Have staffing targets in aged care improved resident outcomes?

A new study has investigated whether the mandated staffing care minutes mandates introduced in 2022 have helped to improve the quality of care for older Australians, or if the effort has missed the mark.

This study, led by Flinders University researchers from the Registry of Senior Australians (ROSA) Research Centre, based at SAHMRI, analysed data from over 2,000 aged care homes across Australia, looking at how well care staffing targets were being met, and whether this impacted residents’ experiences and quality measures.

“Since October 2022, Australia has set individual targets for total care and registered nurse minutes for aged care homes, based on the assessed care needs of their residents,” lead author Associate Professor Stephanie Harrison, a researcher in Flinders’ Caring Futures Institute and SAHMRI, shared.

“These targets are a positive step, but these are the minimum levels of care that homes should be providing, and it remains unclear whether they are sufficient to drive meaningful improvements in care quality.”

The data came from five reporting periods across January 2023 to March 2024. Meanwhile, the team examined how various factors, such as facility ownership, size, and location, correlate with compliance with total care and RN minute targets.

Additionally, the study explored links between staffing levels and indicators like resident experience and quality of care (e.g., falls, medication management, restrictive practices).

Key findings

1. Rising compliance with staffing targets

• The proportion of facilities meeting or exceeding total care minute targets rose from 41% in Q1 2023 to 53% by Q1 2024.
• Median compliance improved from 96% to 101% over the same timeframe.

2. Ownership and size matter

• Government-owned facilities significantly outperformed for-profit and not-for-profit providers in meeting care minute targets.
• Adjusted rate ratio (RR) for total care minutes: For-profit: 0.76 (95% CI: 0.75–0.78); Not-for-profit: 0.82 (95% CI: 0.80–0.83)
• Smaller facilities were generally more successful in meeting both total and RN minute targets compared to medium and large ones.

3. Geographic and socioeconomic disparities

• Facilities in rural or socioeconomically disadvantaged areas were less likely to meet RN minute targets.
• Conversely, those in more advantaged areas were more likely to achieve these goals (RR for RN minutes in the most advantaged quintile: 1.09; 95% CI: 1.05–1.13).
• Regional variation also played a role, e.g. Queensland and Western Australia facilities exceeded targets more often than those in New South Wales.

“The data suggests that location and facility size play a crucial role in the ability of an aged care home to provide adequate staffing levels,” Associate Professor Harrison said.

“Government-run facilities were also more successful in meeting and exceeding care minute targets. As smaller, government-run facilities are replaced by larger, for-profit services, this is an important area to monitor.”

4. RN staffing challenges

• While total care staffing showed steady improvement, RN-specific staffing targets were harder to meet.
• Only 38% of facilities met their RN minute targets in early 2023, improving to 51% by early 2024.
• Larger for-profit facilities particularly struggled with RN staffing.

5. No clear link to resident experience or quality metrics

• Surprisingly, no statistically significant associations were found between care minutes (total or RN) and star ratings for resident experience or clinical quality measures (e.g., falls, pressure injuries).
• Researchers noted that survey limitations and the lack of individual resident data might obscure true effects.

“This challenges the assumption that simply increasing staffing will automatically improve care quality,” Associate Professor Harrison added.

What does this means for the sector?

This study paints a nuanced picture of Australia’s aged care system. Structural advantages like small size, government ownership, and urban location seemingly improve compliance with care minute targets.

However, simply increasing staffing may not directly translate into better resident outcomes, suggesting that other factors, such as skills mix, staff training, turnover, and care models, also matter.

Moreover, the disparities across rural and disadvantaged areas underline the need for targeted policy support, especially as Australia’s aged care system shifts toward larger, for-profit operators.

Associate Professor Harrison said a holistic view to care quality is needed, with providers better off looking beyond staffing targets alone.

“Adequate training, staff retention strategies, and tailored models of care that meet individual resident needs are all important for policymakers to consider,” Associate Professor Harrison said.

“Improving care means investing in workforce development, especially in rural and remote communities where staffing challenges are more pronounced. Recent initiatives to support the provision of aged care staff in rural and remote areas should be monitored to see if this helps to improve equitable access to care in these regions.

“Monitoring staffing levels in aged care homes remains essential, it provides vital data, but to truly improve the quality of aged care, we must also strengthen the evidence base and address the ongoing challenges facing the sector.”

Aged care quality is a complex equation involving not only staffing numbers but also who is delivering care, where, and how.

While Australia’s individualised care minute targets have driven positive change in staffing compliance, this study reveals that hitting numerical targets alone is not enough.

Continued investment in workforce development, especially in disadvantaged areas, and broader access to aged care data will be essential to truly improve resident outcomes.