industry & reform
Round the clock
Everything providers need to know about the 24 / 7 nursing mandate .
By Elise Hartevelt
Aged Care Insite delved deeper into the details of reporting , breaks , and exemptions after the roundthe-clock nursing mandate became law on July 1 .
The reform has emerged as a significant concern , especially for small and rural aged care facilities who are grappling with nursing shortages .
Recognising that not all homes could meet the requirement by July , the health department has allowed certain facilities to apply for temporary exemptions .
Residential facilities with up to 30 operational places in Modified Monash Model ( MMM ) 5 , 6 , and 7 locations can be exempted from the 24 / 7 nursing mandate between July 1 , 2023 , and June 30 2024 .
The MMM locations are based on data from the 2020 Aged Care Workforce Census showing that smaller , rural and remote facilities had lower RN rates than larger ones .
The 24 / 7 RN requirement involves only residential aged care facilities , not residential care services , nor does it include flexible care services , such as Multi- Purpose Services .
While enrolled nurses are not allowed to substitute RNs , a graduate agency nurse registered under the National Law as a registered nurse is accepted .
For co-located services within a single facility , only one RN needs to be present and on duty across all services .
But for split services at different locations , each site associated with the service must have at least one RN onsite and on duty , as they are considered separate facilities .
If there are two or more co-located services within a residential facility , they ’ ll
10 agedcareinsite . com . au only be eligible for an exemption where their combined operational places are 30 or fewer .
Additionally , exemption criteria are based on operational places , not occupied places , because the department said it would provide ‘ more stability for providers .’
Using occupied beds as a criterion could lead to homes sometimes being eligible and sometimes not due to changes in the number of residents in care .
If a facility is exempt from the 24 / 7 RN mandate , they still need to meet the other obligations , including the 200 care minutes from October 1 2023 .
The government is providing residential facilities with a 24 / 7 RN supplement through the AN-ACC funding model that should cover up to 60 residents per home .
Providers who are granted an exemption will continue to receive subsidies for their residents through AN-ACC , but won ’ t receive the 24 / 7 nursing supplement .
They can opt out of the exemption if the home can meet the 24 / 7 nursing requirement , after which they ’ ll receive the subsidy .
Eligible aged care homes can apply for an exemption for free anytime since April 3 .
From July 1 , 2023 , all aged care providers are required to report monthly on the 24 / 7 nursing responsibility , including exempt facilities .
The government is developing a new web-based system called the Government Provider Management System ( GPMS ) that ’ ll be used for 24 / 7 RN reporting .
While more information will become available closer to July , the department indicated that an RN is considered ‘ on duty ’ when taking breaks .
But if an RN leaves the premises during a break , the provider must report this period as if no other RN was present on-site and on duty .
Facilities ineligible for exemption and unable to meet the mandate are expected to undertake comprehensive workforce planning to address immediate and longterm workforce supply .
The department suggested strategies such as having a qualified RN as a supernumerary after-hours coordinator to manage clinical care needs .
Earlier this year , the aged care and quality commission said they ’ d consider the circumstances and steps taken by the home to meet the responsibilities .
The Commission is ‘ unlikely to take serious enforcement action against providers ’ if there are no other compliance or performance issues , according to a recent department webinar .
Several programs and incentives are in place to assist providers in attracting and retaining nurses , including payments for nurses working in aged care for 6 to 12 months .
It also funds scholarships for nurses and allied health through the Australian College of Nursing and the transition into practice program to attract more students to aged care .
To tackle workforce challenges in rural and remote areas , the department has commissioned independent research to explore evidence-based alternative arrangements . The final report is expected late in 2023 . Additionally , the department plans to use data from the 24 / 7 nursing reports to develop a model for identifying issues in specific regions and designing future exemption arrangements .
These efforts aim to refine the exemptions policy from July 1 , 2024 .
Aged Care Minister Anika Wells told ABC Q & A host David Speers that the ‘ vast majority of facilities ’ had 24 / 7 nursing in place .
However , Ms Wells couldn ’ t share the exact figures .
“ A lot of people have told us they ’ re going to do it from July 1 , but they ’ re not doing it yet ,” she said .
“ The numbers will come in when people start reporting on their 24 / 7 nursing policy from July 1 .”
Last year , the Albanese government introduced two pieces of legislation to reform the aged care sector .
The Aged Care Amendment ( Implementing Care Reform ) Bill 2022 included a raise to 200 care minutes per resident per day by October 1 2023 , including 40 nursing minutes .
By October 1 2024 , care time will increase to 215 care minutes , of which 44 nursing minutes .
From July 1 , 2023 , all aged care facilities must have an RN on-site and on duty 24 hours a day , seven days a week .
The second bill , the Aged Care and Other Legislation Amendment Act 2022 , introduced the new AN-ACC funding model and launched a Code of Conduct for aged care workers . ■