Although the current Australian government has made an effort to improve the quality of care in aged care, it seems that the depreciated sector has not yet settled.
In 2018, the Australian Federal government introduced a Royal Commission into aged care, following reports regarding elder neglect and poor aged care condition at the time (Royal Commission into Aged Care Quality and Safety 2018). The Australian government has also spent $19.9 billion on aged care in 2018-19 to improve the quality of care in this sector (Commonwealth of Australia 2018). Further, in 2018, the Aged Care Quality and Safety Commission amended the Aged Care Quality Standards, assisting aged care providers in offering better quality care. The novel eight quality standards have also been used as guidance for quality assessors to consider when assessing compliance (Australian Government Aged Care Quality and Safety Commission 2020).
Despite the government’s efforts to improve the quality of care in the sector, there still remain reports that older Australians are not receiving the care they desire and deserve. According to Royal Commission into Aged Care Quality and Safety, 39.2% of older Australians residing in aged care facilities experience elder abuse such as neglect, emotional or physical abuse (Royal Commission into Aged Care Quality and Safety 2020). Some of the challenging issues in the sector are reported to be: lack of staff, lack of skill mix, high workload, lack of staff training, utilising inexperience staff including Registered Nurses, Assistants in Nursing (AINs)/Carers, utilising inexperience managers without leadership skills (Australian Nursing and Midwifery Federation 2020), having a high amount of documentation due to Aged Care Funding Instrument (ACFI) system requirement, and low levels of salary.
In addition to these issues, the COVID-19 pandemic has added to the pressure for those working in the sector.
The Australian Nursing and Midwifery Federation has been continuously trying to inform the government regarding the critical condition of aged care, aiming to implement more effective actions that can improve the quality of care in this sector. They recommended that five key areas that need to be addressed. These include: mandating staffing ratios- minimum staffing levels and skills mix, legislating requirements for clinical governance, legislating transparency and accountability measures for aged care providers, guaranteeing workforce capacity, and considering registration for unregulated AINs/carers. There are concerns that failure to address these issues can exacerbate low morale, burnout, poor staff attraction and retention, and high-stress levels amongst the workforce, which can lead to a reduction in the quality and safety of the care is provided to vulnerable Australians (Australian Nursing and Midwifery Federation 2020).
It is the responsibility of the government to not only implement measures for quality auditing of compliance of the care providers with the aged care quality standards, but also, to ensure ongoing quality assurance of the process of the care by the aged care providers. Ongoing auditing of care by the Aged Care Quality and Safety Commission is not the only method that can guarantee the quality of care. The government should instead support care providers in maintaining quality assurance in their care system. This can be done by:
- providing training for Registered Nurses and AINs/carers,
- considering a minimum ratio for staffing levels and skill mix (average 4.3hrs of care per day delivered by a skill mix of 30% RNs, 20%ENs, and 50% AINs/Carers),
- increasing the wage for aged care employees,
- promoting positive cultural perceptions of older people and those who work in the aged care sector (Australian Nursing and Midwifery Federation 2020),
- and revising the Aged Care Funding system so that staff do not need to spend a lot of time for ACFI purposing documentations and instead, they can focus on the care that should be provided to older Australians.
Vulnerable older Australians deserve a world-class care system that can provide safe, high-quality care and respectful and dignified care. It is hoped that the Australian government consider more appropriate actions to improve the quality of current care in the depreciated aged care sector.
Australian Nursing and Midwifery Federation.2020. Response to counsel assisting final submissions to the Royal Commission into Aged Care Quality and Safety. http://anmf.org.au/documents/submissions/ANMF_Response_to_Counsel_Assistings_Final_Submissions_to_the_Aged_Care_RC.pdf, November 2020
Australian Government, Aged Care Quality and Safety Commission. 2020. https://www.agedcarequality.gov.au/providers/standards, 3 November 2020
Australian Nursing and Midwifery Federation. 2020. National COVID-19 in Aged Care Survey-Final Report. http://www.anmf.org.au/documents/reports/ANMFAgedCareCOVID-19Survey2020_FinalReport.pdf
Commonwealth of Australia, Department of Health. Report on the Operation of the Aged Care Act 1997 2018-19 https://www.health.gov.au/health-topics/aged-care
Royal Commission, into Aged Care Quality and Safety. 2020. Elder Abuse in Australian Aged Care Facilities. https://agedcare.royalcommission.gov.au/news-and-media/elder-abuse-australian-aged-care-facilities
Royal Commission, into Aged Care Quality and Safety. 2018. https://agedcare.royalcommission.gov.au/about/terms-reference.
Dr Mozhdeh Tahghighi, PhD in Psychology, Master of Nursing Science, is a Clinical Nurse Manager in the aged care sector