Irene McInerney has been a nurse for 40 years, working almost entirely in aged care.
"I've got a real passion for that area," she said.
"Older people just deserve the best of respect and care in their vulnerable years."
Ms McInerney is a registered nurse but previously worked as an enrolled nurse — a role that needs a diploma and supervision.
She said both roles were vital in aged care, and she was shocked to find out earlier this month that one of her former employers, Southern Cross Care, plans to make all its enrolled nurse positions in Tasmania redundant.
"Quite frankly, I was outraged."
"Enrolled nurses are licensed, they've got their experience, they've got the clinical eyes that registered nurses rely on, and we've got to stop what's going on."
Southern Cross Care, which has nine homes in Tasmania, has attributed its decision to a lack of funding attached to new aged care reforms.
Unions believe other providers are already starting to exploit a loophole in new reforms to cut costs, and want the government to step in with legislative change.
Labor made fixing aged care a key election priority.
Informed by recommendations from the Royal Commission into Aged Care Quality and Safety, residential aged care homes will need to have a registered nurse on duty 24/7 by July 2023.
And by October 2023, all residents will need to receive an average of 200 direct care minutes per day, including 40 minutes from a registered nurse.
The remainder of the minutes are to be provided by a mix of enrolled nurses and personal care workers, but there are no specific mandated minimum minutes for each of those roles.
Many homes across the country have already started implementing the changes, and last month the new funding model to help fund the increased care kicked in.
But Southern Cross Care said there was not adequate funding for enrolled nurses under the reforms, and so it was axing those positions from its homes.
Opposite to government's intention: union
The federal secretary of the Australian Nursing and Midwifery Federation, Annie Butler, said the union had warned that providers would replace enrolled nurses with lower-paid care workers unless the government mandated minimum care minutes for enrolled nurses too.
She said Southern Cross Care seemed to be the tip of a potential iceberg, with nurses reporting that other providers have been offering care worker contracts to enrolled nurses in New South Wales and South Australia.
"If it's not stopped, it's going to start rolling out across the country. It is absolutely in opposition to what the government wants and what the government is trying to achieve."
In a statement, the chief executive of the Aged and Community Care Providers Association, Tom Symondson, said the sector had also warned that failure to give weight to enrolled nurses could create "perverse incentives" in an environment where two-thirds of homes were operating at a financial loss.
"Some providers may have to reorganise their staffing in order to meet new care minute requirements," he said.
Care from enrolled nurses falling
Dr Nicole Sutton is a senior lecturer at UTS Business School, and was a lead author on a recent UTS Ageing Research Collaborative report into Australia's aged care sector.
The report showed the amount of care being given by enrolled nurses had been declining for the past three years, falling by 28 per cent to about 13 minutes per resident per day.
Dr Sutton said that was consistent with international studies, which showed that when the idea of minimum staffing standards was introduced, there was a risk of the "substitution effect".
"This is when you've got minimum staffing standards that focus on a specific role, and that means that some homes will divert resources away from other roles," Dr Sutton said.
"It also means that if you don't have specific ring-fencing around some roles, then homes that are financially stretched are likely to reduce the number of staff in particular roles such as enrolled nurses, and instead make up any difference using lower-paid workers, such as personal care workers."
Dr Sutton said while enrolled nurses were technically funded under the new funding model for care minutes, UTS modelling had found that the initial price settings of that funding might not be sufficient to cover the full cost of the staffing increase.
"Particularly because since those settings were put in place in March, there's been a massive acceleration in inflation and wage costs, and wage pressures across the sector too."
'Ring-fencing' enrolled nurses a solution
Nurses met with Health and Aged Care Minister Mark Butler and Aged Care Minister Anika Wells in Canberra on Wednesday.
They want 20 per cent of the incoming mandated minimum direct care minutes to be dedicated to enrolled nurses, so providers can not replace all their enrolled nurses with cheaper staff.
"It's got to be stopped, it's a moral outrage," Ms Butler said.
In a strongly worded statement last week, Ministers Butler and Wells said they were very concerned and disappointed with Southern Cross Care's decision last week.
A statement from the Department of Health and Aged Care said the government was closely monitoring enrolled nurse utilisation in residential aged care and could consider legislative changes "if there were found to be systemic issues".
"This could include consideration of separately requiring EN minutes within the care minute requirements," the statement said.
Dr Sutton said ring-fencing enrolled nurses could be a good way to mitigate the risk of them being substituted with care workers, as long it did not affect registered nurse care minutes and homes were able to source enough workers in an environment where there were many staff shortages.
She said it was important to get the aged care staff mix right.
"Often [enrolled nurse] roles involve lots of face-to-face interaction with residents and their families, as well as supervising personal care workers, so we don't want to lose them," she said.
"What's more, if we do lose them, it's likely to put more pressure on registered nurses and increase their workloads."
Southern Cross Care declined an interview request.
