The Department of Health and Aged Care has released a guide for aged care providers on the new requirements for care minutes and for having a registered nurse on-site 24/7. Attwood Marshall Lawyers Wills and Estates Associate Larisa Kapur summarises the guidance and the government’s ongoing work in this space.
Introduction
Amid severe staff shortages and fears of inadequate care currently affecting aged care centres across the country, the government introduced a raft of new rules last year. The aim is for providers to step up their responsibilities towards their residents, who are often the most vulnerable people of society.
The new requirements draw on recommendations from 2021’s Royal Commission into Aged Care Quality and Safety and the government’s 2022 election commitments.
Among promises to cap home care administration and management charges, ban exit fees, and ensure better transparency on how funds are spent, were two requirements that have caused a significant shake up to the industry.
One was the responsibility for approved providers to ensure a registered nurse is on-site and on duty 24/7 in every residential aged care facility they run.
The other is the requirement for approved providers to make sure certain categories of care staff meet a minimum standard of time with each resident for quality and safety.
The mandatory “care minutes” apply to residential care services, whereas the 24/7 registered nurse responsibility applies to residential facilities (i.e. a building or complex of buildings used to provide residential aged care). The minutes racked up by registered nurses count towards the overall care minutes.
The Department of Health and Aged Care recently released a 48-page guide, split into eight sections, that sets out these two requirements in more detail, including a breakdown of various definitions, activities, targets, reporting and quality assurance.
Mandatory care minutes
Under the Aged Care Act 1997, approved providers must maintain an adequate number of appropriately skilled staff so that the care needs of residents are met. The new requirement for care minutes adds to this responsibility, establishing a minimum quantity of care by registered nurses, enrolled nurses (ENs) and personal care workers and assistants in nursing (PCW-AINs).
Care minutes can only be delivered by these three categories of workers. The guide sets out which specific activities can count towards the mandatory units, and which cannot. There is a strong focus on direct clinical care and personal care activities.
Example activities that are included are:
- Registered nurses providing complex patient assessments or developing care plans that evaluate care
- Enrolled nurses carrying out patient assessments, wound management and administering prescribed medications, as delegated by the registered nurse
- PCW/AINs helping residents with daily living routines and carrying out other tasks delegated by the nurses.
Providers should already be targeting 200 care minutes per resident per day, including a minimum 40 minutes of registered nurse time every day. That requirement has been in place since 1 October 2022.
However, from 1 October 2023, those targets will become mandatory. From 1 October 2024, the time requirements will increase to 215 minutes per resident per day, including a minimum 44 minutes of registered nurse time every day.
Each service will have individual targets based on the case-mix of their residents and what care they require. That means approved providers with a higher-than-average proportion of high needs residents will need to engage additional staff and be required to lodge more care minutes.
Reporting
Care minutes must be included in providers’ quarterly financial reports.
The Health Department is expected to run a data validation process to check whether the care hours and labour costs data being recorded are reasonable. Any discrepancies or questionable patterns identified are likely to raise flags for inaccurate reporting or counting non-care activities as care activities.
If flagged, providers will need to review and resubmit their data by a strict deadline. If providers do not allow their data to be checked, the minutes won’t be included in the star ratings process which means they will get a 1-star rating for the staffing subcategory.
The publication of star ratings on the My Aged Care website only came in to force in December 2022, and the program aims to boost transparency in the sector and provide older Australians and their families with the right information for choosing residential aged care facilities.
The system currently takes into account four separate categories of assessment: quality indicators, compliance, consumer experience and staffing minutes.
Registered nurse on site 24/7
From 1 July 2023, approved providers need to make sure that every residential facility they run has a registered nurse on-site and on duty 24 hours a day, 7 days a week.
The requirement was legislated in the Aged Care Amendment (Implementing Care Reform) Bill 2022, which was passed by Federal Parliament on 27 October 2022.
The aim is to give residents better access to care, allow registered nurses to manage issues as first responders, and prevent unnecessary trips to hospital emergency rooms.
Reporting
Approved providers will need to submit a monthly report from 1 July 2023, detailing every period of 30 minutes or more when a registered nurse was not on-site or on duty, including the reason and alternative arrangements that were made in their absence.
The obligation is also expected to inform each centre’s staffing star rating, contributing to their overall star rating.
Funding arrangements
The government announced in its 2022-23 budget that it will allocate $1.9 billion to the roll-out of care minutes requirements.
Those funds are in addition to the $5.4 billion that was promised as an uplift over four years to the AN-ACC funding model, which replaced the Aged Care Funding Instrument in October 2022. The newer model involves each aged care resident being classified by an external independent assessor. The assessor reads care plans, speaks with staff and performs clinical assessment to understand the time required to provide care to each resident.
In relation to the 24/7 registered nurse requirement, the government said that services with up to 60 residents per day over a month may be able to access a monthly supplement for employing extra registered nurses.
The government has also promised to help support, build and train aged care workers. It has already built several programs to attract, retain and educate skilled age care workers, particularly focused on rural and regional areas.
Future work – watch this space
The Health Department is still developing and refining these new requirements for care minutes and the 24/7 registered nurse duty.
Some of the ongoing projects include modelling workforce shortages of registered nurses to ensure that safe and quality care can still be delivered.
The department is also developing audits on the reporting of the 24/7 registered nurse requirement.
Both these projects are expected to be the subject of targeted consultations later this year.
In addition, the Health Department is still considering how exemptions to the care minutes could be granted. Once finalised, an exemption framework – as recommended by the Royal Commission – will be announced well in advance of any commencement date.
Meanwhile a 12-month exemption from the registered nurse 24/7 responsibility can already be accessed by residential facilities with 30 or less operational places and which are based in small rural towns, remote communities and very remote communities (as defined by the Modified Monash Model).
That exemption comes after Health Department figures obtained by ABC News show that there is a workforce gap with 8,400 registered nurses and 13,300 personal care workers needed next year.
Attwood Marshall Lawyers – helping people at every stage of life
Attwood Marshall Lawyers are big advocates for much-needed change in the aged care sector to better protect the elderly and professionals who work tirelessly looking after the ageing community.
We are dedicated to helping people navigate the complex aged care industry and the various care options available. There are several legal and financial factors that need to be considered when an individual considers moving into an aged care facility or reviews existing service agreements, and a solicitor who specialises in aged care is best placed to help guide you through each consideration.
If you or a loved one needs legal advice about transitioning to aged care or reviewing service agreements or an estate plan, please contact our Wills & Estates and Aged Care Department Manager, Donna Tolley, on direct line 07 5506 8241, email dtolley@attwoodmarshall.com.au or free call 1800 621 071 at any time.
