22 December 1999

The Future for Aged Care Nursing?

The federal government's reform of aged care which began in 1997 was to give providers flexibility by creating a de-regulated aged care industry which would provide improved care outcomes for residents.

Unfortunately, the results of these policies, and the fact that Queensland facilities are funded at the lowest rate by the federal government, mean that our members in aged care are constantly dealing with staffing level and skills mix crises, non-replacement of staff on sick or annual leave, increasing numbers of high care residents being cared for in low care facilities with insufficient qualified staff, and a campaign to deny the health care needs of residents in aged care facilities by the promotion of ill-conceived 'social' or 'domestic' models of care.

Continued chronic under-funding and de-regulation of the aged care industry means qualified nurses in aged care are now an endangered species.

While not all providers have an 'anti-nursing' philosophy, many complain they are having trouble attracting qualified staff to the industry. However, there has been little attempt to genuinely address the issues of recruitment and retention of nurses within this sector. In fact, the opposite seems to be the case!

Nothing has been done by employers to address the inequality of wages between aged care and the acute sector. Onerous workloads, refusal to retain nursing titles, position descriptions or the career structure and failure to publicly recognise the contribution made by nursing to holistic models of care are sending a clear message to both current and potential specialists in aged care that they are not valued by the industry.

Many providers are ignoring the requirement under the Quality of Care Principles that initial and on-going assessment, planning and management of care for residents is to be done by a registered nurse.

This, coupled with under-staffing and pressure on non-nursing staff to do nursing work, means that many qualified nurses are concerned that their nursing registration is being made vulnerable.

How many of you can state categorically that the quality of care has improved in your facility? How many of you can state categorically that staffing levels have increased, that skills mix has improved, that the numbers of registered and enrolled nurses in residential aged care facilities have increased?

The Minister for Aged Care, Bronwyn Bishop says all that is to be left to the Accreditation Agency and market forces through the approval only of those services that meet the standards. Standards Monitoring is defunct and reliance is placed on the process of risk management, that is, responding to complaints. The accreditation of aged care facilities is not mandatory until January 2001 when our members are suffering now.

Aged Care Forum Being Planned!
Individual nurses in aged care facilities are powerless to remedy the problems. In order for nursing to have meaningful influence over the future we need to come together to identify our objectives and strategies. The QNU will be holding a forum in early February 2000 for aged care nurses, to assist in planning our collective strategies for the future. Further details about the Forum will be published in Union Update and specific mailouts to members in aged care.

ACCREDITATION EXPLAINED
This is a Quality Assurance process introduced through the Aged Care Act 1997 and the Aged Care Principles 1997 and is based on the concept of continuous quality improvement.

Accreditation is the formal method of recognising acceptable standards of services provided to residents in aged care. It should be noted that only accredited services will continue to be eligible to receive funding under the Aged Care Act 1997 after January 2001.

The Aged Care Standards for Accreditation comprise four areas:

Standard 1 - Management Systems, Staffing and Organisational Development; 
Standard 2 - Health and Personal Care; 
Standard 3 - Resident Lifestyle; and 
Standard 4 - Physical Environment and Safe Systems.

These Standards are contained in Chapter 11.7 of the Residential Care Manual and a separate booklet, Standards and Guidelines for Residential Aged Care Services. Both of these publications have been provided, free of charge, to every aged care facility in Australia by the Commonwealth Department of Health and Aged Care.

Each Standard comprises expected outcomes and a number of criteria. Aged Care providers should understand that the Standards are only one component necessary to meet the requirements for accreditation. Other components are the requirements for:

• Certification (Building Approval);  
• Concessional Resident Ratios; 
• Prudentials; and 
• Resident's Rights and Responsibilities.

To achieve accreditation a number of steps are to be followed including:

• Preparation - a critical phase in which providers and staff gain an understanding of the procedure and start a process of self-assessment identifying strengths and weaknesses;
• Application for Accreditation - must be received by the Accreditation Agency by 31 March, 2000
• Desk and site audit by the Accreditation Agency based on the providers application, with the site audit being undertaken by at least two quality assessors;
• Notification is made to the facility of the result of the assessment which is also publicly accessible. Accreditation may be granted for 1 year, 3 years or it may be withheld;
• Accreditation decisions can be appealed if the provider disagrees with the outcome.

The Residential Care Manual, the Accreditation Guide, the Agency newsletter (The Standard) and the Agency website - http:\\www.accreditation.aust.com - will provide further information. Additionally, contact can be made with the Agency office in Brisbane at Terrace Office Park, Level 2, South Tower, 527 Gregory Tce, Bowen Hills, Q 4006; telephone (07) 3852 3100 or fax (07) 3852 3011.

The QNU continues to campaign actively on the issue of protecting nursing in aged care. The lack of adequate funding provided by the federal government for aged care and for aged care in Queensland in particular, is one of the reasons that a range of providers are seeking to promote 'care' models which seek to marginalise the nursing role and see the 'care' required by elderly people in nursing homes as largely 'social' or 'domestic'.

The QNU attended a rally which was organised by a coalition of aged care groups in Brisbane on 10th December 1999, about funding issues. Queensland is disadvantaged by receiving the lowest aged care subsidies of any state. This matter was identified by the Productivity Commission as requiring prompt action by the federal government. Having received the report of the Productivity Commission earlier this year, the Minister for Aged Care, Bronwyn Bishop, has only just announced that Queensland will receive an increase in funding - but not until 2001, with, it appears, the bulk of the funds not being available until 2002.

Queensland requires these funds NOW! While we are happy to support those groups which call for proper funding for aged care, we are also active in warning employers that we expect any increase in funding to be spent on providing proper nursing care for residents. On that basis, we continue to call for the federal government to require providers to account for the money they are given to employ nurses. In the meantime we encourage all members to ensure that these issues are visible in the public. We need to win the support of the community to win these arguments.