August 1999

2 Year Review of the Aged Care Act - QNU Final Submission Summary

The QNU has made a final submission to the 2 Year Review of the Aged Care Act. This follows on from our original submission and representations by officials and members at two consultative forums held in Queensland earlier this year.

The following is a brief summary of our comments in relation to each of the Terms of Reference.

Affordability of care for consumers

Residents in nursing homes require nursing and personal care and the provision of care in these environments is a health issue. The QNU opposes any moves towards a two-tiered health system or user pays model in aged care. Access to either general health care or nursing home care must be based on clinical need, not ability to pay.

Quality of care for consumers

Many people who are admitted to nursing homes come from a home environment where there are community care packages, domiciliary nurses, home help, meals on wheels and for many the constant caring presence of the family. Despite this, their requirements are more than can be provided for in that environment.

Accompanying cuts to operational and administrative staff have also placed added pressure on nurses to perform 'domestic' work. The effect on quality of care is obvious - residents wait longer to have their care needs attended to as nurses are washing dishes and cleaning toilets.

The QNU calls for accountability of care funds to be under the joint authority of the Director of Nursing (or nurse in charge of the service) and the provider, as well as an urgent increase in the Standard Hourly Rate for Queensland

Administration and paperwork changes for both consumers and providers

The QNU is calling for a change to the requirement for validation of funding through documentation. Based on nurses' comments, the QNU believes this contributes to increased workloads and is an ongoing barrier to quality of care for consumers. In aged care, documentation is more often driven in style by validation requirements than by professional nursing models. It has become the practice in many facilities for nurses to document well beyond professional nursing and legal requirements in order to protect the nursing home's funding income. As a result some nurses are spending in excess of four hours a day on documentation, although no funding allocation is available for this activity. Validation occurs by a rigorous and often subjective examination of the nurse's documentation. The futility of such validations seems evident when accountability for money provided for nursing staff is not then required by government!

How the residential aged care system works with other service sectors including community care.

The QNU has been advised by members in public and private hospitals of an increase in hospital admissions of nursing home and hostel residents for illnesses or injuries which previously would have been cared for in their aged care facility. Members believe these increases are due to the reduction in the numbers of qualified nursing staff in nursing homes. This not only results in cost shifting, but is a direct negation of the government philosophy of 'ageing in place' - which was originally put forward to reduce the 'shunting' of older people between facilities.

In the community sector, the award of Community Aged Care Packages to aged care facility providers appears to be contributing to nurses' workloads. The QNU has had many calls from members who now find they have to provide care in the community in addition to their current residential care - without a corresponding increase in staffing.

The QNU has requested that the government monitor these trends (that is, the increase in hospital admissions from aged care facilities and the usage of residential nursing staff to fulfil community obligations) in order to prevent the exploitation of both residents and nurses.

The QNU is concerned that in some circumstances access to registered nursing staff in facilities with averages of one Registered Nurse for between 30 to 60 residents (with some as high as 150 residents) is less than 1.8 hours a day. In many instances, this is less nursing care than provided through a daily visit from a domiciliary nurse Sufficient funding must be available in Queensland to provide appropriate numbers of nurses with appropriate skills levels to provide nursing home residents with the health care they require. This funding must be the subject of accountability mechanisms - that is, providers should be required to prove this money has been spent on employing nurses. QNU monitoring in aged care has shown that cuts in nursing hours are the single most significant result of the removal of accountability for care funds.