The Australian Nursing and Midwifery Federation (ANMF) wants a registered nurse on duty around-the-clock in all of the nation’s aged care facilities to improve care for vulnerable older patients with complex and chronic conditions.

The ANMF has called for mandated 24/7 RNs in residential aged care facilities as one of six recommendations outlined in its submission to a Senate inquiry set to shine the spotlight on the future of Australia’s aged care sector workforce.

The ANMF has also recommended mandated minimum staffing levels and skill mix for RNs, enrolled nurses (ENs) and assistants-in-nursing (AINs) or personal care workers (PCWs) in aged care, and for minimum education and licensing for AINs.

It’s also pushing to close the wages gap between nurses and AINs working in aged care and their public hospital colleagues.

ANMF federal secretary Lee Thomas said the recommendations aim to strengthen the under-resourced workforce in the midst of a shortage of 20,000 nurses, in a sector where nurses are undervalued and underpaid.

Ms Thomas said the size and composition of the direct care workforce is the key ingredient to providing quality, safe care to the nation’s rapidly ageing population.

“Staffing levels must be urgently addressed,” she said.

“Without legislated requirements in all Australian jurisdictions to mandate a minimum number and type of nursing and care staff, safe and quality care for the elderly cannot be assured. That is a huge concern for all of us.”

The inquiry, due to report on June 30, will consider areas including future aged care workforce requirements, challenges in attracting and retaining aged care workers, and aged care workforce difficulties in regional towns and remote communities.

It will also examine remuneration, working environment, staffing ratios, education and training, skills development and career paths for aged care workers.

The ANMF submission shows the changing composition of the aged care workforce at a time when a growing number of residents are being assessed as high care.

It states the number of full-time equivalent (FTE) RNs in residential aged care dropped 14 per cent between 2003 and 2012, the number of ENs rose slightly at 0.5 per cent while the number of AINs/PCWs grew 50 per cent.

The shift away from employing RNs coincided with a 25 per cent increase in the number of operational residential aged care places, rising from more than 151,000 in 2003 to more than 189,000 in 2014.

There’s also been a rise in the number of residents assessed as high care, from 64 per cent in 2003 to 83 per cent in 2014, while more than half of residents had a diagnosis of dementia in 2014.

The ANMF says it strongly supports AINs/PCWs in aged care as an integral part of the nursing team alongside RNs and ENs.

“However, the workforce data clearly indicates a substantial shift towards the employment of AINs/PCWs at the expense of registered and enrolled nurses in a care environment where the work in many instances requires the skills and knowledge of either a registered or enrolled nurse,” the submission states.

“The consequence of this shift is that the quality of care provided to the elderly has been directly affected.”

Ms Thomas said many “frustrated and distressed” members and supporters have made submissions to the inquiry.

“They talk of poor working conditions and wages, inadequate staffing levels coupled with high workloads, and the unreasonable professional and legal responsibilities placed upon them,” she said.

“It’s a perfect storm and the reason why we struggle to retain, let alone recruit staff into the aged care sector.

“As the country’s largest union, the ANMF welcomes the opportunity to take part in this inquiry and we ask that Senators listen to our concerns and the concerns of our members.”