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Staff ratios in aged care: an ongoing debate

The need for mandated staff-to-patient and staff-to-resident ratios in the health and aged care sector are once again up for debate following an announced election promise from the Queensland Labor State Government.

Ratios for aged care are once again being lobbied (Source: Shutterstock)
Ratios for aged care are once again being lobbied (Source: Shutterstock)

Premier Annastacia Palaszczuk announced on 30 October that if her government was re-elected on 25 November, it would commit $167 million to a number of health and aged care initiatives including:

  • Expanding safe nurse-to-patient ratios in acute public mental health wards
  • Introducing public reporting on safe staff-to-patient ratios in aged care settings
  • Lobbying the Commonwealth Government to staff-to-resident ratios (including nurse-to-resident ratios) in private aged care facilities
  • And harnessing the expertise of nurses to lead programs to improve the coordination and integration of patient care between hospitals and the primary care and aged care sectors

Queensland Health Minister Cameron Dick says the the announcements are commitments to patient safety and care quality.

“Implementing and reporting on these ratios is a key component of our commitment to patient safety and quality care,” he says.

“We will continue to maintain and report on safe nurse-to-patient ratios in a range of acute care settings.”

Minister Dick adds that as part of the second stage of nurse-to-patient ratio implementation in Queensland, the ratios will be extended to all public acute mental health wards.

Queensland Nurses and Midwives’ Union (QNMU) Secretary Beth Mohle has commended the Palaszczuk Government’s decision to introduce public reporting on nurse-to-resident ratios in State Government aged care facilities and to lobby the Federal Government for nurse-to-resident ratios in private aged care nation-wide, after making the call to have legislated nurse numbers in aged care facilities legislated just days prior.

While the QNMU has welcomed the election promise announcement, Leading Aged Services Australia (LASA) Chief Executive Officer (CEO) Sean Rooney has written to the Queensland Premier to ‘query this approach’ and propose a more ‘informed and appropriate way forward’.

The CEO has further condemned the debate saying that efforts would be better served by focusing on the quality outcomes for older Australians rather than mandated staffing ratios.

He says that it was not negotiable that older Australians and their families should be assured that the quality of care and services they are receiving meet stringent national standards of quality and safety.

“However, notwithstanding recent public commentary in aged care regarding staff-residents ratios, quality of care is not as simple as the number of staff on duty or arbitrary staffing ratios,” Mr Rooney explains.

“The basis for deciding on staffing levels and their skills mix needs to be driven by the actual care needs of individual residents.

“Flexibility to adjust the staffing mix as the profile of residents change is a very important consideration and I believe we risk losing sight of this in the current debate.”

Mr Rooney refers to the Australian Government’s 2011 Productivity Commission Report, Caring for Older Australians, which finds that while there are superficial attractions to mandatory staffing ratios, there are also downsides.

The report notes that “an across-the-board staffing ratio is a fairly ‘blunt’ instrument for ensuring quality care because of the heterogeneous and ever-changing care needs of aged care recipients - in the Commission’s view - it is unlikely to be an efficient way to improve the quality of care”.

The report adds that “imposing mandated staffing ratios could also eliminate incentives for providers to invest in innovative models of care, or adopt new technologies that could assist care recipients”.

Mr Rooney says technology could have a huge role to play in the future of aged care and that the workforce of tomorrow will be dramatically different from the workforce of today and yesterday.

“New models of care and the use of new technologies will result in us working very differently in the future as compared to the past,” he says.

“This too will impact on the number, mix and competencies of the age services workforce of the future.”

He adds that the Federal Government’s recently announced Aged Care Workforce Taskforce is responsible for developing a wide-ranging workforce strategy focused on supporting safe, quality aged care for senior Australians.


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