Considering the new minimum staffing standards for Australian residential aged care

Abstract

Objective To compare the historical staffing patterns and organisational characteristics of Australian residential aged care facilities (RACFs) against the new minimum staffing standards recommended by the Royal Commission into Aged Care Quality and Safety (RCACQS). Method Retrospective data analysis was used to compare the staffing levels and characteristics of 1705 RACFs (for 4 years, 2016–19) with the three new mandatory staffing requirements. De-identified datasets were provided by the RCACQS, obtained under its legal authority. Results Only 3.8% of RACFs have staffing levels at or above all three requirements. Although many (79.7%) already meet the requirement to have a registered nurse (RN) on-site for morning and afternoon shifts, few have staffing levels above requirements for total direct care per resident per day (10.4%) or care provided by an RN per resident per day (11.1%). Historical levels of on-site RNs, total direct care, and RN care vary significantly across facilities of different size, location and provider scale. Conclusion The new staffing standards, to be mandatory by 2023, prescribe minimum requirements significantly higher than existing levels, particularly in care per resident per day. Each of the three requirements will likely have a differential effect for different types of RACFs. What is known about the topic? International evidence suggests that introducing mandatory minimum staffing standards tends to increase the amount of care provided by staff in residential aged care facilities (RACFs). However, the impact of staffing standards is influenced by the stringency of the minimum threshold relative to existing staffing levels, the capacity of organisations to increase their staffing levels, and the specific way the regulation is formulated. What does this paper add? This paper explores the potential implications of the three national minimum staffing standards, to be in force by October 2023, specifying total direct care, care received by a registered nurse (RN), and an RN on-site. By examining the existing staffing levels of Australian RACFs, it identifies the extent to which facilities already meet the new standards and the characteristics of facilities with staffing levels above and below the three requirements (individually and in combination). What are the implications for practitioners? The study informs both policy and practice in relation to the likely effects of implementing the national minimum staffing standards for residential aged care in Australia. It demonstrates that the new minimum thresholds are likely to require substantial increases in staffing across the sector, both in terms of all direct care workers and RNs. It also shows that the three requirements are likely to have a differential effect for RACFs of different size, location and chain affiliation, thereby guiding policy about the future needs for Australia’s aged care workforce.

The quality effects of agency staffing in residential aged care

“…Workforce shortages – a key driver of agency staffing – are already a perennial challenge within the sector and are expected to continue in the next decade 4,26 . In the near term, staffing shortages are likely to be exacerbated as providers attempt to increase staffing levels to meet the incoming mandatory minimum standards, 27 while managing the workforce demands and disruptions from the COVID‐19 pandemic 28 . Another reform that may alter providers' workforce models is the windup of the Aged Care Approval Round programme (‘bed licenses’) in 2024 29 .…”

Staff perspectives on end-of-life care for people living with dementia in residential aged care homes: qualitative study

“…The participants of this study emphasized the observed benefits of of care to residents living with dementia and end-of-life care needs, suggesting regular staffing patterns were integral to achieving this. However, difficulty with staff retention, as echoed in the findings from our study, remains an enduring problem for the aged care sector (24). The international health services community ought to prioritize research that will assist in building a sustainable aged care workforce capable of withstanding the pressures of an aging population, recognizing and responding to the increasing prevalence of dementia among the cohort, and delivering high-quality palliative and end-of-life care to these people.…”