I thank the Committee and the Secretariat for work that has been done in relation to this inquiry and thank the people and organisations that made submissions and gave evidence at the Committee's hearing on 9 November 2021.
The Aged Care and Other Legislation Amendment (Royal Commission Response No. 2) Bill 2021 (the Bill) is intended to respond to recommendations of the Royal Commission into Aged Care Quality and Safety. The Minister for Health and Aged Care, Greg Hunt, described the Bill as 'the second stage of aged-care legislative reform to deliver the high quality and safe aged care that our senior Australians deserve'.
The Royal Commission highlighted very serious problems with the aged care system, and no one doubts that urgent action is required to provide better quality of care and services to our senior Australians.
The Bill will progress a range of important reforms, including replacing the outdated Aged Care Funding Instrument (ACFI) model of funding with the new Australian National Aged Care Classification (AN-ACC); improving regulation of the aged care workforce through worker screening and a code of conduct that applies to both workers and providers; extending the coverage of the existing Serious Incident Response Scheme; and enacting improved governance and financial oversight measures.
Unfortunately, however, the Government's leisurely approach to reform which is endorsed by the majority of members of this Committee, fails to look hard at measures that can be implemented to bring prompt improvement, specifically the Royal Commission's recommendation that approved aged care providers be required to ensure that a registered nurse is on duty in a residential facility for at least both morning and afternoon shifts (16 hours per day).
The case for prompt implementation of this reform, and indeed for a 24/7 registered nurse presence at residential facilities, is quite compelling.
Currently, as was confirmed by the Royal Commission, there is no nationwide requirement that nursing homes must have at least one registered nurse on duty at all times. This inconsistent approach leads to significant variations on the level of care and quality afforded to residents and negatively impacts the working lives of staff providing that care within Australia. It also sees unnecessary transfers and admissions to hospitals for aged care residents.
Nursing home residents are older, frailer, and have high rates of complex comorbidities and polypharmacy. There are also large numbers of cognitively impaired residents (i.e. dementia) and residents with mental ill health issues. This means that there is a need for staff with strong clinical knowledge and skills in gerontology, the physiological processes of ageing and their implications for wellbeing in later life. Registered nurses are well placed to holistically care for residents with needs across each of these domains.
Many residents of aged care facilities are not receiving the level of care they require, this is largely due to the increased levels of underqualified staff trying to provide care, and in many instances without the supervision of qualified registered nurses. This puts residents at unnecessary risk of illness, injury and preventable death.
Nurses provide safe, person-centred and evidence-based practice to support and improve the health and wellbeing of residents and, in partnership with the person, promote shared decision-making and care delivery between each individual resident, nominated partners, family, friends and health professionals.
Registered nurses are educated to a minimum standard and are bound by their professional standards and code of conduct to provide person-centred care, a core tenet of nursing practice. Person-centred care helps to ensure better outcomes, satisfaction with care, that each individual resident is cared for in accordance with their unique needs and preferences.
The amendment to the Bill I have proposed would amend the Aged Care Act 1997 to require all approved aged care facilities to have at least one registered nurse on duty at all times within an aged care facility. The registered nurse will be required to provide care and supervise the provision of care to residents of an approved aged care facility.
This proposed amendment attracted support in a number of submissions to the inquiry.
Palliative Care Australia supported the proposal to require residential aged care providers to ensure at least one registered nurse is on duty at all times, noting that 'there may be some rare exceptions to this based on strict criteria such as geography'.
Aged and Disability Advocacy Australia also supported the proposal, stating that it considers having at least one registered nurse available 24 hours per day to be 'a minimum care standard'.
The Australian Nursing and Midwifery Federation (ANMF) expressed strong support for the purpose of the proposed amendment:
The ANMF strongly recommends that the Government implement a phased introduction of 24/7 RN [registered nurses] in nursing homes as a matter of urgency. Care provided by registered nurses is especially important in nursing homes due to an increasing number and proportion of residents with complex care needs, polypharmacy, dementia, mental health care needs, chronic and acute conditions, functional disabilities, and frailty.
The ANMF made a detailed submission regarding the importance of a 24/7 registered nurse presence in nursing homes as well as the ANMF's recommended phased implementation plan for ensuring suitable staffing levels and skills mixes in nursing homes including RN presence 24/7.
While the Royal Commission recommended nursing homes to have a registered nurse in every aged care facility by 1 July 2024, aged care facility residents, their families, the aged care workforce, and the wider Australian community cannot wait that long. Due to chronic understaffing and skills shortages some residents just aren't receiving the care they deserve, and July 2024 – and probably a date sometime after that – is just too far away.
Regrettably the Government members of the Committee, rather than engaging positively with this proposal, have casually dismissed it. Their inability to think proactively and with ambition means that there will be further delay in the implementation of an important measure that would make a significant improvement to the care and well-being of aged Australians residing in residential care facilities.
Fortunately, separately from the proposed amendment to this Bill, I have introduced a private senator's bill, the Aged Care Amendment (Registered Nurses Ensuring Quality Care) Bill 2021, to achieve the same outcome.
In the event that the Senate does not pass the amendment to this Bill that I have proposed, the Committee should have the opportunity to engage further with the specific reform proposed. Accordingly I will move that the Aged Care Amendment (Registered Nurses Ensuring Quality Care) Bill 2021 be referred to the Committee for further inquiry and report.
The question of ensuring the best possible care and support for elderly Australians is too important not to be further considered in the life of the current Parliament.
Recommendation
That the Senate pass the Bill with the amendment proposed by Senator Patrick.
Senator Rex Patrick
Independent Senator for South Australia