As the Australian federal government's requirement for 24/7 registered nurses (RNs) in residential aged care comes into effect from 1 July 2023 (with mandatory care minutes to follow from 1 October 2023), regional and remote residential aged care services are considering whether they can remain open in the face of extreme RN shortages.
While no one disputes the value of more nurses and care minutes for improving care outcomes, the focus on these new requirements has overshadowed the harsh realities of RN workforce constraints faced by regional and remote aged care providers. Struggling to meet even the current workforce requirements, these mostly not-for-profit providers must also contend with an inflexible regulatory environment, putting their mission and sustainability at significant risk.
Aged care providers in regional and remote areas face immense difficulty attracting registered nurses, despite offering lucrative salary packages that can double what they would be offered in metro areas. They must rely on ludicrously expensive FIFO or DIDO agency staff (who don’t know their residents or systems) and lesser qualified Enrolled Nurses (who simply can’t replace an RN’s scope of practice). In the end, this impacts their compliance and their financial sustainability.
Anika Wells recently argued that providers should feel optimistic about the aged care sector's prospects and assured them that no facility would be closed for not meeting the care minute and registered nurse targets. However, this call for optimism misses the point. The reality is that regional and remote aged care providers are barely managing to meet current quality standards relating to workforce due to RN workforce constraints. What’s more, when the Aged Care Quality & Safety Commission assesses these struggling providers, no concessions are made to account for such constraints. Minister Anika Wells might say that no home will be closed if they don't meet the targets, but these providers will be penalised by the regulator in other ways (eg. sanctions and forced exits) for failings which are not of their making.
Yes, common sense changes must be made to the RN targets and mandatory care minute requirements to ensure that providers who are doing everything they can to meet the targets are not unfairly penalised. This will allow them to concentrate on their primary objective of caring for their residents. The Aged Care & Community Providers Association has proposed some very sensible amendments to the legislation in this respect. I would also argue that the government should revisit the use of the Modified Monash Model to assess remoteness and therefore funding/available exemptions. The current model does not accurately reflect the realities that many regional and remote services operate in, particularly in Western Australia where even towns with relatively large populations are isolated by the tyranny of distance from the rest of the State.
However, ultimately, the focus of the government must be on the broader issue of addressing the RN workforce shortages in regional and remote areas. Among other things, this needs to include a reining in of the Aged Care Quality & Safety Commission to require it to actively consider the context within which aged care services operates including any constraints which are not of its making.
Further, the government should create a specific visa category for skilled migrants willing to work in aged care in regional and remote areas. This would help alleviate the workforce shortage by tapping into a pool of skilled and dedicated professionals who could contribute significantly to the aged care sector.
The unspoken crisis faced by regional and remote aged care providers must be acknowledged and addressed to prevent the gradual retreat of not-for-profit providers from these areas. By recognizing the workforce shortages and regulatory challenges, providing targeted support, creating a specific visa for skilled migrants, and revisiting the Modified Monash Model, we can ensure that aged care providers continue to fulfill their mission and that elderly Australians in regional and remote areas receive the care they deserve. Only through a comprehensive and tailored approach can we truly address the ongoing workforce and regulatory crisis impacting the regional and remote aged care.
This article first appeared in Amber Crosthwaite's article for Business News Magazine on 28th of April 2023.