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Budget Commentary - Professor Joanne Travaglia of the UTS Faculty of Health

Budget Commentary - Professor Joanne Travaglia of
Photo: Jo Travaglia
By Professor Joanne Travaglia

While the Federal Government can see that more staffing is required for best practice aged care, it should have gone much further in the May Budget to ensure best practice healthcare for the nation’s aged community.

While the promised $17.7 billion of funding for the aged care over five years is a significant start to improving outcomes for aged Australians, it does not go far enough to solve the ingrained problems in the sector.

The Royal Commission into Aged Care Quality and Safety estimated that one in three people living in aged care in Australia experiences neglect, or physical or emotional abuse. Lack of training was identified as one of the principal causes of this substandard care, along with inadequate staffing levels and a lack of skills.

The Government will provide $216.7 million over three years to upskill staff, including by making specialist aged care nursing scholarships available. But this is not enough to address the urgent need for skills upgrading and training and the obvious need for the auditing of aged care services.
The sector needs far more funding for upskilling, particularly in looking after patients with dementia. As many as 70% of people in residential aged care could be living with dementia.

Dementia, including Alzheimer's disease, overtook lung cancer as the second leading cause of death for men and was the leading cause for women in 2019, according to the Australian Bureau of Statistics (ABS).

The Royal Commission found that nurses and general practitioners do not have a full understanding of the needs of people living with dementia. It is therefore crucially important to train workers to better care for those with dementia and in aged care more generally.

What we also need to do is to draw more skilled workers to the sector. In aged care homes around Australia, the Royal Commission found there are not enough trained workers, particularly nurses, to care for the nation’s aging population.

Too often, the mix of staff who provide aged care is not matched to the needs of older people. Even at the level of raw numbers, it is not clear where the extra staff will come from, particularly as COVID-19 continues to disrupt the flow of people into Australia.

Importantly, the Budget does not address the need to attract more nurses into aged care. We have seen a gradual fall in the number of nurses working in the sector and, alongside that, a decline in the quality of medical services that aged patients receive.

The Royal Commission found that registered nurses comprised 21% of the residential direct-care workforce in 2003, but by 2016, this had dropped to around 15%. The proportion of enrolled nurses also dropped, to 10% from 13%.

The budget will fund a retention bonus of $3700 for nurses who work for the same aged-care provider for 12 months, but it does not tackle the lack of career pathways for nurses.

Many nurses having left the sector or choosing to work in other healthcare areas with more rewarding workplaces, and a one-off bonus will not be enough lure them back.

Crucially, the Royal Commission identified that the aged care sector as a whole is not just underpaid but also undervalued. Many registered nurses are not happy working in aged care, and no amount of money can fix that.

The Royal Commission recommended an injection of $10 billion a year and the Budget falls short of allocating that amount.

The implications of this can be seen in some of the targets, such as the government’s plan to reduce the home care waiting list by 80,000 over the next two years.

However, reduction of that size is not likely, given that the Royal Commission found that, as of June 2020, almost 103,000 older people were waiting for a package.

Other Budget measures include staffing requirements for residential care, under which every aged care resident will receive 3 hours and 20 minutes of care a day. Of that, at least 40 minutes of that care will need to be provided with a registered nurse.

From July next year, at least one registered nurse will need to be on shift at every aged care facility for a minimum of 16 hours a day. But the Royal Commission recommended a nurse be on site 24 hours a day to ensure a better standard of safety and care.

Again, the Government has not responded adequately to a key recommendation.

At the very least, the Government should have mandated minimum staffing levels in aged care homes and insisted on there being a registered nurse on-site 24 hours a day in all aged care facilities.

Its reluctance to respond to the Royal Commission’s demand in this area clearly indicates that the problems are many and various. More than just money is required to solve the problems – careful planning and determination by all stakeholders are crucial.

About Professor Joanne Travaglia

Professor Joanne Travaglia is a medical sociologist with a background in health services research, management and leadership. She is Professor of the Master of Health Services Management, Director of the Centre for Health Services Management, and Discipline Lead (Health Services Management) in the Faculty of Health, UTS. After training as a social worker, she has worked in the health, welfare and higher education fields. Joanne has undertaken research on policy implementation, service development and provision; age and disability care; organisational diversity; cultural competence; peer support; leadership and management development in healthcare; and adult education and training. Over the last two decades, she has received multiple evaluation and research grants, including contracts with Australian and international governments.

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