HealthJanuary 29, 2024

Aged care reforms create new demand for skilled nurses

The vital contribution of registered nurses has been highlighted under new rules for Australian residential aged care facilities.

Within the next 10 years, nearly one in five Australians will be more than 65 years of age. As Australia braces for soaring demand for aged care services driven by this ageing population and increased life expectancy, a raft of reforms and a new Aged Care Act are in the works to build on the universal right of older Australians to high-quality, safe, and timely care.

After a Royal Commission investigation into the sector, there is also a renewed focus on the role of registered nurses and other aged care workers – traditionally underpaid and overworked – in a system already under strain due to staff shortages.

Nurses have the clinical skills to provide person-centred care that improves health outcomes for this elderly population. This is reflected in changes introduced this year to the standards around having a registered nurse presence in aged care facilities as well as longer mandated care times for residents. With these new rules in mind, it is even more crucial to train and retain more nurses capable of providing high-quality care to older Australians.

Nurses working in aged care are likely to be in even higher demand after major changes recently rolled out across Australian residential facilities. This comes as an ageing population and staff shortages have turned the national spotlight on the way that older Australians are cared for.

Updated residential care standards have been introduced in response to recommendations from the Royal Commission into Aged Care Quality and Safety (2021). In its report, the commission highlights the importance of taking steps to ensure there is an adequate supply of well-trained nurse practitioners, registered and enrolled nurses, allied health workers, and personal care workers ready to enter the profession.

Nurses acknowledged as essential workers

On 1 July 2023, the Department of Health and Aged Care introduced mandatory minimum level of care, requiring aged care homes to have at least one registered nurse (RN) on duty and on-site 24 hours a day, 7 days a week.

The government later expanded on its commitment to aged care with a requirement that aged care homes deliver a sector average of 200 minutes of care per day to each resident, including 40 minutes of RN care. This will rise to 215 minutes of care beginning 1 October 2024.

The introduction of a mandatory care minute responsibility for residential aged care seeks to improve residents’ access to personal and clinical care. That care, which can only be delivered by RNs, enrolled nurses (ENs), personal care workers, and assistants in nursing, includes tasks ranging from medication management, wound care, bathing and washing, to engaging with allied health services, and developing care plans and strategies.

A month after the 24/7 nurse requirement was introduced, Minister for Aged Care Anika Wells reported a positive uptake, with nearly 88% of facilities having a registered nurse on-site around the clock. However, there have also been reports of aged care providers having to close their doors due to an inability to attract enough nursing staff.

An experienced nurse always being on hand enhances residents’ safety and can prevent unnecessary trips to a hospital. They can employ a range of specialised skills, including:

  • Medication management
  • Pressure injury prevention
  • Wound management
  • Continence care
  • Pain relief
  • Falls prevention and mobility assistance
  • Infection control
  • Dementia care
  • Palliative care

Focus on patient-centred care

As part of the aged care reforms, nurses must also now abide by the Aged Care Quality and Safety Commission’s code of conduct, introduced in December 2022.

These include:

  • Acting in a way that treats people with dignity and respect
  • Allowing them to make decisions around their care
  • Providing services in a safe and competent manner, with care and skill
  • Acting on concerns about matters that may impact the quality and safety of care

This all ties into the new Aged Care Act, which is being developed with the aim of creating a person-centred and rights-based aged care system that will replace the Aged Care Act 1997.

Valuing a trained workforce

Aged care providers have been urged to develop a plan to recruit, train, and retain their staff to ensure full RN coverage, with strategies to assist their ENs and other care workers attain higher qualifications.

In 2022, the Committee for Economic Development of Australia (CEDA), an independent think tank, predicted an annual shortfall of up to 35,000 aged care workers.

“(Wage levels) are part of the problem in attracting and retaining workers,” the report states. “Workers in the sector make substantially less than those working in similar roles and with similar qualifications in adjacent industries such as disability and healthcare. The industry must also address other working conditions, such as hours and rostering, training, and career progression.”

The Australian Government has since backed pay rises for care workers and increased funding for training and education programs. A range of government initiatives to build the workforce include bonus payments and scholarships. Transition- to-practice programs support nurses new to aged care with specialist training in gerontological nursing and mentorship from senior nurses. Student nurses can take part in the Aged Care Nursing Clinical Placements program, which enables them to gain experience in aged care settings.

Tapping into nurse expertise

Ensuring nurses can work to their full scope of expertise is also important, as well as providing the necessary support staff around them. A 2023 national survey of Australia’s nursing workforce found that about one-third of nurses working in residential or community aged care settings were not being allowed to use more of their skills or experience.

Australian Primary Health Care Nurses Association president Karen Booth said, “We can’t afford to have (nurses) clinically under-utilised. If nurses in aged care had the time and resourcing to provide more advanced levels of care, such as preventative care and to properly manage chronic conditions with their patients, this would help improve the overall health of their patients and reduce the burden on the health system.”

Nursing graduates are also important talent resources for the rapidly changing aged care sector, and it is important to prepare them through transition-to-practice programs, such as the one offered by the Department of Health and Aged Care. Effective transitioning and onboarding of new nurses is crucial to help graduate nurses gain professional knowledge and confidence within the context of aged care.

In a recent discussion led by Lippincott® Solutions at the 2023 National Nurse Education Conference, panellist Siobhan See, RN, Clinical Education Lead with UnitingCare Queensland, highlighted challenges the organisation has faced in the aged care sector.

“A lot of the graduates come into aged care because they didn't get a Queensland Health placement, and we don’t pay them as much as Queensland Health,” she said. “So, they're stepping into an RN or an EN position in an aged care facility where they’re essentially running the facility. We’re putting in time and effort into trying to make the graduate program something really supportive.”

Learn how Lippincott® Solutions can support nurses working in Aged Care.

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