workforce
The rural reaction
Photo: Taylor Leopold @unsplash
Nurses discuss the effects of changes to the
system on aged care far away from cities.
Julie Henderson interviewed by Dallas Bastian
F
unding and resource shortfalls. Staffing shortfalls. Skill-mix
and knowledge deficits.
These were some of the barriers to care delivery RNs and
enrolled nurses said they face working in rural aged care, as part
of a study exploring their perceptions of the impact of reforms in
the sector.
Dr Julie Henderson, from Flinders University, was a member of
a research team that interviewed RNs and enrolled nurses working
with aged-care residents in rural South Australia. Of the 11 nurses
interviewed, seven worked in multipurpose services (MPS) and
four in residential aged-care facilities (RACF).
One RN working in an RACF identified difficulties in accessing
the “right sort of dressings” for wound care, while another
talked of “stealing from Peter to pay Paul” to provide adequate
equipment. “There was also a perception that the situation was
worsening,” the article read.
The paper also quoted another RN working in an RACF as saying:
“I see people who have more and more complex needs, being
looked after by less qualified people, and I’m not quite sure how far
we can go down that road without something having to give.”
Aged Care Insite sits down with Henderson to discuss the
reforms affecting aged care in rural areas and how the issues
nurses identified affect their capacity to deliver the care required.
ACI: What were some of the aged-care reforms that
sparked this study?
JH: In 2011, the Productivity Commission made a number of
recommendations about funding of aged care, to make it more
30 agedcareinsite.com.au
sustainable because of the ageing of the population. They’re
arguing that there aren’t going to be enough younger people in the
workforce to be able to pay, through taxation dollars, for aged care.
Some of the things they did were to introduce a user-pays
system. This involved the re-establishment of the accommodation
bond, and the introduction of a savings and credits scheme, which
enables older people to pay the bond. They’ve also removed the
distinction between high and low care, and they’ve reduced the
reporting requirements and also removed restrictions around the
licensing of aged care beds. What that has meant is greater private,
for profit, ownership of aged care now than previously. Though, in
rural Australia there’s less of it. In rural Australia, there has been a
movement away from government provision of services.
You interviewed RNs and enrolled nurses working with
residents of aged care in rural South Australia. Some of the
key barriers to care delivery they identified included funding
and resource shortfalls, and staffing shortfalls. What did the
interviews reveal about the impact these issues are having on
nurses’ capacity to deliver the care required?
This research is part of a larger research agenda that we’re
undertaking at Flinders University, into missed care in nursing.
What underpins that research is the idea that nurses and carers
can no longer deliver all the care required because there is
insufficient staff and resources.
As part of that, they have to prioritise what they deliver. That
means some aspects of care just cannot be performed.
We found that this differs by funding model. For example, the
residential facilities are being funded under the ACFI model, and
because of the skill mix they have, there are shortfalls around
delivering some of the complex healthcare needs the residents
require. Meanwhile, for the multipurpose services, which are
often attached to hospitals, there is a shortfall around social care