Will providers reduce bed numbers to meet 24/7 RN exemptions?

With the July 1 deadline to have a Registered Nurse (RN) on site 24/7 fast approaching, experts warn that some aged care providers may consider reducing bed numbers to meet last-minute exemptions.

The wheel’s have been in motion for 24/7 RNs since 2021, meaning there has been plenty of time to prepare. But that’s easier said than done when limited numbers of RNs are on offer and a workforce exodus during COVID-19 truly challenged the sector.

Now, the Government has introduced 12-month exemptions for a select number of providers who are struggling to recruit RNs, but Maree Bernoth, an Associate Professor at Charles Sturt University, said they haven’t seriously acknowledged the anxiety caused by the impending deadline.

“From 1997 to now, that’s over 26 years, Government policy has deliberately reduced the number of registered nurses and people with experience in aged care, including allied health professionals, from the industry,” Professor Bernoth said.

“Now the Government turns around and says we want you to reinstate those skilled people but they’re not there.

“Yes, we want registered nurses in aged care but there has to be a more realistic time frame to attract registered nurses to aged care and especially in our rural and remote areas.”

The exemption for aged care providers is quite limited and is focused on rural and regional providers.

A one-off, 12-month exemption from the 24/7 RN responsibility is available for facilities located within regions 5-7 of the Modified Monash Model (MMM) with 30 or fewer approved beds. Providers must also show they have alternative care models in place and they’re actively looking to recruit RNs.

Professor Bernoth said the 30-bed threshold could push some providers to reduce the number of beds in their homes to become eligible.

“I don’t want to alarm people but reducing bed numbers is certainly a possibility if the industry is struggling to meet these requirements and the Government’s making them mandatory and rigid,” she explained. 

“The other danger is that smaller facilities will close and that is not what we want. We want our rural facilities to stay open. 

“We know how important they are to a community, we know that people taken out of their community it has a big impact on their mortality and quality of life. We need to keep rural and remote facilities viable and open and attractive places to live and work. 

“They’re trying to be compliant but the resources aren’t there to enable them to be compliant.”

A thorough exemption review process is likely to deter struggling providers, while a Spokesperson for the Department of Health and Aged Care said an exemption would only be approved if a provider has demonstrated they “have appropriate alternative arrangements in place to ensure the clinical care needs of their residents are met”.

“This approach seeks to balance the need to increase RN coverage to address the understaffing issues highlighted by the Royal Commission, while also taking into consideration that workforce shortages in some areas will mean that some facilities will not be able to meet the 24/7 requirement,” the spokesperson said. 

But as the 2020 Aged Care Workforce Census revealed, smaller homes and rural and remote operators both have lower RN coverage than larger metropolitan homes, while there was a 37% turnover rate for RNs and Nurse Practitioners during the report’s 12-month data collection period.

Currently, Professor Bernoth says the sector is about 8,000 RNs short of where it needs to be. And although there are programs in place to boost those numbers in the long term, greater flexibility with 24/7 RN requirements could alleviate existing stress factors.

“Instead of having a registered nurse at a small facility, there might be a registered nurse, nurse practitioner and allied health professional for a couple of facilities in the area so they can each access the same experts,” Professor Bernoth explained.

“A group of specialists that smaller facilities can call on and be visited by regularly to oversee the care provided, assist with any challenges and maintain the quality of care for older people.”

Risk-based exemptions

When Hello Leaders reached out to the Department of Health and Aged Care to ask if they perceived any risk of providers reducing bed numbers, a spokesperson said there’s no reason for facilities to do so.

They said the Aged Care Quality and Safety Commission (ACQSC) would recognise a number of factors when determining whether a provider has put in the appropriate amount of work to be eligible for an exemption.

“They [ACQSC] have indicated they will take a risk-based and proportionate approach to regulating compliance, including taking into consideration genuine attempts to recruit RNs and the steps the provider is taking to ensure quality and safe care is being delivered during the times a RN is not on-site,” the spokesperson said.

“As such, the Department’s assessment is that there is no reason for facilities to reduce their operational places (beds) to meet the eligibility criteria for the exemption from the responsibility.”

It’s currently unclear how many providers are facing challenges with recruiting RNs. According to Aged & Community Care Providers Association (ACCPA) Chief Executive Officer (CEO), Tom Symondson, more than 80% of ACCPA members already have RNs on a 24/7 roster.

But he does hold concerns for smaller providers and homes that are struggling to make inroads, especially when they’re already in a tough position as a regional operator.

“Those who are unable to fulfil the requirement are more than likely in areas where staff shortages are acute and where agency staff are less likely to be readily available,” Mr Symondson said.

“We want to avoid any aged care home closures, particularly in regional and rural areas. [The] closure of homes has a devastating impact on residents, families, and communities, and would not be in anyone’s interests.

“We need a considered response towards providers of country aged care services who have made genuine attempts to recruit nurses but have been unable to do so due to ongoing workforce shortage.”

Mr Symdonson said older Australians do not deserve the risk of being displaced from their communities due to the loss of local aged care services, and urged the ACQSC to provide additional support to providers making genuine attempts to recruit staff.

He echoed Professor Bernoth’s thoughts on diverse approaches to accessing healthcare professionals outside of metropolitan settings.

“We would also encourage the consideration of innovative models, particularly for rural and remote areas,” Mr Symondson said.

“Models that support telehealth access, for example, could be explored for providers who cannot recruit RNs.”