Royal Commission: nursing home staffing light years behind the rest of the world

Article published 24 October 2019

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A RESEARCH paper by the Aged Care Royal Commission has found that residential aged care in Australia is grossly understaffed when compared internationally.

The research looked at staffing level rating systems from Germany, Canada and the USA. The researchers found that the framework which presents the most potential for shaping Australian aged care policy is the USA Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare system.

The CMS system uses a ‘casemix’ approach in determining adequate staffing levels. A casemix system takes into account the mix of residents within a facility. The system will adjust for each facility depending on how many residents are in a facility and the complexity of care required for residents. This way accurate information can be used to determine the number of staff and the skill mix of staff necessary to ensure safety in a facility.

Australia’s current residential aged care funding instrument (ACFI) is inadequate as it does not adjust for the mix of different needs that residents require nor does ACFI mandate appropriate staffing levels.

The CMS system rates staffing levels of facilities between one and five stars. The researchers suggest that the median point between a two and three star rating of CMS is the point at which a facility is likely to have quality problems. Therefore aged care facilities with a one or two star rating are considered to be providing an unacceptable level of care.

It was found that 58 per cent of Australian residents in aged care homes receive care that has a one or two star rating.

To lift staffing levels to three stars, which is the lowest acceptable level of care, staffing hours would need to increase by 37.3 per cent in one and two star facilities. In order to achieve five stars in all Australian aged care facilities staffing levels would need to increase by almost 50 per cent.

The researchers suggested that a system similar to the CMS should be implemented in Australia.

Such a system will require additional funding to increase staffing levels to acceptable standards. It was stressed however that this funding must be made in conjunction with reform to the aged care sector.

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