Yet this "blunt instrument" delivers results in hospitals where patients have "ever-changing needs".
To date, protests and petitions to boost staffing ratios have failed. Mandated nurse-to-resident ratios are opposed by Ken Wyatt, Minister for Aged Care, and the peak bodies representing for-profit and non-for profit aged care homes. They argue mandated ratios would increase costs and limit flexibility.
But the current "flexible staffing" approach leaves the decision whether to have a registered nurse on duty at the discretion of the provider/manager. Evidence suggests some managers do not employ additional staff when care needs increase.
The following example illustrates why staffing levels should not be decided entirely by managers.
I witnessed an elderly woman die in excruciating pain because no-one on the night shift was qualified to administer the prescribed morphine.
My friend was so traumatised by the situation, she could not remain at her mother's bedside to hold her hand.
Nurses improve health
Although the needs of older people in aged care homes are variable, over 80 per cent of residents have high care needs. The staffing profile of aged care homes today does not reflect the resident profile. If it did, we would have seen a large increase in the number of registered nurses.
Instead, the number of registered nurses has decreased while the number of less-skilled personal care attendants has risen substantially. Registered nurses now account for less than 15 per cent of the workforce, while personal care attendants make up 72 per cent.
Overseas studies show the ratio of registered nurses-to-residents has a positive impact on the standards of care in an aged care home. This research demonstrates that staffing levels and skills are the most critical determinants of care in an aged care home.
Whether residents' care needs are due to cognitive decline, incontinence or chronic pain, residents invariably benefit from having registered nurses on duty.
Tax dollars for nurses not managers
Although aged care homes are not funded to provide hospital-level care, the government subsidy of around 0 a day for each resident should be tied to direct care for residents, not profits for providers. However, StewartBrown's Aged Care Performance Survey indicates the top 25 per cent of aged care homes made a profit of ,285 per resident per year.
Although additional staff will increase operating costs, it is alarmist to state that some aged care homes, particularly those in rural and remote areas, will be forced to close. The worst-case scenario is that governments may need to assist some aged care homes to remain viable.
In Victoria, many rural aged care homes are owned by the government. In 2016, the Safe Patient Care Act was introduced, This Act prescribes ratios of registered nurses for the 181 publicly-owned aged care homes.
Fig 5. Treatment with PARP1 inhibitor improved mitochondrial biogenesis in chagasic mice.
C57BL/6 mice were infected with T. cruzi, treated with PJ34 (12.5 mg/100-?l/mouse, intraperitoneally, twice a week for three weeks beginning at 45 days’ pi, and sacrificed at 150 days’ pi. (A) RT-qPCR evaluation of myocardial level of PARP1 mRNA, normalized to GAPDH mRNA (n ? 5 mice/group, triplicate observations per mouse). (B-E) Representative Western blot images of myocardial level of PARP1 with GAPDH loading control (n = 3 mice/group) and PAR levels in mice treated with increasing concentration of PJ34 (0–25 mg/kg) are shown in B & D, respectively. Densitometry analysis was performed for all Western blot gels from n ? 6 mice/group, and PARP1 and PAR levels (normalized to GAPDH levels) are shown in C & E, respectively. (F&G) Representative gel images (F, n = 3 mice/group) show myocardial levels of 10 kb mtDNA with 177-bp mtDNA and 96-bp GAPDH (nuDNA) fragments as controls. The PCR amplification was performed for 28 cycles. Densitometry analysis was performed on PCR gels representing n ? 6 mice/group, and density of the 10 kb mtDNA band, normalized against mtDNA and nuDNA fragments, is presented (G.a&b). (H-O) Bar graphs (n ? 5 mice/group, duplicate or triplicate observations per sample) show the myocardial (H-K & N) and plasma (L, M & O) levels of H2O2(H), 3-nitrotyrosine (I), protein carbonyls (J&L), lipid hydroperoxides (K&M) and antioxidant capacity (N&O). (P) Myocardial parasite burden in chronically infected (± PJ34 treatment) mice was determined by qPCR amplification of Tc18SrDNA and normalized with GAPDH (n? 5 mice/group, three observations per mouse). Data in all bar graphs are plotted as mean value ± SEM, and statistical significance are marked as *infected vs. control and #infected/PJ34-treated vs. infected/untreated (*,#p<0.05, **,##p<0.01, ***,###p<0.01).