The federal government’s proposed new Aged Care Act hasn’t gone far enough to ensure a sustainable, accountable and high-quality aged care system, the Australian Nursing and Midwifery Federation (ANMF) has argued.

In its submission to the Community Affairs Legislation Committee’s Inquiry into the Aged Care Bill 2024, the ANMF says that while it represents long-overdue improvement over the existing Aged Care Act 1997, some “significant omissions remain”, including no direct mention of care minutes and the abandonment of provisions for a Worker Voice.

“It would be disappointing if failure to undertake bold and fearless reform now simply results in the need for another Royal Commission at some point in the future,” the ANMF warns.

The union’s submission identified nearly a dozen omissions within, or relating to, the Bill, and issues not properly addressed in the draft legislation that it believes would further strengthen the sector and benefit older Australians seeking or receiving aged care services, aged care workers, providers, government and regulators.

Workers are crucial to achieving the objects of the Act

The ANMF is concerned that the proposed Act fails to recognise the importance of the workforce and make explicit provisions for setting a workforce quality standard outlining the basic conditions needed to ensure workers are supported to deliver high-quality care and achieve the objectives of the Bill.

“Workers are the backbone of the aged care system and if supported to do so, can supplement the regulation of aged care, enhance transparency of direct care funding, reduce the regulatory burden and increase the cost-effectiveness of system administration, by being the ‘eyes and ears’ that enhance regulatory processes,” the ANMF stated.

“Without primary legislation, which requires regulation to determine the minimum number of workers needed to deliver high-quality care, provides workers with legitimate real time pathways to report risk to older people through understaffing, and avoids penalising workers for decisions outside their control, older people remain at risk.”

Care minutes

The ANMF is concerned that the Bill, in its current form, excludes any direct mention of care minutes. It is also worried that it lacks an enforceable requirement for registered providers to employ adequate numbers of well-trained and supported staff to deliver high-quality direct care.

“Current regulatory mechanisms are not fit for purpose; they do not impose specific obligations on providers to ensure transparency regarding care minute compliance and have minimal direct consequences for providers,” the ANMF said.

To strengthen the Bill to ensure high quality care, the ANMF suggested including specific provisions such as “the delivery of high-quality nursing services by sufficient numbers of qualified and experiences direct care workers”. It also called for amendments to “empower aged care workers to raise concerns” and an additional category added to reportable incidents to enable real-time reporting of poor-quality care arising from failure to comply with direct care minutes.

Importance of Enrolled Nurses

The ANMF is advocating for the legislation to include provisions that “halt and reverse” the significant reduction in enrolled nurse (EN) care minutes seen across the sector following the introduction of reforms. While recent changes allowing providers to use ENs to fill 10% of care time allotted to registered nurses go some way to supporting the role in aged care, the ANMF says the Bill should be amended to further acknowledge their important role.

Regulation of the care worker workforce

The ANMF is concerned that there has been a failure to adopt a robust, Australian Health Practitioner Regulation Authority (Ahpra) based regulation scheme for the currently unregulated aged care workforce. It believes that weaker alternative proposals again miss an opportunity to improve the capacity and capability of the currently unregulated carer workforce.

Worker Voice provisions

The ANMF is extremely disappointed at the planned abandonment of provisions for a Worker Voice and Quality Care Advisory Body, which it says would have been crucial for integrating worker feedback into the delivery of aged care services.

“Its absence creates a gap that may allow unscrupulous providers to continue to evade their responsibilities, ultimately undermining care quality and worker conditions.”

Fees, payments and subsidies

One of the biggest shifts under the proposed new Aged Care Act is the government’s plan to increase consumer contributions towards aged care costs. While the government will pay for all clinical care services, it wants Australians to fork out more for everyday living costs.

“We believe this proposal undermines the principles of universality and equity in Australian healthcare,” the ANMF argued in its submission.

“Aged care should be publicly funded and owned, particularly as the sector relies heavily on taxpayer support and should provide equitable access. The proposed and illogical separation of clinical and non-clinical care also creates an unnecessary distinction that can lead to financial burdens for residents while undermining comprehensive care.

“It is also unclear how this illogical separation will be funded and how it will impact the time nurses and care workers have to provide care.”

The ANMF will provide evidence to the Inquiry at a public hearing next week.