment of the aged care sector, revealing that reforms implemented by the Albanese Government had not solved the sector’s longstanding problems.
“It’s a wake-up call for everyone in aged care,” Ms Butler said.
“We simply can’t assume that aged care is fixed. The lived experience of frontline nurses and carers shows these reforms may have led to some welcome improvements (such as RN 24/7), but they certainly haven’t gone far enough to fix a broken system.
“It’s clear that serious systemic problems still persist, including poor staffing ratios, caring for large numbers of residents with minimal staffing and support, which is impacting the ability to deliver high-quality care, with understaffing also leaving nurses and carers open to physical, verbal and emotional violence.
While the Federal Government invests more than $25 billion in residential aged care, Ms Butler said the sector was not seeing the return on this investment.
“Legislated staffing requirements, including mandated care minutes, simply aren’t working and recent changes to the way care minutes are audited have not led to improvements.”
In response to the findings, the ANMF has made a range of recommendations to fix the aged care system, including:
- Replacing care minutes for residents with mandated staffing ratios that are aligned with evidence-based benchmarks;
- Introducing mandatory, standardised risk assessment and person-centred care planning to prevent and manage workplace violence and aggression;
- Introducing nationally consistent, competency-based workforce training on violence prevention and management;
- Developing and implementing a staged de-privatisation strategy to reduce for-profit ownership of aged care services and expand public and not-for-profit services;
- Legislating transparent, standardised public reporting of provider financial performance and use of government funding;
- Strengthening the role, resourcing and enforcement powers of the aged care regulator to ensure providers’ compliance and accountability of public funding.
“To finally fix the problems, we need structural changes that address workforce shortages and skills mix and provide stronger protections for staff facing daily workplace violence and aggression,” Ms Butler said.
“Enhanced financial transparency and regulatory oversight will also ensure that providers are held accountable for the billions of dollars in taxpayer funding that is meant to be for care.”
To ensure older Australians receive safe and dignified levels of care, the ANMF recommends transitioning from the current care minutes system to mandated staffing ratios and skill mix requirements.
“Mandated staff-to-resident ratios across all shifts would provide a clearer, more enforceable standard and importantly, reduce the potential for the manipulation of care minutes reporting by some providers,” Ms Butler added.
“Ultimately, the quality of Australia’s aged care system depends on the strength and resilience of its workforce. By implementing these recommendations, we can work with the Federal Government to build a sustainable, accountable and high-performing aged care system that better supports nurses and carers and delivers safe, person-centred care for residents now and into the future.”
Read the full report here
