6 May 1999

Aged Care and Prescribed Services Update

Some very significant changes in the provision of aged care services have occurred over the last two and a half years. The latest is an attack on the Prescribed Services provision and details of the changes approved by the Minister are outlined below. It should be noted that residents are required to have initial and ongoing assessment by a registered nurse.

What are Prescribed Services?

Broadly, prescribed services refer to services that need to be provided by appropriately qualified staff. Requirements for nursing care were identified under the Quality of Care Principles 1997. These Principles set out basic nursing care requirements based on resident acuity. The requirements included provision for 24 hour on site care by a qualified nurse where there are eight or more high care residents.

Many proprietor organisations lobbied strongly for these provisions to be removed (particularly the requirement for 24 hour registered nurse coverage in facilities with 8 or more high care residents) on the basis that it was not efficient or cost effective. They particularly targeted examples of stand-alone dementia units, arguing that care of dementia residents did not require services provided by registered nurses. The QNU and ANF argued that to change these provisions simply to pacify dementia units would adversely affect the whole of the residential aged care sector, and that dementia residents do in fact need the services of registered and enrolled nurses.

Quality of Care Amendment Principles (No. 1) 1998

The new principles, recently approved by Minister Warwick Smith include the provision that care and services are to be provided in a way that meets the Accreditation Standards and the Residential Care Standards.

The new principles require initial and on-going assessment, planning and management of care for residents to be carried out by a registered nurse, or other professional appropriate to the service (eg. medical practitioner, stoma therapist, speech pathologist, physiotherapist or qualified practitioner from a palliative care team). These services may include, but are not limited to the following:

• establishment and supervision of a complex pain management of palliative care program, including monitoring and managing any side effects;
• insertion care and maintenance of tubes, including intravenous and naso-gastric tubes;
• establishing and reviewing a catheter care program, including the insertion, removal and replacement of catheters;
• establishing and reviewing a stoma care program;
• complex wound management;
• insertion of suppositories;
• risk management procedures relating to acute or chronic infectious conditions;
• special feeding for care recipients with dysphagia (difficulty with swallowing);
• suctioning of airways;
• tracheostomy care;
• enema administration.

All high care residents are now required by law to receive nursing services provided by a registered nurse.

The Resident Classification Scale (RCS)

Question 18 of the RCS relates to Technical and Complex Nursing Procedures. There are two lists of services under this question. List 2 is identical to the list of nursing services listed above under the Quality of Care Amendment Principles and contains the assumption that all items will be carried out by a registered nurse and be based on the initial and on-going assessment, planning and management of the care recipient's care by a registered nurse. List 1 also lists a range of nursing procedures that need to be carried out in accordance with the requirements of relevant State/Territory legislation. The QNU has argued that all these procedures should be carried out by qualified nurses. An Enrolled Nurse under the supervision of a registered nurse can effectively and appropriately perform procedures in List 1.

Documentation

It should be noted that it is the view of the QNU that as part of the assessment, planning and management of the resident care process, the registered nurse is required by law pursuant to sub-section 3.8 Nursing Services under the Quality of Care Amendment Principles, to undertake the preparation and development of the plan for the care of the resident. Consequently, the registered nurse must be pivotally involved in the documentation of the record of care of all residents.

2 year review of Aged Care reform

Members will be aware that the Federal Government is required to conduct a review of the reforms in Aged Care - in particular the Aged Care Act 1997 - within the next 12 months.

As part of the QNU's preparation for this review, we have published the results of a 12 month survey on the Impact of Aged Care Reform on Nurses. The results have been distributed to aged care members, branches and relevant organisations and Queensland members of federal Parliament (past and future).

A major part of the review process commences in November with the conducting of focus groups around the country. The two Queensland groups will be held in Townsville and Brisbane. The QNU was asked to nominate members to attend each group session, and two members of the QNU Aged Care Reference Group and a QNU official will attend the focus groups. Members will be kept informed of progress and outcomes of the review as that information becomes available.