Senior Counsel assisting the Aged Care Royal Commission have recommended mandated staffing ratios be implemented in residential aged care in their closing submissions put forward today at the two-year long inquiry’s final hearing.

The call for mandated staffing ratios in aged care is among 124 recommendations that were outlined by Senior Counsel Assisting, Peter Rozen QC and Peter Gray QC, for commissioners to consider.

Other key recommendations include a new Aged Care Act that protects the human rights of older people, establishing an independent Aged Care Commission responsible for administering and regulating the aged care system, and compulsory registration of personal care workers.

The Counsel Assisting team’s final submissions state “the time for real action to improve staffing levels in residential aged care is now” and recommend the Australian Government implement a minimum staff time quality and safety standard for residential aged care.

Counsel assisting say the staffing recommendations should be implemented in stages – the first step launching on 1 July, 2022, and a second on 1 July, 2024 – to ensure proposed new requirements align with recommended training reforms and providers and government have enough time to prepare.

Specifically, the proposed recommendation, Minimum staff time standard for residential care, says from 1 July, 2022, the Australian Government should require providers to engage registered nurses, enrolled nurses and personal care workers for at least 215 minutes per resident per day for the average resident, with at least 36 minutes of that staff time provided by a registered nurse.

The minimum staff time standard should also require at least one RN on site at each residential aged care facility for morning and afternoon shifts.

From 1 July, 2024, the recommendation argues the minimum staff standard time should increase to 215 minutes per resident per day for an average resident, with at least 44 minutes of care provided by an RN, or 264 minutes per resident per day for an average resident, with at least 36 minutes of staff time provided by an RN.

Further, from 1 July, 2024, at least one registered nurse should be on site at each aged care facility at all times. Approved providers with a higher than average proportion of high needs residents would also be required to employ additional staff.

Another of Counsel assisting’s recommendations tackled how wages for aged care workers could be increased and working conditions improved.

They propose that employee organisations who represent the industrial interests of aged care workers covered by the Aged Care Award 2010, the Social, Community, Home Care and Disability Services Industry Award 2010, and the Nurses Award 2010 should collaborate with the Australian Government and employers and apply to vary wage rates in the awards to reflect the work value of aged care employees in accordance with the Fair Work Act 2009.

Overarchingly, counsel assisting recommend replacing The Aged Care Act 1997 with a new Act that provides an aged care system based on a universal right to high quality, safe and timely support and care to enable older Australians to live active and meaningful lives, receive high quality care and be treated with dignity.

According to counsel assisting, the most significant of its 124 sweeping recommendations for reform submitted to the Royal Commission are:

• A new Act based on human rights principles for older people
• A new planning regime for aged care which provides demand-drive access rather than the current rationed approach
• A new independent process for setting aged care quality standards
• A new enforceable general duty of care on approved providers
• Mandated staffing ratios in residential aged care
• Compulsory registration of personal care workers
• An independent pricing authority that will determine aged care prices appropriate to the provision of high quality and safe aged care srvices
• An independent Australian Aged Care Commission responsible for administering and regulating the aged care system

Counsel assisting’s final submissions state evidence heard by the Royal Commission confirms that the level of substandard care being delivered in the current aged care system is “far too high”.

“The weight of evidence before the Royal Commission supports a finding that high quality aged care is not being delivered on a systemic level in our aged care system and the level of substandard care is unacceptable by any measure.”

Counsel assisting note that many of the problems uncovered by the Royal Commission are not new.

“In the last 20 years, there have been repeated reviews and aspects of the aged care system, many of which addressed recurring problems. While we acknowledge that governments are not obliged to adopt all recommendations of a review, they have tended to respond with piecemeal reforms to aspects of the aged care system, which have not resolved underlying problems.”

Counsel assisting believe their series of reforms can address systemic problems and improve the quality and safety of aged care in Australia for the benefit of older people and the entire community.

They say their blueprint for the future represents a fundamental and generational change in direction from the approach embodied in existing legislation.

“Older people in need of care and support should have a universal right to high quality care. Care that is of high quality, safe, empowering and timely and which assists older people to live an active, dignified, self-determined and meaningful life.”

The final report set to be handed down by the Aged Care Royal Commission in February next year should set a new bar for aged care in the country, the submissions argue.

“Looking after older people should be a part of who we are. We should have an innate respect for them and elevate their place in our community.”

Read Counsel Assisting’s final submissions and recommendations here