Submission to the House of Representatives Standing Committee on Health, Aged Care and Sport’s Inquiry into Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018

COTA Australia welcomes the opportunity to contribute to the House of Representative’s Standing Committee on Health, Aged Care and Sport’s Inquiry into the Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018 (the Bill).

We acknowledge that there are many excellent and capable workers within aged care and support the recent open letter from the Minister for Senior Australians and Aged Care to the aged care workforce. In the letter, Minister Wyatt states ‘I am confident that the aged care sector as a whole is committed to providing senior Australians with high quality care and services’.

We also welcome the recent release of the Aged Care Workforce Strategy Taskforce Report ‘A Matter of Care – Australia’s Aged Care Workforce Strategy’. The report highlights 14 strategic action areas, all of which COTA Australia supports in principle.

Workforce is also one of the five key areas addressed in COTA Australia’s latest position paper ‘Keep Fixing Australia’s aged care system … taking the next steps in tandem with the Royal Commission’, along with improvements to the provision and transparency of information for consumers. In addition to wanting increased pay for aged care staff, better and improved training, the need to have more aged care workers and ensuring that workforce issues are approached in a whole-of-sector manner, we explored the issue of fixed, mandated ratios. A summary of the evidence base for the use of staffing ratios is included as an attachment to our position paper.

Evidence is inconclusive as to whether mandated ratios directly improve quality and safety outcomes for residents. If mandated staff ratios cannot be guaranteed to lead to improvements in quality and safety, then serious questions need to be asked as to whether it is appropriate to impose them. In addition, there is evidence that a mandated staff ratio can lead to facilities who have staffing above minimum ratio levels deciding to reduce their staff, thus impacting negatively on residents in other ways. Our conclusion following the review of evidence was that we do not support fixed and mandated ratios, but do support a more qualified workforce with the right skills mix. What is clear is the ratios are not the place to start. Ratios that increase numbers of poor staff will result in worse outcomes. Improved training, skills development and remuneration are where we should start. If we later end up with care hours ratios we will do so on a much sounder basis.

The Aged Care Workforce Strategy Taskforce also identifies the issue of costs involved to reach the proposed staffing ratio level. In its report the Strategy states “Stewart Brown estimate that the effect of legislating direct care staffing hours to 4.3 hours per resident per day would increase care staffing costs by an overall average of $53.09 per bed per day ($19,379 per bed per annum, currently estimated to be a 20 to 25 per cent increase in total costs for organisations).” COTA presumes that such a significant increase to funding could only occur through a mix of Government subsidies and consumer contributions. Further consideration would need to be given to the capacity of consumers to contribute more and the increase in quality that would be achieved from this measure.

While COTA is unconvinced that mandated, fixed staffing ratios are the answer, based on the limited review of the literature, COTA does believe there are a number of things that can be done to improve consumer outcomes in the broader area of staffing. One of those things is the publication of staffing levels.

COTA Australia believes consumers are entitled to know information about the services they receive and are about to receive. Staffing skills, levels and qualifications are among the most frequently requested information from consumers about residential aged care facilities. COTA therefore calls on Government to make it a requirement for residential facilities to make publicly available the information on their staff including qualifications, quantity of staff and the ratio of staff to residents. In order for this to be meaningful for consumers we believe it must be published in a manner that identifies a facility to be directly compared on a like to like basis with similar facilities.

COTA Australia presents additional specific feedback on changes to aspects of the Bill that we believe are required to ensure that this amendment to the Aged Care Act achieves its intended ‘aim of creating greater public transparency in the provision of residential care services and informing members of the public in any choice they may make regarding residential care services.’