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Issue #1729      May 4, 2016

NSW govt to deregulate nursing home care

The aged care system is under attack from the NSW state government with a bill before Parliament to remove the requirement for a registered nurse (RN) to be present 24/7 in nursing homes where there are high care needs. This could leave nursing homes with elderly residents requiring high levels of care staffed by unregulated and unlicensed carers with no professional accountability, just an employee employer relationship.

NSW Nurses and Midwives’ Association marching in May Day parade, 2016. (Photo: Anna Pha)

The government’s action follows a recent inquiry into registered nurses in NSW nursing homes. The inquiry recommended the retention of the legal requirement in the Public Health Act for a registered nurse to be on site at all times in aged care facilities where there are people with high care needs.

So what does the Baird pro-big business government do? It ignores the recommendation and puts before Parliament a bill to remove the requirement.

The consequences for residents of nursing homes will be disastrous while the private, for-profit nursing home industry stands to make a killing in higher profits. And it is an industry with large monopoly corporations on the rise. The demand for aged care beds is expected to reach 392,000 by 2025.

Unregulated, unlicensed staffing

It would leave thousands of pensioners and other vulnerable, elderly people in the care of unregulated and unlicensed staff.

Brett Holmes, general secretary of the NSW Nurses and Midwives Association (NSWNMA) warned that by upsetting the staffing skill-mix in residential aged care facilities, the NSW government was setting Australians up for more horror stories of neglect and hospitalisations.

“Having an appropriate skills mix in aged care facilities where there are people with high care needs is crucial. At an average age of 83.5, Australians entering aged care facilities are older and frailer than ever before, many with chronic and complex care needs. This is why it’s so important to have legislation to enforce that high level of care going forward. This decision will send NSW backwards.”

The federal government Quality of Care Principles 2014, defines standards for carers as having the “the appropriate knowledge and skills to perform their roles effectively” – wording that might best be described as a lawyer’s picnic and a patient’s nightmare.

With the removal for the presence of registered nurses 24/7, the only requirement to become a carer in a aged care facilities would be a five-week online course. Would this provide the “appropriate” skills?

Facilities could be left with residents requiring high levels of need being cared for by an unlicensed and unregulated workforce.

How does anyone learn such skills as the insertion, care and maintenance of tubes, including intravenous and naso-gastric tubes or the management of the insertion, removal and replacement of catheters online!

Likewise other nursing responsibilities for suctioning of airways, tracheostomy care or dialysis treatment.

The nursing skills required can also involve the complex administration of medications, clinical decisions and dealing with drugs of addiction.

Language is another issue. RNs must meet a minimum language requirement. Overseas students working part-time are not required to do a language tests. This can make it difficult for residents, who might also be hard of hearing, pose risks in handling medications, equipment and carrying out procedures.

The result will be many more night and weekend calls to GPs, who have already indicated that they are only prepared to deal with RNs, and to hospital emergency departments.

Aged care facilities are most likely to employ a registered nurse during week days when there are no penalty rates. The most skilled RNs in the largely private, for-profit aged care sector can be paid between $5 to $6 an hour less than their counterparts in the public health system. It is not surprising that nursing homes have difficulty in attracting RNs.

This may not affect the upper end of the market where hundreds of thousands of dollars are required in deposits. Such nursing homes are not reliant on government funding to pay for a registered nurse. In fact the presence 24/7 of a registered nurse would be a selling point. Not that all of these expensive nursing homes always meet government requirements.

The government also refuses to adopt another recommendation for genuinely unannounced inspections to occur at any time of the day on any day of the week to check compliance with other regulations.

“It’s very sad news for NSW’s elderly and families who rely on aged care facilities to operate to a standard of care that allows the elderly to have a dignified journey through the final years of their lives,” Holmes said.

The NSWNMA are waging an extensive campaign in NSW. Around 165 organisation and individuals made submissions to the inquiry into registered nurses in NSW.

On May Day members of the NSWNMA marched in Sydney with hands tied under the banner “If you don’t care, we can’t care”, sending a powerful message to state and federal governments.

Give your support

The NSWNMA needs your support. The union says that the Minister for Health is expected to make her decision some time in 2016. To ensure the right decision is made, please contact your local MPs and raise awareness within your communities.

There is a draft letter you can send to the Health Minister and your MPs on the union’s website: www.nswnma.asn.org.au

You can also register your support, sign on to receive campaign updates, like the Aged Care nurses facebook page, follow RN24/7 on Twitter, and other suggested actions.

Next article – May Day Roundup

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