‘Impossible’: rural aged care struggles with 24/7 nurses

Rural aged care providers have said having enough 24/7 nurses on-site by July would be 'impossible' as they struggle to recruit registered nurses to live and work in regional areas.

Sue Thomson, chief of regional aged care provider McLean Care, said their advertisements were not yielding any applicants despite offering accommodation, travel expenses and above award pay.

"It's been incredibly difficult," Thomson told Nursing Review.

"It's putting a lot of pressure on us and our existing staff.

"It's almost like the 24/7 nursing mandate is an impossible target, especially for regional and remote Australia."

She said pressure had quadrupled after the health department released the exemption rules late last month, indicating that only 5 per cent of Australia's aged care providers would be eligible.

"There are simply not enough registered nurses around to get the 24/7 coverage across all aged care facilities and the healthcare sector," Thomson said.

"We're competing for what is becoming one of the most precious resources in the country."

Last July, aged care minister Anika Wells announced major reforms to improve quality care, transparency and accountability of providers.

The Aged Care Amendment Bill 2022 required that providers should have a registered nurse on-site and on-duty at all times from July 1st, 2023.

The bill also raised resident care time to 200 minutes per day, including 40 nursing minutes, by October 1st, 2023.

Yet, rural aged care providers said they're scrambling to employ enough nurses to meet the deadline amidst a nationwide staffing shortage.

Federal data from late last year estimated that the reform's impact on the aged care sector would lead to a shortage of 11,800 registered nurses by the next financial year.

A Wells office spokesperson later said the 'workforce gap had shrunk since that briefing note was produced', lowering the estimate to 8,400 registered nurses.

"If the government wants us to meet the requirements, they need to provide us with more nurses," Thomson said.

"But in order to do that, they need to understand the actual depth of the nursing shortage across all sectors.

"That's the next logical step that needs to be taken."

Not-for-profit provider McLean Care is one of Australia's largest aged care organisations in the North-West region of NSW and Darling Downs region of QLD.

They provide residential, community and home-care services to over 3,200 people in predominantly rural and remote parts of Australia.

One in four of Australia's aged care homes is estimated to operate in rural, remote or very remote areas.

Aside from a national nurse shortage, data anticipated that facilities in regional areas have over 10 per cent more homes operating at a loss.

As a result, accountancy firm StewartBrown estimated that over 50 aged care homes could be closing their doors within a year.

Aged care provider Shepparton Villages was one of those who had to close Hakea Lodge in northern Victoria last month due to a lack of staff and financial challenges.

"The burden of proof is on us when the whole nation knows there are not enough registered nurses," Thomson said.

"It just seems counterproductive to put a burden like that on us when we're already putting in so much work in trying to meet the mandates."

Last year, over 500 rural homes indicated they would seek exemption from round-the-clock nurses after the Aged Care Amendment bill was announced.

But the current exemption rules would suggest that just 5 per cent of aged care homes could apply.

The department said that only small facilities of under 30 registered beds in rural and remote Australia (MMM 5-7 locations) could apply for a one-off 12-month immunity.

Under these rules, none of McLean Care's five residential facilities is eligible.

However, the government is yet to announce the official penalties involved when a provider fails to meet the requirements.

A department spokesperson told ABC News last year that those seeking exemption would 'need to prove they had taken steps to ensure clinic care needs were met.'

He continued that it would advise the Aged Care Quality and Safety Commission before approving exemptions.

Commissioner Janet Anderson told the Sydney Morning Herald last year that only providers who seemed 'uninterested in meeting the 24/7 nursing mandate would fall within the regulator's sights.'

Anderson also said the commission would 'take a risk-based and proportionate approach to regulating the new requirement.'

Nevertheless, Thomson said the lack of clarity around sanctions has led to significant stress across the board and within their workforce.

"You can imagine the anxiety this causes," Thomson said.

"The commission has already said they would take proportionate action – so, what does that mean for services that can't recruit the numbers?

"We're already paying our staff above the award rate and have also put a bonus structure in place to meet salaries with the healthcare sector – we can't do much else."

The average annual salary for a registered nurse in aged care in NSW ranges from $70,000 to $90,000.

On the other hand, registered nurses working in NSW hospitals earn between $85,000 to $120,000 a year.

While the Fair Work Commission (FWC) ruled a 15 per cent pay rise for aged care staff, including nurses, in December last year, Thomson said it would do little to solve the issue.

Other rural providers, including Adina Care in Cootamundra, NSW, have been offering incentives, including pay above the award rate – but to no avail.

Thomson said they frequently fly in agency staff from Brisbane to fill the roster gaps in their rural QLD facilities.

She estimated that McClean care is spending an average of $28,000 a month on agency staff accommodation, excluding their wages.

"We'll offer them a roster that suits their lifestyle, and we'll pay for their travel and provide accommodation," Thomson said.

"It's a real juggling act at times to offer that to agency staff without impacting a nurse that has remained true to the organisation."

Uniting NSW.ACT, one of the country's leading aged care providers, said nurse recruitment was significantly harder in regional parts of Australia.

"It will be next to impossible to meet the new staffing requirements by the July deadline," a Uniting NSW.ACT spokesperson told Nursing Review.

"The challenge will be exacerbated with the new mandates.

"Although we applaud the government setting higher quality standards, we need them to be realistic and have enough people available to make the new standards achievable."

Uniting has hired an additional 100 registered nurses in response to the upcoming minimum staffing requirements.

Of the 580 nurses employed in 2018, they now have 700 working across 74 aged care facilities.

While the provider said it also raised wages to compete with hospital salaries, it called for more government resources to compensate for the increased labour cost.

Uniting also urged for clarity around the compliance processes and consequences of not meeting the new requirements.

"Being draconian with imposing consequences for services not meeting minimum staff levels could see further bed closures," the Uniting spokesperson said.

"Such an outcome would be particularly acute in regional areas, where homes are already experiencing significant financial viability pressures due to workforce shortages and increased costs."

Chief of WA aged care provider Baptistcare, Amanda Vivian, said agreed the sector faced a number of pressing issues, not least of which is staff recruitment and retention.'

Earlier this week, BaptistCare announced a merger between the NSW & ACT provider and WA organisation to improve financial sustainability and staffing levels.

Vivian said she hoped the merger would better align the organisation with the federal government's coming reforms, including the 24/7 onsite nursing mandate.

"No one in the industry is immune to the pressure on the existing aged care workforce and the current staffing crisis in health care in general," Vivian said.

"We are working towards meeting the mandated care minutes and on-site nurses, although we highlight that even the health department has acknowledged the staffing shortage.

"But as a larger organisation, we'll be better equipped to meet this challenge."

Aged care provider RSL LifeCare told Nursing Review they were on track to meet the standards of aged care personnel as required by the government.

"We appreciate that the sector is under pressure, like many healthcare sectors," an RSL LifeCare spokesperson said.

"It's important that governments and stakeholders continue to work together to encourage more workers to take up aged care.

"We must ensure that those in aged care and assisted living are provided the highest standards of care."

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