AGED care reform is too slow and does not go far enough, frustrated experts say, leaving residents and their families to navigate life at nursing homes stretched beyond their limits.
And service providers say they are doing everything they can but are limited by dwindling staff numbers, which is putting a lot of pressure on existing staff.
The introduction of mandated staff ratios for the first time was the "big change" coming out of the Royal Commission into Aged Care Quality and Safety, says University of NSW Professor Kathy Eager, who designed the new aged care funding model.
But in the midst of a "genuine workforce shortage" it was taking the industry a long time to respond.
"The system's now in transition and you'll read all these stories ... about homes that won't be able to meet the staffing standards because they can't attract and retain staff, for example," Professor Eager said.
That was likely to continue being a "major issue", despite being designed to drive improvements in the quality of care, Professor Eager said,
"And the one thing we know absolutely is that the quality and safety of aged care is directly linked to the number and mix of staff you've got.
"This is a sector where the quality of care was really awful, awful enough that the government of the day called a royal commission, which is not something governments do lightly, and overall we've seen some improvements, but we've also seen some areas where there's been virtually no improvement."
The question was, what's a reasonable timetable to expect improvements, and that issue was being compounded by genuine workforce shortages in the human services sector, Professor Eager said.
"We can't get enough registered nurses in residential care," she said.
"We can't get enough care workers in the disability sector. And so you get to the point that says, well there's all these people who need care and we don't have enough staff. What do we actually do with those people?
That's where governments come in, she said, because ultimately governments are responsible.
"But we need to be really clear - these are huge issues that require system-level changes that are gonna take years to sort through. Residential age care was neglected for over a decade. It is getting better, but certainly I'm frustrated. I don't think the pace of change is fast enough. And equally I'm sure residents and families feel even stronger than I do about it."
Newcastle-based geriatrician, John Ward, said part of the issue was the way aged care has been separated from health care, and a more holistic approach was needed.
"Nursing homes were never meant to do what they're being asked to do," Dr Ward said.
"When I started as a geriatrician 40 years ago they looked after people who needed high-level nursing care and people who couldn't stay at home."
Now nursing homes are caring for people with chronic mental illness, older people with developmental disability who all get dementia and associated behavioural challenges, as well as young men with frontal head injuries, Dr Ward said.
"They were off in long-stay hospitals being looked after by specialised staff," he said.
"The government closed all of these places, knowing they could dump all these people into aged care facilities where there is one environment, one mix of staff who are usually poorly trained, and poorly paid, and they're trying to look after some of the most difficult people.
"They don't have enough nurses and they don't have nurses with specific expertise with wound care, incontinence, end of life care, and dementia, and they can't get GPs to provide the proper primary care for these people so a small number of GPs are trying to do a huge range of stuff.
"The ones that are prepared to do this work end up with an enormous number of residents under their care.
Dr Ward, aged 79, said two of the GPs who work out at the west side of Lake Macquarie are almost his age, and there is no one behind them.
Meanwhile, hospital-based medicos were complaining that 10 per cent of hospital beds were occupied by people who need aged care, but their problems are too complex and no one will take them, he said.
"The health system does not understand that it's a system, and if you let one part of it fall over like aged care, the rest of the system breaks down."
Previously there were 400 beds in the Hunter for older people with complex issues such as challenging behaviours and dementia, Dr Ward said - Allandale nursing home at Cessnock which had 340 beds, 24 beds at Boronia at James Fletcher Hospital, 22 beds in Morisset, and 21 at an aged care facility at Wallsend.
"Not one bed has been built except for the Hammond Care facility at Cardiff with 80 beds for people with dementia and difficult behaviours," he said.
"It's just as important as any other part of health. It is not helped by the divided responsibility between the commonwealth and state governments, each is trying to pass off the cost to the other
"I know some of the providers are probably not doing the right thing, but by god it's a broken industry."
Service providers in contact with the Newcastle Herald unanimously agree that the industry is facing some serious challenges, many stemming from a lack of available staff and the level of demand on services.
Raad Richards, Chairman of the Port Stephens Veterans and Citizens Aged Care facility Harbourside Haven Gardens, said in the case of that nursing home they were working closely with the Aged Care Quality and Safety Commission (ACQSC) after it found areas for improvement, as reported on Tuesday.
