Is this the perfect storm? Workforce management in residential aged care by Sara Golding

A trend in declining funding, pressure to introduce staffing ratios, an increase in resident complex care needs combined with the difficulty in recruiting and retaining staff – is this the perfect storm in residential aged care workforce management? In isolation, each of these issues can prove challenging for Providers, not only in providing the level of care required for each of its residents but also in the financial viability of the organisation. To support you ‘weather the perfect storm’ we off our thoughts . . .

Funding

ACFI subsidies account for nearly 61% of providers’ revenue. Conversely, staff accounts for approximately 67% of costs in residential aged care.

For many Providers, it can be challenging to maintain the funding levels they have when residents depart. Departing residents can not only result in an occupancy decline but also in a funding decline, for example, if a lower care need resident replaces a departing high care resident.

Working with our clients we see, that often resident onboarding, funding and rostering teams working in isolation of each other. Unfortunately, this results in organisations maintaining rosters at the same staffing level for too long.  Compounded by the lack of real-time visibility of occupancy and care requirement actionable change is difficult and puts financial stress on a business.

Integrated technology will support a multi-disciplinary approach by providing the real-time data required for each part of the business to make informed decisions or at the very least drive the internal conversations and collaboration required for better business outcomes.

Staff Ratios

Staffing ratios in Residential Aged Care have again been called into question by the Australian Medical Association urging for a regulated nurse to resident ratios to be considered in the Aged Care Royal Commission. One of the strategic initiatives identified through the Aged Care Workforce Strategy Taskforce was to establish a standard approach to workforce planning and skills mix modeling. The taskforce found that a mindset shift is needed from thinking about the workforce and workforce planning in isolation to having these informed by each resident’s care needs and, these should be supported by each organisation’s business model, with responsibility taken by the board or managing body for effective delivery.

While there are benefits to mandatory staffing ratios, there are also downsides. The Australian Government’s 2011 Productivity Commission Report, Caring for Older Australians found that across-the-board staffing ratios are a fairly ‘blunt’ instrument for ensuring quality care. This is because of the diverse and ever-changing care needs of aged care clients. In the Commission’s view, it is unlikely to be an efficient way to improve the quality of care.

Imposing mandated staffing ratios runs the risk of disincentivising providers from investing in and creating innovative models of care or adopting new technologies that might benefit recipient care.

Whether staffing ratios are mandated or not, organisations will need to be able to quickly and easily report on its staffing skills mix, resident care hours and non-care hours. It will become critical in the ability to attract residents, retain staff and satisfy the regulatory requirements of an unannounced visit.

Talking to the industry, we have heard reports that during recent unannounced visits the department is now reviewing the last few months rosters at Sites and looking at the skill mix within them.

We are directly supporting a person-centred care approach to rostering with our clients. To be able to support this, the collaboration between the care staff who intimately understand the care requirements of their residents and the rostering staff who need to ensure those care needs are being met as well as the cost to care will be paramount. Those organisations who can act with agility, responding to the changing care requirements of the people it cares for will undoubtedly outperform those who act on outdated data.

Complex Care Needs

The Aged Care Workforce Strategy Taskforce report ‘A Matter of Care’ highlights that “Older Australians have increasingly complex care needs that frequently require multidisciplinary services drawn from across aged, health and disability care. However, poor coordination of funding across these systems, along with professional practice and education silos, contribute to reduced access to care, diminished care experience and increased costs for consumers and governments.”

In addition to the increasingly complex care needs of aged care residents, the model of care developed by individual organisations can also significantly influence staffing numbers. In the last 6 to 12 months we have seen a real shift in Providers wanting to share with their consumers (residents and their families) the staff mix rostered as this is seen as a marketing tool to attract residents and staff to their organisation.

Consideration from cross-functional teams about the care requirements of an organisations residents will enable complex care requirements to be met whilst monitoring funding levels and ensuring that appropriate ongoing education is taking place across the working cohort.

We find that those Providers who have strong supporting technology together with a collaborative multi-disciplinary team achieve better care outcomes for their residents.

Recruitment & Retention

As the Australian population ages, there is expected to be exponential growth in employment opportunities. The question is, how do we attract and retain talent to the industry?

The over 65’s make up 15% of our population and forecasts project that this cohort will make up 17% by 2024 and 20% by 2044. According to McCrindle Research, ‘if we are to keep the current ratio of aged care workers to people aged over 85 in our nation, we need to add 77,976 workers in the next 10 years, which equates to recruiting 650 new workers per month, in addition to replacing 668 retiring staff per month.’

Recently chatting to a long-serving aged care worker, she said: “she finds it really rewarding but at the same time it can be frustrating.” Despite her important role, other health care workers have better pay conditions than she does. This is a common theme with nursing staff reporting that their pay is less than that earned by nurses within other health care settings, whilst care workers feel that their salary does not adequately reflect the level of responsibility required in their work.

How can we attract and retain the level of workers Aged Care required now and, in the future if the work is demanding and the wages don’t reflect the work being carried out?

Clearly the government needs to address the wage gap between Aged Care and other care professionals, however, organisations can attract and retain staff by ensuring their rosters are fair and equitable.

The opportunity

Cross-functional teams working together to align staffing levels with care requirements, the model of care and funding are imperative. We frequently find that providers have roster administrators creating and publishing rosters that have no understanding or access to relevant data of the changes that have occurred at their facility. There are no regular multi-disciplinary meetings to discuss whether staffing levels are appropriate for the current landscape and predominantly the technology used by providers doesn’t support them in making informed decisions and in real-time.

Technology that supports business with seamless integration across systems with real-time visibility of its data is a critical element. The days of duplicate data entry and receiving data after payroll closes that tells a provider they overspent should be well and truly over.

Conclusion

The Royal Commission has brought media attention to the industry, unfortunately, the many great stories don’t get the media attention they often deserve, leaving consumers and potential workers feeling that the whole industry is in crisis. We can’t ignore the poor performance of some Providers, but we can talk to the great successes that do and are occurring across the industry so that we can not only attract residents but also the workforce talent that the industry continues to demand.

Providers in the sector will have a much greater chance of remaining viable if they collaborate across their roles, review systems and processes to make sure they are supporting the future of their business and be more innovative in their working models considering alternative options to the traditional models of care historically provided.

One thing is for sure, there is stormy weather ahead and we need to stand together, collaborate, utilise the technology available to us and embrace the changes. For more information about Workforce Management at Mirus Australia or to discuss with Sara in more detail, please click here.