workforce
activities. The nurses are very much focused on delivering medical
care. Because they’re also competing with other services that
the hospitals are providing, often the aged care becomes lower
priority, so that the RNs are being taken away from delivering
care to older people, to perform emergency services, outpatient
services or other services.
Deficits in skill mix and knowledge were identified in both
multipurpose services and residential aged-care facilities.
What were some of the nurses’ key concerns there?
In the residential aged-care facilities, one of the outcomes of
reduced funding has been a shift in skill mix across Australia
towards greater employment of care workers and less
employment of licensed staff. That’s a national trend. There’s been
a shift in the scope of practice of care workers, so they’re taking
on a number of skills that were traditionally performed by RNs;
they’re doing things like medication management.
There are concerns among many nurses that these people don’t
necessarily have the knowledge base to be doing this safely. That’s
an issue across all aged care.
In terms of MPS, where you have RNs who are not aged care
specialists, they have knowledge deficits around specialist
gerontic knowledge, and they also don’t understand the funding
mechanisms the way RNs working within aged care do. There are
definite knowledge deficits around dementia care, meeting the
funding requirements, some of the other specialist knowledge that
RNs working in residential aged care have.
In what other ways have the reforms affected the work nurses
do, or the care they’re able to deliver?
I think one of the major impacts of these reforms is the movement
to the user pay system. That’s having specific impacts in rural
areas. One of the things that we’re starting to notice is that
residential aged care facilities aren’t able to fill their beds anymore.
The accommodation bond is actually becoming a barrier to
people moving into residential aged care in rural areas.
Part of that is because often rural people, particularly farming
families, may be asset rich but they don’t have lots of disposable
income. If they sell part of the farm or some of their property, they’re
actually diminishing the family business for other family members.
Also, the housing prices are less in rural regions, so that what
they can get in terms of housing and selling property is going
to be less than what they can in metropolitan regions. If they’re
having to depend on the user pay system, there’s going to be less
money to actually support that.
Also, the MPS at the moment don’t require the accommodation
bond, so there is the competition now between the MPS and
the residential aged care facilities for residents. A lot of rural
people are choosing the option where they don’t have to pay the
accommodation bond, so they’re choosing to wait for a hospital
bed, rather than go into residential aged care.
You said further research is needed into the impact of the
reforms on the capacity to deliver quality aged care in rural
regions. Based on your study, what are some specific areas that
need to be fleshed out more?
We need to keep an eye on what’s happening in terms of staffing
and skill mix, but it would also be interesting to see what happens
in terms of the user-pays system, to see whether it continues to
result in residential aged-care beds not being filled in rural regions.
At the moment, it’s a relatively new trend and there’s not a lot of
data around. That’s something that needs to be followed.
Certainly, the data I have seen from Victoria suggests [the
user-pays system is] already having quite a big impact there. The
data we’ve got from this study also suggests it’s happening in
South Australia. That’s something we need to continue to follow. ■
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