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People are marching in the streets demanding better care for older Australians in aged care homes after increasing media reports of neglect, abuse and negligence.

If we want to improve the situation for residents, we need more registered nurses in aged care homes. When registered nurses are on duty, residents have better health outcomes, a higher quality of life and fewer hospital admissions.

When I worked as a critical care nurse in hospitals, there was a one-to-one ratio of registered nurses to patients. Some days were busy, others were not. However, because society values "saving lives", legislation ensures every intensive care unit is well staffed.

There are also mandated ratios in childcare centres because society values the safety and welfare of children. Yet we don't take the same approach when it comes to aged care homes.

Is this because we don't value older people?

'Flexibility' not the answer

The 2011 Productivity Commission Report Caring for Older Australians described staffing ratios as "a fairly blunt instrument for ensuring quality care because of the heterogeneous and ever-changing care needs of aged care recipients."

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    Patients were evaluated, on average, every 4 months. At each visit an interval history of any relapse, Incapacity Status Scale, Functional Systems Scale, Expanded Disability Status Scale (EDSS), and a proprietary graded neurologic examinations were obtained.

    Annual MRI of the brain using a contrast-enhanced MS protocol was also obtained for most patients.

    Breakthrough disease was defined as continued clinical relapses, new T2 or enhanced lesions on MRI, or worsening of EDSS or neurologic examination.

    Five patients did not tolerate the increase in frequency of administration. IFNβ neutralizing antibody testing was performed on 25 patients while on twice-weekly dosing, and one patient who failed twice-weekly IFNβ had consistently elevated titers on two determinations (4%).

    African-American patients, patients with a higher EDSS score when switching, and patients with a longer duration of stability on once-weekly treatment were less likely to respond.

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