Adelaide Workshop on Aged Care Program Redesign

The first public session of the Royal Commission into Aged Care Safety and Quality for 2020 was a workshop on the redesign of the aged care system. It was held in Adelaide on Monday 10 February and Tuesday 11 February 2020. In December 2019, the commission issued Consultation Paper 1 on program redesign and called for submissions in response to that paper.

The workshop was used to gather evidence from witnesses in a less formal setting than the public hearings. It helped test propositions in the lead up to the development and finalisation of the recommendations that the Commissioners will make in their final report in November 2020.

On the first day, the Commission presented propositions to industry professionals and researchers around the future structure of aged care. On the second day, the subject was investment and care streams and the transition process into aged care.

Adelaide Hearing on aged care workforce

The Royal Commission into Aged Care Safety and Quality held a hearing in Adelaide on February 21 about the aged care workforce. This continued the inquiry into questions raised during Melbourne Hearing 3, and the Royal Commission’s call for submissions on the topic of workforce in October 2019.

At the hearing, the Royal Commissioners heard evidence from Professor Charlene Harrington and Dr Katherine Ravenswood on workforce issues. Senior Counsel Assisting the Royal Commissioners, Peter Rozen QC, made a 6 part submission outlining some suggested recommendations concerning the future of the aged care workforce.

Counsel Assisting’s submission and recommendations

Mr Rozen QC’s submission addressed staffing numbers and mix, terms and conditions of employment, workforce planning and the role of the Commonwealth, education and training of the workforce and registration of personal care workers.

The submission is based on some very sound principles:

• an approved provider of residential aged care services should have to meet mandatory minimum staffing requirements;
• registered nurses (including nurse practitioners) should make up a greater proportion of the care workforce than is presently the case;
• all aged care workers should receive better training;
• unregulated care workers should be subject to a registration process with a minimum mandatory qualification as an entry requirement;
• the care workforce should be better remunerated and should work in safe workplaces;
• the organisations for which they work should be better managed and governed; and
• the Australian government should provide practical leadership.

The Submission makes the following 11 recommendations.

RECOMMENDATION 1

An approved provider of a residential aged care facility should be required by law to have a minimum ratio of care staff to residents working at all times. The ratio should be set at the level that is necessary to provide high quality and safe care to the residents in its facility and should be based on the following:

• it must be sufficient to achieve a 4 star rating under the current CMS staffing star rating as adjusted for Australian conditions;
• average case-mixed total care minutes of between 186 and 265 minutes per resident per day from a trained workforce comprising nurses (including registered and enrolled nurses), and personal care workers;
• a minimum of 30 minutes of registered nurse care time per resident per day;
• in addition, at least 22 minutes of allied health care per resident per day; and
• that there is a registered nurse (RN) present on each shift and available to direct or provide care subject to limited exceptions.

RECOMMENDATION 2

All approved providers must provide the Department with quarterly staffing levels for registered and enrolled nurses, allied health and other care staff by shift in residential care.

The Department must publish this information at a service level. There needs to be clear explanatory material for older people and their families and carers to access to enable them to understand the published information and compare services.

RECOMMENDATION 3

The Certificate III in Individual Support (Ageing) should be the minimum mandatory qualification required for personal care workers performing paid work in aged care (including residential, home-based, respite, restorative and palliative care).

RECOMMENDATION 4

The Medical Deans of Australia, in conjunction with the Australian Medical Council, the Royal Australian College of General Practitioners and the Australia Medical Association, should establish a working group to:

• review the skills needed by GPs to enable them to meet the anticipated aged care needs of the Australian Population over the next 30 years;
• determine the anticipated need for GPs to deliver geriatric medical services, particularly in the aged care context over the next 30 years;
• review the state of geriatric undergraduate medical education with a view to mandating a core subject that enables the medical graduate to adequately meet clinical needs and anticipate demand; and
• they should have express regard to the ANZSGM Position Statement number 4 – Education and Training in Geriatric Medicine for Medical Students.

RECOMMENDATION 5

Each Australian University Medical School should review its undergraduate medical curriculum with a view towards:

• making geriatric medicine a core element of the undergraduate medical curriculum; and
• making placement in a geriatric clinical setting a required portion of internship training in advance of registration.

RECOMMENDATION 6

The Commonwealth Department of Health should fund and collaborate with the Royal Australian College of Medical Practitioners, the Royal Australian College of Physicians and the Australian Medical Association to conduct an ongoing research program designed to estimate the short, medium and long term demand for geriatric services for older Australians.

RECOMMENDATION 7

The Nursing and Midwifery Board of Australia and the Australian Nursing and Midwifery Accreditation Council should incorporate an introductory module/subject on geriatric medicine and gerontology care into the Enrolled Nurse Accreditation Standards and the Registered Nurse Accreditation Standards.

RECOMMENDATION 8

To increase the supply of nurse practitioners, the Australian Government should introduce scholarship programs (with aged care return of service obligations) for nurse practitioner training and advance skill nursing.

RECOMMENDATION 9

A registration scheme for personal care workers should be established, with the following key features:

• mandatory minimum qualifications;
• scope to require that qualifications be obtained from certain approved training providers;
• ongoing training and continuing professional development requirements;
• minimum levels of English language proficiency;
• criminal history screening requirements; and
• a Code of Conduct and power for the registering body to investigate complaints into breaches of the Code of Conduct.

RECOMMENDATION 10

The Commonwealth should lead workforce planning for the aged care sector, and should identify an agency or body that has overall responsibility for aged care workforce planning, with key actions being:

• long-term workforce modelling on the supply and demand of health professionals and care workers (however described), to inform the development of workforce strategies for aged care;
• overall management of the training pipeline for health professionals and care workers, in partnership with the States and Territories, universities, Registered Training Organisations, National Boards, professional associations, specialist colleges and other key stakeholders;
• driving improvements in labour productivity across the health professions and care workforce (however described);
• ensuring an appropriate distribution of the health professional and care workforce to meet the needs of population across the aged care sector, particularly in rural and regional Australia; and
• facilitating the migration of health professionals and care workers to Australia to address identified health, aged care and disability workforce needs.

RECOMMENDATION 11

The Australian Government should work in partnership with the Aged Care Workforce Industry Council, and provide the financial and practical support necessary to implement the Aged Care Workforce Strategy Taskforce Report recommendations.

The Royal Commission is inviting submissions in response to Counsel Assisting’s submissions on the future of the aged care workforce made on 21 February 2020. The final date to provide submissions in response is Friday, 13 March 2020.

The Commission has published some of the submissions it has received including two lengthy and detailed submissions from the Australian Lawyers Alliance on workforce and program design which the Catherine Henry Lawyers elder law team contributed to.