What's wrong with staffing regulations in aged care? Unsafe staffing in aged-care facilities, which compromises the care of elderly residents, continues. But action to improve staffing also continues.

Last month, NZNO ran three very successful regional training days for caregivers working in aged care, to mark NZNO's National Caregivers' Week. In Wellington there were so many enrolments, a bigger venue was needed. The high attendance at these annual training days, held in Auckland, Wellington and Christchurch, reflects caregivers' hunger for relevant education. Many aged-care employers pay for their staff to attend and NZNO has had requests from employers outside the three cities, to come to their facilities and present the programme for their caregivers and other caregivers working in the same town.

Caregivers attending these days always raise concerns about safe staffing and some hair-raising information always comes to light about facilities that are dearly not staffed safely. This year was no exception, thus it was timely that NZNO and the Service and Food Workers' Union Nga Ringa Toa (SFWU) launched a petition at these training days, calling on the Government to regulate for safe staffing in aged care.

The umbrella organisation for aged-care employers, HealthCare Providers New Zealand (HCPNZ), subsequently issued a press release NZNO scaremongering on staffing ratios, which claimed that what NZNO really wanted was "...a return to the days where everything is government regulated and one size fits all." (1)

Why are staffing regulations needed?

Our petition says nothing about "staffing ratios" but does ask government for mandatory staffing regulations in the sector. There are currently no such staffing regulations. Why do NZNO and SFWU want staffing regulations? Is it because we want "one size fits all", as HCPNZ alleges? If that "one size" is about quality care for every one of our elderly residents, then yes, we are guilty as charged! We know there is a direct relationship between the quality of care and the number and nature of staff available to provide that care.

The Government's 2002 committee of experts charged with considering regulation for the aged-care sector agreed. "There is a significant international literature in healthcare regarding the relationship between the quality of patient care and healthcare staff levels and skill mix." (2) Study after study has demonstrated the relationship between staffing numbers and quality of care. These studies demonstrate a staffing threshold at which staffing is optimum for quality care and that if staffing is under that threshold, then care will suffer. Many studies have also determined that the number of registered nurses available to provide direct patient care has a direct bearing on "... the improved functional status for residents, lower mortality rates, increased discharges from nursing homes, fewer decubitus ulcers, less restraint use, fewer catherisations, urinary tract infections, and less antibiotic use." (3) And, that short staffing and inadequately trained staff generate negative outcomes "...including malnutrition, dehydration, starvation, hospitalisation, high urinary catheter use, low rates of skin care, and low rates of participation of residents in activities." (3)

Clearly, it not just minor inconveniences residents suffer as a result of inadequate staffing--they can suffer greatly because of short staffing and inadequately trained staff. Is this what society wants for those in residential care? Many of the residents in aged-care hospitals are no longer able to speak for themselves; many have a combination of disabilities, including being unable to see, hear, walk, feed or toilet themselves. They are completely dependent on other people to care for them; in fact, they cannot be cared for in an aged-care hospital unless they have been assessed as no longer able to safely care for themselves.

NZNO and the SFWU are petitioning government to do for those in aged-care facilities what it has already clone for another vulnerable population, ie children, eg by regulating the ratio of staff to preschoolers in early childhood education centres and regulations demanding fencing of private swimming pools. Part of the rationale for government regulations in relation to children is because they are vulnerable and unable to care for themselves. Surely those in aged care have similar vulnerabilities and need for protection.

Cost is the issue

Why is the Government reluctant to regulate for safe staffing and why is HCPNZ so scathing about aged-care providers having to staff their facilities safely? The issue is cost. Elderly care is mostly a for-profit business these days. The more staff a provider employs, the bigger the wage bill, which means a smaller return to shareholders. That is "not good for business" It is interesting to note that not-for-profit providers, despite scarce funding, tend to have better staffed facilities than the for-profit providers.

Staffing regulations would mean more government funding would have to be put into the sector because, at present, virtually all staff costs are government funded. Generally, providers will not fund staff costs from their own pockets. Ensuring facilities are safely staffed will cost taxpayers more. But as safe staffing is about preventing unnecessary suffering for our elderly, how can we refuse to meet that cost? Signatories to our petition are telling the Government it is acceptable to continue using tax revenue to fund quality care for residents in aged-care facilities.

In the meantime, can we make a difference to the quality of care in aged-care facilities? HCPNZ says that "DHBs and the Ministry of Health audit all aged-care facilities to ensure that staffing levels are appropriate. Also, if they receive complaints about staffing levels they have the ability to do further investigations and to force any changes they deem necessary." (1)

So, there's a challenge for all those NZNO members working in aged care who tell us about unsafe staffing at their facilities. Keep telling us, but make sure you also tell your DHB and the Ministry. HPCNZ says that's all it takes to make aged-care providers staff their facilities safety--so please act now. Sign the petition and also complain to DHBs and the Ministry.

References

(1)) HealthCare Providers New Zealand. (2008) NZNO scaremonger on staffing ratios. Press release, March 12, 2008. Wellington: author.

(2)) Standards New Zealand. (2004) Indicators for safe aged care and dementia care for consumers. Wellington: author.

(3)) Mueller, C. & Karon, S.L. (2004) ANA nurse sensitive quality indicators for long-term care facilities. Journal of Nursing Care Quality; 19: 1, 39-47.

By industrial adviser Rob Haultain