Bring out the blunt instrument!

Article published 23 April 2019

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THE Aged Care Royal Commission heard evidence from a number of systemic advocacy organisations. Counsel Assisting quizzed them on nursing home staffing.

Apart from CPSA, their response was that mandatory staff-to-residents ratios in nursing homes would be too hard, too blunt an instrument. One organisation even managed to say nothing at all about nursing home staffing, even though it is the key issue in residential aged care.

Here is an excerpt from Royal Commission transcripts.

”That’s part of our apprehension about staffing ratios, it’s a quick easy answer, increase the ratios.  No, there are lots of other components and dimensions to good staffing in aged care.  And one of them is that everybody from the person you meet when you walk in the front door to the gardener to the cooks to people who clean as well as direct care staff all need to understand about dementia because that’s how you make a dementia-friendly environment.”

Unfortunately, this advocacy group failed to indicate how we would get from dramatically understaffed nursing homes to utopia nursing homes where the gardener has the skills and the knowledge to fill in for the Director of Nursing.

Here is another excerpt from the evidence of a second advocacy group.

“… we heard the arguments that if you can do [mandatory staff ratios] in child care, why can’t you do it in aged care.  And I think the reality is that aged care is a much more complex beast than child care.  And we did read [..] the taskforce review of the aged care workforce and we were persuaded by their recommendations that ratios were just too blunt an instrument, given the variety of circumstances including the mix of consumers …”

This advocacy group, like the first one quoted above, did not offer an alternative solution to nursing home understaffing.

One of the Royal Commissioner asked the right question.

“The question for me, [..] it’s pretty hard to establish staff ratios but is that a good enough excuse for not doing so?”

The answer is not just: no, it’s not a good enough excuse.

The answer is that there is no alternative to end understaffing of nursing homes.

The issue is simply this. Aged care providers started reducing staffing levels in an effort to maximise their profits. The Government responded by reducing care subsidies. This created a downward spiral of further staffing reductions followed by further reductions in care subsidies.

Setting mandatory staffing requirements for Government to fund and providers to meet is the only way to break out of that spiral.

Setting these ratios may be a complex exercise, because it needs to take into account resident mix and the physical configuration of nursing homes.

However, just leaving it up to profit-hungry nursing homes to determine staffing is a recipe for disaster: just about every scandal in nursing homes is down to understaffing, directly or indirectly.

Mandatory staffing requirements will not solve all the ills of the residential aged care sector, but it will certainly solve most.

CPSA’s position on mandatory staffing levels is clear: impose them now!


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