Will we have RN24/7 or RN20/7 registered nurses in nursing homes?

Article published 21 June 2023

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Royal Commission recommendations about Registered Nurses (RN) and staff-to-residents ratios are about to be implemented. Effectively?

WILL we have more registered nurses in nursing home? Two important upcoming dates will see the introduction to the Government’s resolution of the nursing home staffing ratios and the RN24/7 issues, as per Aged Care Royal Commission recommendations.

Anything to do with staffing in any industry is difficult these days, with the job market as tight as it is. The aged care industry is no different, but its problems are acerbated by its own penny-pinching and corner-cutting over many years when the job market was far from tight.

Be that as it may, the aged care industry now faces real staff shortages. Many a nursing home provider had put its hope in an exemption regime for the RN24/7 requirement and the “mandatory RN care minutes obligation”.

CPSA thought that exemptions would throw both the RN24/7 requirement and the mandatory care minutes obligation into disarray, a fear expressed in this post just under a year ago. But we are happy to say we were mostly wrong.

Mandatory care minutes

The “mandatory RN care minutes obligation” starts on1 October 2023 and means that in residential aged care each resident must receive 200 minutes a day, including 40 minutes from an RN. This will increase to 215 minutes (including 44 minutes of RN time) from 1 October 2024.

It’s important to realise that these time requirements are average requirements. This means that if a nursing home has 100 residents it must initially provide 20,000 minutes of care per day. It’s not necessarily the case that each resident will get 200 minutes a day. It may vary from resident to resident.

RN24/7 mandatory

1 July will see the start of RN 24/7, the requirement for every nursing home to have at least one registered nurse (RN) available on site. In Department of Health and Aged Care-speak, this is known as the “24/7 RN responsibility”.

It is related to, but different from what the Department calls the “mandatory RN care minutes obligation”. The aged care providers used to (and perhaps still do) call it a ‘blunt instrument’. Much better to let providers decide how much care residents got. Well, they lost that one.

The RN24/7 requirement will in principle apply to all nursing homes. Each nursing home will be paid an RN24/7 supplement, which ranges from $8,000 to $28,000 in non-rural/remote areas and from $9,000 to $77,000 in remote areas.

The Government is granting RN24/7 exemptions, but in doing so it is strictly adhering to Royal Commission recommendations.

To be eligible for an exemption, nursing homes must be located in an isolated area according to a geographical model used by the Australian Bureau of Statistics. It’s limited to:

  • nursing homes further than 10 kilometres by road from a town with a population of between 5,000 and 15,000;
  • nursing homes on remote islands with a population of less than 1,000;
  • nursing homes on a populated island more than 5 kilometres offshore.

Also, nursing homes must have 30 or fewer bed capacity.  This means just leaving a few beds empty doesn’t get you an exemption. It’s the capacity that counts.

Finally, to qualify nursing homes must have appropriate alternative clinical care arrangements in place. This is still a grey area, where the Department and the Aged Care Quality and Safety Commission have some work to do.

At an Estimates Committee hearing, the Department advised it estimates that 130 nursing homes meet the requirements for an RN24/7 exemption. Thirteen had applied by 23 May.

RN coverage threshold

In our earlier post about RN24/7 exemptions we were mostly wrong, but not completely wrong.

From 1 July 2023, a temporary “RN coverage threshold” of an average 20 hours per day over the month will apply to the supplement. This is to allow for unavoidable circumstances such as unplanned leave due to illness or other unexpected personal leave that cannot be immediately filled by another RN. If nursing homes provide less, they miss out on their RN24/7 supplement.

The Government may say that it expects providers to work towards providing full RN24/7 coverage, but how realistic of being fulfilled that expectation is remains to be seen. A review of the threshold will be done later this year to determine whether we’ve got RN24/7 or RN20/7.

For more information please email our media contact at media@cpsa.org.au

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