In an attempt to increase profit margins many employers are sacrificing quality of care through cuts in resources, in particular changes to staffing levels which are impacting on the very nature of health service delivery.
Much of the money used to run health facilities across the health and aged care system is obtained through government funding.
In fact almost 70 percent of total health expenditure in Australia is funded by government, with the Australian government contributing two-thirds of this and state, territory and local governments the other third.
Government expenditure on aged care was $8.4 billion in 2006-07 with the Australian government providing most of the recurrent funding for residential aged care.
Unfortunately while governments provide much of the health agenda funding, they do not hold service providers accountable for how that funding is spent. This issue is particularly pronounced in the private sector which run their services for profit.
Current funding mechanisms mean they do not have to identify or quantify the specific costs associated with the largest portion of their financial outlays: nursing costs.
Who cares for you?
In some private hospitals, employers have attempted to replace their experienced nursing workforce with less expensive classifications or newly graduated registered nurses resulting in fewer experienced nurses left to support the other staff. Inadequate supervision or unrealistic indirect supervision places even greater responsibility on those nurses/midwives left in charge to keep the system safe.
In aged care the situation is much worse—and much more concerning for the community—with standards of care severely compromised at the discretion of the service provider.
In mid-2003, there were about 156,000 people in Australia employed in aged care facilities. Of this about 116,000 (or 57%) were direct care workers (nurses, personal carers and allied health workers) which includes 67,000 unlicensed personal care workers, 25,000 Registered Nurses, 15,000 Endorsed Nurses and 9,000 Allied Health workers (primarily diversional and recreational officers).
Personal care workers in Queensland (including personal carers and assistants in nursing) are currently unlicensed health care workers who are employed across the majority of aged care settings. They are often doing nursing work but they require little training and preparation to undertake their role. Increasingly this unlicensed role is being implemented in hospitals as well.
The number of unlicensed workers in the health and aged care systems is growing at an exponential rate that has the potential and increasingly real likelihood of impacting on the quality and safety of care provided to the community through those systems.
Increasingly replacing skilled, professional, regulated health professionals and workers, these workers are caring for progressively more older, more acutely frail people with multiple physical and mental health co-morbidities without the requisite support, supervision, skills, knowledge and experience.
These workers are being unfairly put under increasing pressure to perform duties that are outside their skills and qualifications. They are valued members of the nurse team who require adequate supervision and support from registered nurses.
Nurses aren’t the only ones concerned with recent research revealing 76 percent of people say they are fairly or extremely concerned about the quality of care provided in aged care facilities.
In fact, 81 percent agree that if nurses are replaced with unlicensed workers then the quality of care will fall.
What’s to be done?
There’s an urgent need to improve openness and transparency in relation to safety and quality of care and accountability for funding across all health and aged care settings.
The lack of consistency in education, training and qualifications for those with direct nursing and personal care responsibilities means there are significant risks to the recipients of this health care and those who provide it.
Government licensing of all direct care workers, in all settings, is critical. Nurses believe that to be employed in that industry the person has to establish their credentials which can range from minimal (eg. not having had any serious criminal convictions that would impact on an assessment of their character in their area of work) to more onerous (eg. having successfully obtained a specified qualification, being required to abide by a code of conduct and/or ethics, and/or practice standards). This option must also provide for basic standards for education, practice and conduct being set as a baseline.
The expansion of non-nursing staff engaged in nursing activities and direct care should be monitored in each facility and reports made available to the licensing authority.
In addition, accountability mechanisms must be established to ensure sufficient staffing and skills mix levels in residential aged care facilities are maintained.
There is an urgent requirement to establish a baseline standard of skill mix and nursing staffing levels in all health and aged care settings. This must be monitored regularly and reported on publicly to ensure that service providers have an incentive to comply with safe staffing strategies. | 
