“Some people who became sick did not report eating romaine lettuce, but had close contact with someone else who got sick from eating romaine lettuce.”
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.
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.
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.
Cate Carnell pointed out on ABC's The Drum that the abuse at Oakden Older Persons Mental Health Service occurred despite a high ratio of registered nurses. However, the Independent Commissioner Against Corruption's investigation into Oakden described poor systems, unacceptable work practices and poor workplace culture. The Commissioner found relatives' concerns fell on deaf ears..