1 October 2018
The Aged Care Minister and provider peak bodies were recently asked to explain their opposition to mandating minimum ratios of registered nurses in aged care homes.
This led to an opinion piece in which their claims were contested.
The Aged Care Guild has recently used a financial argument to oppose ratios, and priced mandated ratios as an extra $5 billion per year.
This is a bit rich from a peak body that represents the 8 biggest aged care providers – some with executives on extremely high salaries.
An article in the Daily Telegraph states: “The bosses of the biggest six aged care companies pocket seven-figure salaries and churn through $2.17 billion in taxpayer funds a year”.
Rather than use a financial argument, the government is using research from The Netherlands to support their opposition to ratios.
A letter from Office of the Hon Ken Wyatt MP contains the following paragraph:
“One of the latest staffing studies, compiled in April this year in The Netherlands, states: “There is no consistent evidence of a positive relationship between the quantity of staff and quality of care”.
It says: “We should think beyond numbers. Instead of focusing on the quantity of staff, we welcome initiatives that consider the quality of a team”.
I have read the research that is referred to in the Minister’s letter, and my assessment is the Office of the Hon Ken Wyatt MP has misinterpreted the findings of the Dutch research.
In 2016, Backhaus, Beerens, Van Rossum, Verbeek, and Hamers undertook a literature review for the Dutch Ministry of Health, Welfare and Sports.
The aim of the literature review was to summarise all the available evidence on the relationship between staffing and quality in aged care homes.
The editorial “Rethinking The Staff-Quality Relationship In Nursing Homes” (2018) provides evidence of a positive relationship between the quantity of staff and quality of care.
This is a matter of fact, not opinion.
It is important to critically read research papers, not to cherry pick sentences that support your position.
Although the authors state: “There is no convincing scientific evidence of a positive relationship between staffing levels or the educational background of staff and quality in nursing homes”, this statement needs to be critically examined.
The first question to ask is: Why did only a small number of studies meet the inclusion criteria?
The answer is crucial to the interpretation of the study. In many countries, there is a lack of data to analyse the relationship between staffing levels or the educational background of staff and quality in nursing homes.
It is simply not possible to undertake rigorous studies on staffing because data is either non-existent or not available to researchers.
In Australia, the data is collected by the Department of Health and financial organisations (e.g. StewartBrown) but this data is not available to the public, including researchers.
In contrast, the US not only collects data but also makes this data available to the public.
So it is important to note that Backhaus and her colleagues stated: “Studies that found a positive relationship [between the quantity of staff and quality of care] were mostly conducted in the US.”
The only country that analyses data on staffing and quality indicators showed a positive relationship.
The US data shows the more staff on duty, the higher the quality of care.
It is therefore not correct to conclude: “There is no consistent evidence of a positive relationship between the quantity of staff and quality of care”.
There is evidence. This evidence is found in the only country that not only collects data on quality indicators but also makes this data available to the public.
Clearly, quantity of staff is not the only determinant of quality of care. But it is a determinant.
Other important determinants are the quality of the team, the manager of the aged care home (responsible for staff morale, supervision etc.) and the owner of the aged care home licence.
It is noteworthy that over the past 20 years only 183 studies undertaken met the inclusion criteria for this literature review.
The most obvious conclusion to draw from this low number is the urgent need to undertake rigorous research.
In Australia, such a study could easily be undertaken. All Victorian-owned aged care homes have mandated ratios.
This provides the perfect ‘laboratory’ – both a control group (Victorian-owned) and an experimental group (private and not-for-profit).
Quality outcomes in Victorian-owned aged care homes could be compared with those in private and not-for-profit aged care homes.
The recent Aged Care Workforce Strategy Taskforce could have undertaken this research.
However, this taskforce morphed into an “industry led” Workforce Strategy Taskforce. Once again, “consultation” and “expert opinion” trumped evidence.
We urgently need empirical evidence to determine the relationship between the numbers and training of staff and standards of care in an aged care home.
This research is needed so we can have an evidence-based policy rather than one that is based on opinions.