Strength, will and knowledge: critical components for aged care nursing

Close-up of woman holding senior's hands leaning on cane

When Gerardine (Ged) Kearney MP, now Assistant Minister for Health and Aged care, made her maiden speech in 2018, she had this to say about aged care:


“While some enterprises in aged care are caring providers that struggle to stay afloat, too many are simply investors who cut costs and services to maintain profit. When 80% of your industry income comes from the federal government coffers, your company should not be listed on the stock exchange. It should not be an option to keep your books a secret. Staffing and skill mix is at a crisis point in private aged care, and it must be fixed. We must show solidarity for the needs of our ageing population, because how we treat our elderly says everything about our values as a nation.” https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:%22chamber/hansardr/8ba325d4-4d2d-4a31-91b3-a83165c5a782/0254%22

Since the 2021 Royal Commission into Aged Care Quality and Safety set out its 148 recommendations and stated unequivocally that Australia’s aged-care system needed major reform, a number of those recommendations have been enacted. Importantly, five years after Ged Kearney’s maiden speech, the need for 24/7 nursing care has been legislated, as has the number of hours of patient care required per resident per day.

This is simply because it is needed and because, for the most part, it was not happening.

There are two key reasons for this: the first was that such requirements are expensive and some of the businesses running nursing homes were not prepared to pay for qualified staff.

The second is that, even if they were prepared to pay, the persistently poor wages and conditions and chronic understaffing in the sector meant that recruitment and retention were ongoing long-term problems.

However, the Australian Nursing and Midwifery Federation (ANMF) has advised that, with legislated requirements for Registered Nurse (RN) 24/7 and mandated care minutes in place accompanied by a wage increase, their members would return to work in the sector.  The Royal Commission recognised that the people we have in our nursing homes are there because they need -er – nursing.

Most people stay out of the nursing home component of residential aged care whilst they are able to live independently. When they are no longer able to care for themselves because they lack “the necessary strength, will or knowledge to do so”, that is when they make the, often difficult, decision to move into the nursing home component of residential aged care.

This quote by the way, forms part of the definition of nursing developed by Virginia Henderson for the International Council of Nurses in 1977 https://www.icn.ch/nursing-policy/nursing-definitions.

Here is a longer portion of the definition:

The unique function of nurses in caring for individuals, sick or well, is to assess their responses to their health status and to assist them in the performance of those activities contributing to health or recovery or to dignified death that they would perform unaided if they had the necessary strength, will, or knowledge and to do this in such a way as to help them gain full or partial independence as rapidly as possible.

So, the whole point about being in a nursing home is that they can no longer perform those “activities contributing to health or recovery or a peaceful death” unaided.

They need nursing care to enable them to do so with dignity and effectiveness. The need for improved nurse staffing and care levels was (and still is) a no-brainer.

Yet today we hear on the radio that some aged care providers are going to close their doors because of these staffing requirements. This quote from the CE of the Brightwater Group in WA

“Unfortunately, modelling of our rosters to meet the new minimum staffing requirements has shown that our smallest facilities will not be best-placed to deliver the quality of care we pride ourselves on in a financially sustainable way”.

The 75 residents from these smaller facilities would be “relocated to other centres that met their needs and price range”. https://www.areanews.com.au/story/8158599/more-aged-care-facilities-close-after-nursing-mandate/

What does that even mean? How can the “quality of care that they pride themselves on” be delivered if their staffing and care ratios are not met?

Surely the key to these closures is the “financially sustainable” piece, rather than the “quality of care” piece? And what does the resident’s “price range” have to do with their relocation? For what feels like the millionth time in my career I ask myself what are we doing running aged care at end of life as if it were simply a business? Old people are not widgets. They are us, if we have the privilege of living that long.

Despite these negative stories in the press today, there is also good news about the staffing requirements overall. According to the ANMF press release today, 80% of nursing homes in Australia have actually met this new staffing requirement already, with a further 9% almost there https://www.anmf.org.au/media-campaigns/media-releases/anmf-says-rn-24-7-is-critical-to-ensuring-safe-care-for-older-australians, thus many aged care providers are actually managing to improve their staffing ratios.

Add to this the Fair Work Commission’s acknowledgement of the severe undervaluation of aged care workers under the current award system, and recommendation to pass-on the full 15% wage increase to workers, and it may well be that those RNs the ANMF represents will return to aged care (which many nurses used to love) and our elderly will get the care they so rightly deserve.

Kylea Tink, independent member for North Sydney, speaking in relation to the Inspector-General for Aged Care, made the following observation in the House of Representatives on 30th March this year:

The Royal Commission provided us with the insight required to fully drive a positive change in the operation of the system, and we must fully embrace that opportunity. We cannot afford to let this potential for positive change pass us by. The same urgency with which these recommendations were presented is the urgency with which we must deliver on them” https://www.aph.gov.au/Parliamentary_Business/Hansard/Hansard_Display?bid=chamber/hansardr/26436/&sid=0043

I once heard it said that the elderly are the one group against whom we discriminate to which we all hope to belong. When we no longer have the “strength, will or knowledge” to care for ourselves, we will hope against hope that the providers of care staff their facilities appropriately to deliver to us a proper skill mix and adequate care time.

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