The tightrope of compliance and funding models – QLD’s BlueCare predicted to cut 60% of ENs across 21 aged care facilities

The complexity of regulation, financial planning and quality care has collided in BlueCare’s latest staff announcement. Naming adjustments to regulation and federal funding as the impetus, the Queensland aged care provider has announced it will be cutting a sizable amount of its EN workforce. The nurses’ union has publicly stated they believe 81 permanent EN jobs will be revoked across 21 of Bluecare’s 40 centres.

EN numbers to be reduced

The provider currently has 130 ENs on the books, the union claims that this will mean only 49 will retain their jobs. The provider, however, has shared that the numbers of ENs to be cut is “still to be determined” and has hedged the final numbers could be “significantly less than quoted”.

The announcement has drawn frustration from both residents, loved ones and the union. A large player in the sector, BlueCare is understood to be one of the most sizable not-for-profit providers in Queensland. The leadership team have publicly called the decision “difficult” and pointed to issues to “adjust” key components of the operation, namely, its workforce, to rapidly changing regulation and funding from Government.

Care concern

Angela Ray’s mother, Lynne Crepin, is a resident at BlueCare’s Rothwell facility east of Brisbane. The family is deeply concerned by the announcement due to the great care they have seen towards Crepin so far, that they pin-point as EN specialised care. Speaking to the ABC, Ray expresses that the experience with BlueCare “had so far been good.”

Ray worries, that with the cut in ENs, “I feel like it might force them to only prioritise clinical things that have to be done … like the medications and the dressing changes and things like that,” continuing, “but it could leave the … social or psychological issues, those needs, unmet.”

Communication opportunities

Ray highlights that in her communication to BlueCare leadership, she has raised the concern about reduced capacity for personal care, and possible reduction in resident satisfaction due to limited and interrupted continuity of care. “In my mother’s case, she doesn’t have the ability to speak to me about her concerns, whereas I know that [with] the nursing staff [EN] there, I can have some really good and helpful conversations with them about mum’s condition.” Ray also expressed her sadness at the lack of direct communication regarding the intended job cuts.

The reaction from residents exhibits the key need for explanatory communication to residents and loved ones in the lead up to significant announcements. Additionally, when it comes to the care of loved ones, clearer underpinning reasons as to the decision to impact a significant cohort of trained professionals transparency is worthwhile for all provider leadership. So too is the impetus to provide substantive strategy explanation as to how quality care will not be compromised.

Union reaction

The Queensland Nurses and Midwives Union (QNMU) is staggered by the “huge scale” of potential job losses. Sarah Beaman, secretary, sees ENs contributing to high quality care in “complex” situations, with TAFE-qualified clinical hours of experience.

“These nurses are so important. They check hundreds of elderly residents daily,” Beaman notes, “these removals of BlueCare enrolled nurses will have swift and serious ramifications.

“You can’t take this many people out of an aged care workforce at that skill level and not replace that skill level and not see a care drop.”

Core to front-line frustration is the confusion as to the strategy of the cuts, Beaman shares her incomprehension at the justification, seeing the move as impacting care of residents without resulting in a reduction in their fees.

Beaman asserts, “When you have got assets in excess of $2 billion and revenue in excess of $2 billion they can afford to pay enrolled nurses $39 an hour.”

Compliance, funding models and unintended consequences

The complexity of the situation, however, must assess the unintended consequences that Government regulatory compliance models have brought to bear. Providers across Australia continue to reel from significant funding and regulatory changes while sincerely trying to maintain excellence in care.

BlueCare has expressly named the new mandatory care minute targets as underpinning their decision to cut the sizable amount of ENs across their Queensland centres. The provider explained that, “Providers are not funded appropriately to retain Enrolled Nurses. Under the current model, the care enrolled nurses provides can only contribute 10 per cent toward [those] targets.”

“We can no longer sustain this funding gap and have had to make the difficult decision to review our Enrolled Nurse workforce.” The group articulates, “We want to be very clear: this decision does not reflect the value we place on our enrolled nurses.”

For some, it is in looking at the wording of Government regulatory change, that lack of value for trained ENs may be an interpretation, and an unintended implementation result. 

ENs contribute 10% to care minute targets

As directed by the Department of Health, Disability and Ageing, “From 1 October 2024, approved providers are able to meet up to 10% of their RN care minutes target with care time delivered by ENs.” Many providers see this as incongruent with effectively leveraging the key skills and quality care that ENs perform for residents across the country. To tie their contribution to such a low percentage of care is seen by many, across provider and clinical leadership, as counterintuitive to supporting residents to receive quality care, and supporting the financial viability of aged care as a sector.

The Department sees the 10% counting of EN minutes towards the mandatory threshold as, “recognis[ing] the important role of ENs in aged care and improv[ing] recruitment and retention of these skilled workers. It also helps providers to meet their care minutes if they are facing RN workforce shortages.” Yet with a skills shortage of RN in aged care, the frustration of leadership in the sector is heightened at tying funding to such a limited percentage for ENs. 

For many leaders in aged care, the announcement from BlueCare highlights again the complexity and need for deepened communication between peak bodies, members and relevant Government ministers and departments. With the introduction of care minutes, regulatory oversight seeks to entrench quality of care, yet the unintended consequences of this regulation and funding model approach impacts widely. Felt across the sector, by residents, front-line staff and the sector as a whole, excellence in care, skilled labour retention, sector wide financial viability and compliance oversight continue to be jostled by concurrent multi-facted complexity. As many experts have said, it will take a concerted effort of brilliant minds, from all sectors, Government, private and personal to try to “get it right”.

The growing need of financial acumen across aged care leadership is starkly clear as well. In understanding the full extent of cost, profit and financial viability, executive leadership must be able to articulate clearly why profits are placed across certain areas of function, and not others. As a sector in the significant and highly-scrutinised position of looking after some of Australia’s most vulnerable, decisions impacting skilled staff and concerned residents warrants transparency, humility and renewed conversations with Government as to unintended and inefficient consequences of policy.