Royal Commission: Make nursing home staff ratios mandatory!

Article published 25 February 2020

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THE Aged Care Royal Commission has now moved into the phase where it is looking at solutions to the serious problems it discovered over 2019.

Towards the end of each hearing this year, expect a submission by Counsel Assisting containing recommendations that are very likely to make it into the Royal Commission’s final report in November.

On 21 February, Counsel Assisting’s first submission was about workforce, including staffing levels.

See the Box for the text of that first recommendation, which completely accepts what CPSA and others have been campaigning for over the years.


·       An approved provider of a residential aged care facility should be required by law to have a minimum ratio of care staff to residents working at all times. The ratio should be set at the level that is necessary to provide high quality and safe care to the residents in its facility and should be based on the following:

·       It must be sufficient to achieve a 4-star rating under the current CMS staffing star rating as adjusted for Australian conditions.

·       Average case-mixed total care minutes of between 186 and 265 minutes per resident per day from a trained workforce comprising nurses (including registered and enrolled nurses), and personal care workers.

·       A minimum of 30 minutes of registered nurse care time per resident per day.

·       In addition, at least 22 minutes of allied health care per resident per day.

·       That there is a registered nurse (RN) present on each shift and available to direct or provide care subject to limited exceptions.



The reference to the “CMS staffing star rating as adjusted for Australian conditions” is to the methodology used in the United States.

Applying this to Australia, more than half (57.6 per cent) of Australian residents currently receive care in aged care homes that have unacceptable levels of staffing (1 and 2 stars).

Only 15.8 per cent nursing home residents get four star care (considered to denote good practice).

25.2 per cent of residents (a quarter) receive acceptable 3-star care.

Only 1.4 per cent of residents get 5-star care (best practice).

For all residents to receive at least four stars would require overall increase of 37.2 per cent in total care staffing.

The current average care time per resident per day in Australian residential aged care facilities is 180 minutes, including 36 minutes of registered nurse care time.

To achieve the four-star rating, Australian facilities would need to deliver a minimum of 242 minutes of care.

Impossible to achieve?

Not at all!

Australia spends an estimated 1.2 per cent of GDP on aged care and is among the lowest of a group of twenty-two comparable countries which spend an average of 2.5% of GDP.

It’s time for Australia to pull its socks up.

The Opposition has already committed to implementing all of the Royal Commission’s recommendations. The Australian Government should do the same.

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