Ideagen report reveals challenges in meeting Australia's aged care reforms

Nov 27, 23

A new Ideagen report released today has revealed almost one-in-five aged care providers say it is ‘impossible’ to meet the Federal Government’s ambitious round-the-clock nursing requirement.

From 1 July 2023, the Australian Government has mandated that all residential aged care providers must have a registered nurse (RN) on duty and onsite 24/7.

Secondly, from 1 October 2023, providers must also provide a mandatory 200 care minutes per resident per day, including 40 minutes with an RN.

However, the reforms are so demanding that 71% of aged care providers say they are struggling to recruit and retain enough registered nurses, who are often paid less than their colleagues in public hospitals.

In addition, almost half (40%) believe providing 200 care minutes a day to each resident will be ‘difficult to achieve’ and 21% said it was ‘impossible to achieve’. Less than 10% believed the care minute requirements were ‘easy to achieve’.

The findings are contained in the fourth annual Ideagen Aged Care Workforce Report released today.

Ideagen (formerly Complispace) Senior Vice President David Griffiths said the results of the research were confronting for aged care providers, government, employees and older Australians alike.

“Registered nurses are one of the most in-demand professions in the country, yet the aged care system we are moving towards doesn’t seem to acknowledge they can find better paid work elsewhere in public hospitals,” Mr Griffiths said.

“The Royal Commission into Aged Care found that older Australians needed better care from better qualified staff.

“However, the reality in implementing a new system without the corresponding investment, is it is doomed to fail.

“The Australian Government has sensibly acknowledged that not all providers will be able to meet the new threshold for round-the-clock nursing supervision from day one.

“But it is becoming clearer that some providers will never be able to meet the new standards without further support.”

Earlier this year, Aged Care Minister Anika Wells conceded the government would fail to meet its policy commitments. She noted that 80% of facilities were meeting the 24/7 nursing requirements, 9% were steadily working towards it, while 5% in rural or remote areas would never be able to meet it.

Those facilities that are unable to meet the requirements would receive exemptions and support.

To help retain aged care workers in the sector, the Fair Work Commission increased wages of direct care and some senior food services employees in the aged care by up to 15% from 1 July 2023, costing the Australian Government an extra $11.3 billion.

However, the scale of the structural problems may be beyond the Australian Government’s capacity to fix.

The Ideagen Aged Care report found that 53.8% of aged care providers say it is either ‘difficult to achieve’ or ‘moderately challenging’ to have a 24/7 RN on site and on duty at their facility. A further 12% said it was ‘impossible to achieve’.

On the positive side, the ACT is the nation’s reform leader with 41% of respondents believing having a RN on duty at all times is ‘easy to achieve’.

Registered nurses are the third most sought-after skill in Australia with 10,211 current vacant nursing roles, up from 3,081 in June 2020, according to Jobs and Skills.

While the current nursing shortage is confronting, demand for nurses is only going to increase as Australia’s population ages, putting further strains on a system struggling to cope.

The Australian Government’s Intergenerational Report released in August this year forecast the number of people aged 65 will more than double by 2062-63, with those over 80 expected to triple to more than 3.5 million people, and the number of centenarians expected to increase six-fold.

Australia only spends about half of what comparable countries do on aged care (1.1%⁵ of GDP vs the OECD average of 2.5%). Denmark and Sweden spend more than 4%.

This helps explain why 66% of aged care homes operate at a loss, costing in excess of $1.05 billion for the 2023 financial year.

The dire financial position of the sector has started a national debate on whether wealthier older Australians should contribute more to the cost of their own lifestyles, rather than relying on a shrinking proportion of younger working age taxpayers.

Ideagen Aged Care Funding Report that was released in May this year found almost three-quarters of Australians were willing to sacrifice their own inheritance so their parents and grandparents could enjoy their retirement.

“There are limits to how much taxpayers can provide to support older Australians who can fund their own care,” Mr Griffiths said.

“The Federal Government needs to enable greater co-contribution models for those who can afford it, while ensuring consistent, high quality care for those who can’t.”

The Ideagen research also found that almost one-third of all aged care workers are contemplating leaving the sector within the next three years, owing to stress, excessive paperwork and poor pay.

However, this was an improvement as 50% of workers surveyed last year said they intended to leave the industry within the next three years.

Key Findings:

24/7 registered nurse requirement

• 8% say it is either ‘difficult to achieve’ or ‘moderately challenging’.
• 12% say this is ‘impossible to achieve’.

200 care time minutes and 40 RN minutes per day

• 40% of respondents said it was ‘difficult to achieve’.
• 32% say ‘moderately challenging to achieve’.
• 21% say its ‘impossible to achieve’.
• 7% said the 200 minutes was ‘easy to achieve’.

State by State Comparison

• South Australia had the largest turnover with 29.63% saying either their entire management had been replaced or over half the management team had left.
• Tasmanians were unsurprisingly the most likely to leave the industry within one to three years at 36.36% as they were the group calling the most for more staff at 90.9%.
• South Australians are the most likely to leave the aged care industry in less than one year at 27.16%. The state is also experiencing some of the worst staffing levels as they also recorded the highest number of no new staff members compared to other states.
• South Australian respondents reported the highest number of no new staff members at 4.94% compared to last year when all respondents said they had new staff.

Workforce churn

• Nationally, 30% of workers said they could see themselves leaving the industry within one to three years.
• 34% of respondents said there had been turnover of less than half of the management team or no management team member had left.
• 3% said either the entire management team had been replaced or over half of the management team had left.
• Stress was the largest factor that caused workers to leave the industry at 81%. This was followed by excessive overtime/expectations (73%), too much paperwork (68%), and remuneration (49%). This was similar to last year where stress and poor pay were the top two reasons as to why workers left the industry.

Wages

• 4% of respondents this year said the 1 July 2023 wage increase had no effect on quality and efficiency of their work.
• 69% said the increase had ‘harmed quality, efficiency, and things are worse now,’ and 4.61% said it had ‘improved quality and efficiency’.

Acquisitions

• Over 10% of respondents said their facility had been acquired or consolidated in the last year.

New staff

• 97% of respondents say they had new staff at their facility but the number of respondents that said they did not have new staff in the last year increased.
• 6% of respondents said they did not have new staff compared with 0.61% last year.
• Only 17% of workers describe their new staff as well prepared and only 3% describe them as very well prepared.
• 44% describe new staff as adequately prepared (requiring extra training/supervision but posing no risk to residents).
• 32% describe new staff as unprepared and in need of extra training/supervision to prevent risk to residents.
• 4% describe new staff as so unprepared that they pose a risk to residents even with extra training and supervision.

About the aged care industry

• Over 4.1 million Australians, about 16% of the population, are currently over the age of 65.
• About 1.3 million of the 4.1 million people currently receive some form of government subsidised aged care. About 1 million people remain in their own homes and receive a range of occasional or regular visits from nurses and other support staff.
• The Government’s 2023 Skills Priority List report noted in both 2022 and 2023 there was a shortage of aged care registered nurses. It also pointed to aged and disabled carers that had been in shortage since 2021. The report said low staff retention in the care sector could be a result of poor working conditions.

The Ideagen Aged Care Workforce Report is available to download here