The study of more than 3200 aged care workers in Australia confirms commonly held beliefs that liberalisation of ownership in the industry is squeezing services to residents – particularly in the private for-profit sector as corporates move in.
While government and not-for-profit residential aged care facilities (RACF) were less prone to missed services, both private and publicly-owned nursing home sectors are reporting poor staffing and resourcing pressures.
Nurses and care workers say they are increasingly hard-pressed to provide 26 standard services, including responding to call bells and meeting toileting needs within five minutes.
Other services commonly missed in the private sector include moving residents who are unable to walk from bed to chair, ensuring residents are not left unsupervised, wound care and checking residents’ skin and mouth.
Residents’ blood glucose monitoring was more likely to be missed in the public sector.
Of the 27 factors identified as causing missed care, government employees reported significantly lower scores for 16 items. The reverse was the case with responses from the private sector.
With privately-owned facilities generally having more residents per staff member than in the public sector, the quality of care is unable to keep up.
“Private for-profit ownership is increasing and we need to study this closely,” says lead researcher Dr Julie Henderson, from the College of Nursing and Health Sciences at Flinders University.
“Too few staff, resident complexity, inadequate skill mix and unbalanced resident allocation are cited as the main perceived reasons for missed care.
“There are many things impacting upon the safety and quality of care but we need to keep an eye on this user-pays space.”
Sponsored by the Australian Nursing and Midwifery Federation (ANMF), the study found widespread holes emerging in delivering of basic nursing and personal care services compounded by cost-cutting in staff numbers compared to resident levels – along with inadequate worker skills including less experienced nurses and carers.
The paper points out that Australian Government cutting restrictions on ownership of RACFs is resulting in large corporations buying more not-for-profit nursing homes and running them as private for-profit RACFs.
“This can result in them going downhill, as can other changes in regulations that involves private non-government not-for-profit facilities having increasing difficulty getting government funding,” Dr Henderson says.
“People know it’s happening but once it becomes a business venture and profit becomes a motive then we need to see what that means to the quality of care.”
Further research is needed on the impact of facility ownership upon capacity of nurses and personal care workers to deliver care, the researchers say.
‘The impact of facility ownership on perceptions of missed care in Australian residential aged care’ (August 2018) by Julie Henderson, Ian Blackman, Eileen M Willis, Terri Gibson, Kay Price, Luisa Toffoli, Rob Bonner, Jennifer Hurley, Trish Currie, from the College of Nursing and Health Sciences, has been published in the Australian Journal of Social Issues DOI: 10.1002/ajs4.50.