Commissioners were inquiring into staffing numbers and skill mix, the terms and conditions of employment in the aged care sector, workforce planning and the role of Government in that, workforce education and training, and the registration of personal care workers.
This hearing was a similar format to the hearings held last year, both witnesses appeared via video link and were questioned by Senior Counsel Assisting Peter Rozen QC and Counsel Assisting Erin Hill.
Expert advocates for minimum staffing levels
First witness for the day was Professor Charlene Harrington, Professor Emeritus (retired) of Sociology and Nursing, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, who made an appearance from the United States.
She explained the process behind the current United States five star rating applied to aged care facilities to measure quality and how important minimum staffing levels are to good care in nursing homes.
Professor Harrington explains that there is more of an importance on a minimum number of Registered Nurses (RN), along with nursing staff.
"There have been over 150 research studies looking at nursing home staffing and many of those studies show that it is the RN hours that make a big difference and far more important than the… nursing assistant hours. So it is very important that nursing homes have adequate RN staffing levels," says Professor Harrington.
"Of course this is the more expensive staff, so nursing homes like to save money so they don't always have enough RNs."
She has referenced a study in her submission, a United States study in 2001 by the Centres for Medicare and Medicaid Services (CMS), which she described as the "gold standard" for setting staffing levels in aged care.
Professor Harrington believes the study still stacks up nearly two decades on and should be implemented in aged care facilities to reach high quality care.
"It was the most important study and first major study that showed if you didn't have a certain level of staffing, there was harm or jeopardy to the residents," says Professor Harrington.
"Since that time, there have been many other research studies that have looked at the importance of staffing but they haven't always set a level of staffing."
The CMS study outlined minimum hours on average per day per resident to be 4.1 hours, and if a resident had higher acuity, that would need to increase.
Additionally, the study found RNs would need to provide 45 minutes per resident per day at a minimum, to deliver high quality care.
Professor Harrington strongly believes this study is very much "applicable", saying, "I think [the care hours] could actually be higher. This is the main study that we have to show that if it is lower than that, there are serious consequences."
In the United States, Professor Harrington outlined, the biggest problems are poor staffing levels, low wages, poor quality oversight by the Government, and issues with financial accountability requirements.
Poor societal views on aged care persist
The second witness for the day was Dr Katherine Ravenswood, Associate Professor in Employment Relations, Auckland University of Technology, New Zealand (NZ), who states that Australian and NZ have very similar issues with labour standards and funding in aged care.
Counsel Assisting Hill inquired whether there was a reluctance in NZ to improve the labour standards and funding for aged care and asked why that might be the case.
Dr Ravenswood explains that the shift in Government and social views around the role of the public sector and Government is causing labour standards and funding to not be a priority.
"In recent decades, we have had a shift towards a neoliberal view," says Dr Ravenswood.
"There is a reluctance in how the sector operates, both in residential aged care and home and community support, but it is also how the Government operates.
"What we must note is that in this care work, we've relied on low labour standards and low wages for a long time, that is based on gender discrimination that perceives the work to be low skills, low values, and low worth.
"This also interacts with the clients, older people are perhaps not prioritised in society or in health care. So when we connect unspoken attitudes towards workers, who are [considered] a feminised occupation, as well as their clients who are older people, I think that it means that essentially discriminatory attitudes stop us moving forward and prioritising the labour standards in addition to the previous ideology of neoliberalism as well."
Dr Ravenwood adds that while care workers wages have increased in NZ, the overall state of the job as it is perceived in the community and by managers is still low.
Add the end of the Commission, Counsel Assisting Rozen says their submission would include minimum nursing ratios, however, it is "necessary" to implement a transition period.
The next Royal Commission hearing is expected for March but has not been officially confirmed. Subscribe to Talking Aged Care for all the updates on the Royal Commission.