"During the accreditation process we had a number of areas where the standards were unmet, and by working very closely with the Aged Care Quality and Safety Commission we developed a continuous improvement plan, and involved an external consultant, and the commission has accepted that plan and to date we have worked through most of the issues and the commission is satisfied with our progress and hopefully we can complete those actions by end of April," Mr Richards said.
"The sector does suffer major challenges, particularly in relation to workforce, and these become more challenging when you are operating within regional areas because aged care facilities are competing for a small pool of staff.
"Nevertheless, it is the way it's going and we, through our association with government, the Federal Department of Health, we hope to work through issues of funding, training of staff, and the need for a bigger pool of staff to work in aged care, but the situation remains very challenging. The fact that the government is requiring registered nurses in facilities 24/7 from July 1 - a number of facilities will not be able to satisfy that requirement because there aren't enough registered nurses.
"Across Australia there is a need for 11,000 to 12,000 registered nurses, so where are we going to get them from, and that's not just aged care but hospitals and right across health nationally."
A spokesperson for Uniting NSW ACT said it had been acknowledged that continuing challenges with COVID-19 and severe skill and workforce shortages have all led to increasing difficulties for many providers, and Uniting had not been immune.
A Uniting nursing home at Elermore Vale, Koombahla, was named on ACQSC's non-compliance register for the period of July 1, 2022, to February 28, 2023, for not meeting two out of 42 requirements.
An improvement plan was implemented and the facility has since been accredited for a further three years, the statement said.
"When an instance of non-compliance arises, we work with the Commission to address it immediately and regularly undertake our own internal improvement activities.
"We know that delivering quality care needs constant review and attention. We are committed to doing this work in each of our homes, whilst also, as the recent Aged Care Royal Commission pointed out, stressing the need for government, the community and ourselves as providers, to address the chronic underfunding, immature governance and poor workforce planning which has characterised aged care in Australia for many decades."
A Calvary spokesperson, responding to the same report naming three Calvary-owned and run aged care facilities, said the relevant matters there were also addressed immediately.
"All three homes received full re-accreditation of three years," a statement said.
Until the Commission conducts its next unannounced assessment visits, these "Not Met" remain on the register, despite the matters considered "closed".
The CEO for Hakea Grove Aged Care at Hamlyn Terrace, Jo Heslin, said information on ACQSC's non-compliance register was seven months old, and their case, too, had been closed.
"The ACQSC compliance teamy are satisfied there is no immediate risk to residents," she said.
"Our star rating reflects this also. Our resident surveys and reports tell us that our residents feel very safe in our care. The ongoing staff shortages prove to be challenging but this does not deter from our core focus on residents' care."
At two facilities which had above national average rates in quality measures published on the federal government's My Aged Care website said they were specialist facilities, and the star ratings issued did not take that into account.
At Taree's Alkira Lodge, 49 per cent of residents were physically restrained, 27 per cent above average.
According to My Aged Care, high use of physical restraint is an indicator of poor quality care that can lead to physical and mental harm, and should "only be used as a last resort to protect a person's safety".
It is one of five quality measures introduced off the back of the Royal Commission into Aged Care Quality and Safety.
The CEO of Bushland Health Group Limited, Errol Curran, which owns Alkira Lodge, said the home has been re-accredited until 9 August 2025 by the Aged Care Quality and Safety Commission.
"As there are 40 residents living in our secure Memory Care Unit at Alkira Lodge, these residents are all considered to be subject to an environmental restraint, which is deemed for reporting purposes to the Government to be a physical restraint," Mr Curran said.
HammondCare General Manager Residential Care, Angela Raguz, said HammondCare Cardiff, where 55 per cent of residents experienced one or more falls, 23 per cent above the national resident, said it was a specialist dementia care home for residents with complex needs who other providers may not offer care.
"Across all Quality Measures, the Department of Health and Aged Care's myagedcare Star Ratings has HammondCare Cardiff 4 stars out of 5 stars for its Quality Measures.
"The higher falls rate may reflect the profile of people we care for who are mobile rather than bed bound, and we minimise restrictive practices wherever possible.
"We focus on harm prevention rather than zero falls as we believe in people's freedom to move around."
WHAT DO YOU THINK? Join the discussion in the comment section below.
Find out how to register or become a subscriber here.
