With the aged-care numbers in Australia on the rise, today close to 200,000 elderly Australians are residents of aged care homes. At least 80 per cent of them require high care, because they have dementia, chronic pain, incontinence, sleep disorders or depression, or a combination of these disorders. Managing these conditions requires the experience and expertise of a team of healthcare providers, including registered nurses, doctors, psychologists, psychiatrists and physiotherapists.
However, many aged care centres are short of skilled staff and employ personal care assistants who are not qualified enough to handle such a demanding task. At present there is no legislation in place to ensure that every aged care home has a minimum of one registered nurse on the site at all times, but such a law is sorely needed. While trained registered nurses are competent to evaluate, monitor and manage such distressing and complex medical conditions; personal care attendants do not have the requisite training or experience to handle such patients.
In Australia, registered nurses should necessarily have completed a three-year bachelor degree in nursing, and enrolled nurses should have completed an 18-month diploma. They should have obtained a registration with the Nursing and Midwifery Board of Australia and must meet certain minimal standards in order to practise in the country. Personal care assistants, on the other hand, need to have completed an Ageing Support courses such as a Certificate 3 in aged care, which can be completed in five short weeks. They are not required to have any prior experience or exposure to the field and they are not overseen by a Board or governing body.
Registered and enrolled nurses who take care of the aged are skilled at administering medication, managing nutrition and hydration plans, controlling infection, monitoring dementia, depression and other challenging behaviours, managing chronic care patients and so on. Personal care assistants, on the other hand, are trained to take care of the residents’ personal hygiene activities, such as washing and toileting. They also perform routine tasks such as assistance with meals and help residents move around. They are supposed to report to a registered nurse, and let them know about any sudden or alarming changes in the behaviour patterns of the patients under their care. In the event that there is no registered nurse who is overseeing the care of a group of such patients, timely treatment often is withheld from them and this can even have disastrous consequences.
The Aged Care Act (1997), states that providers must maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met. However this is not enforced through federal legislatives that mention any specific staff-to-resident ratios or skill prerequisites in Australian aged care homes.
Recently, however, the Victorian government has introduced the Safe Patient Care Act. This Act lays out the ratios of registered nurses for around 30 or so state-owned aged care homes. It specifies that during the morning shift, one registered nurse is required for every seven residents; while in the afternoon, one registered nurse is mandated for every eight residents. During the night shift, one registered nurse is required to be present for every 15 residents. This situation has happy outcomes, with residents getting better care and fewer among them having to be shifted to hospital.
The rising deficit in skilled nurses in the country has led to an influx of aged care workers who, armed with just a diploma, have started on a career in healthcare in Australia. While many of them do study further and become qualified nurses, at present over half the workforce is comprised of personal care assistants – who, while they are sincere workers, do not have the requisite experience or training to take responsibility for large numbers of aged patients. In fact, due to the shortage of registered nurses and the rising numbers of elderly patients, one registered nurse is often required to oversee the care of up to a 100 residents. This results in inadequate personal attention, leading to conditions like pressure ulcers, poor nutrition and negligent care.
It is important that the federal government must mandate nursing homes to provide at least one registered nurse at all times, and more in case there are larger numbers of patients in the home. By implementing appropriate nurse-resident ratios, the care given to the aged can be greatly enhanced.