Residential aged care 24/7 registered nurse responsibility: reporting, supplement and other information

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘24/7 registered nurse responsibility’, ‘Mark Richardson – Assistant Secretary, Residential Care Funding Reform Branch’, ‘Stephanie Kaiser – A/g Assistant Secretary, Workforce Branch’, ‘Danaye Mylonas – Business Design Lead, Residential Care Funding Reform Branch’, ‘Department of Health and Aged Care’, ‘1 June 2023’, ‘health.gov.au/aged-care-reforms’, with an image of QR code on screen]

[The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen]

Mark Richardson:

Hello everyone and welcome to our ninth Residential Aged Care Funding Reform webinar. As with previous webinars please note that today’s event is being recorded and will be available later for those who would like to watch it again or who are not able to attend. The slides are now available on the Department’s website. You can access these by scanning the QR code on the slide that you can see now.

Before I go any further, I would like to acknowledge the Traditional Owners and Custodians of the lands on which we are meeting today. I am in Canberra on the lands of the Ngunnawal and the Ngambri people. I would like to pay my respects to Elders past, present and emerging. I would like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander people who are here with us today.

My name is Mark Richardson. I am the Assistant Secretary of the Residential Care Funding Reform Branch at the Department of Health and Aged Care. Joining me today are my colleagues Stephanie Kaiser, Assistant Secretary of the Workforce Branch and Danaye Mylonas, Business Design Team Lead in the Residential Care Funding Reform Branch.

There will be a Q&A session at the end of the webinar. You can lodge questions in the Slido box on the right-hand side of your screen. If you can’t see Slido you can also access it via a link in the chat on the bottom right of your screen.

We do have a fair bit of information to get through today however we will attempt to respond to as many questions as possible at the end of the presentation. All questions and answers including ones that we may not get to will be available after the webinar and published on our website. We’d also like to know what you thought of today’s webinar and how we can improve for future sessions. So, if you can complete the short survey at the end of today’s session that would be most appreciated.

As you know the 24/7 registered nurse or RN responsibility will commence on 1st of July 2023. This new responsibility is well aligned with providers’ existing responsibilities under the Aged Care Quality Standards in the Aged Care Act 1997 to provide safe and quality care at all times. It also aligns with the Royal Commission into Aged Care Quality and Safety’s final report recommendation, that is recommendation 86, that minimum staff time standards should be adopted for residential care including having at least one RN on site at each residential facility at all times.

The aim of the new responsibility is to improve access to clinical care at all times through high quality nursing care that other care staff may not be able to provide due to their limited scope of practice. To this point I note that data provided to the Royal Commission by the Australian College of Emergency Medicine indicates that up to 40% of all transfers of residents from residential aged care facilities to hospital emergency departments are potentially avoidable through the provision of quality clinical care.

Evidence provided to the Royal Commission also indicates that almost half of all ambulance transfers from a residential aged care facility to a hospital emergency department occur after hours - at a time when staffing levels in residential aged care facilities are reduced, with limited access to nursing care, particularly from RNs.

Some of the key contributors to avoidable presentations to hospital emergency departments include events such as falls, antimicrobial misuse, poor wound management, medication error, end of life care and palliative care. These are all conditions and situations that RNs are well placed to manage.

Mandating 24/7 RN care therefore helps reduce the risk of clinical deterioration and allows onsite RNs to manage some issues as first responders and potentially prevent unplanned admissions to acute facilities or transfers to emergency departments.

Now, unlike care minutes, there is no phasing in of the 24/7 RN responsibility. This means all providers must aim to meet the 24/7 RN responsibility from the 1st of July 2023.

Having said that, the Government has recognised the workforce pressures in attracting and retaining a suitably skilled and competent workforce, particularly in rural and remote areas. As such providers can apply to the Department for a 12-month exemption from the 24/7 RN responsibility of residential facilities that are located in Modified Monash Model (or MMM) 5, 6 or 7 areas and with 30 or fewer operational beds.

I should highlight though, that we will only grant an exemption if a provider can show that they have adequate alternative clinical care arrangements in place to ensure the needs of residents are met when an RN is not available.

If you believe you’re eligible for an exemption and haven’t been contacted by the Department, I encourage you to email us at the email address shown on this slide to find out more about the process. There is also a QR code to take you to information about exemptions on our website.

We are aware that many providers not eligible for an exemption are concerned about what will happen if they can’t recruit enough RNs to meet the new 24/7 RN responsibility. We have some links and QR codes on this slide which will take you to the Aged Care Quality and Safety Commission’s Regulatory Bulletin on this issue, a letter from the Commissioner to all providers and a recording of the webinar the Commission held on the 18th of April that clearly explains the Commission’s approach to the regulation of the new 24/7 RN responsibility. The Commission has also published some Frequently Asked Questions in response to questions received during their webinar.

Where facilities are not meeting the 24/7 RN responsibility, the Commission will consider the steps that a provider has taken to fulfil their responsibilities, including efforts made to recruit and retain RNs and the clinical governance and clinical care arrangements they have put in place to ensure that clinical needs of residents are met.

In short, the Commission has assured providers that it will take a fair and sensible approach to the regulation of the 24/7 RN responsibility and are not likely to initiate enforceable regulatory action where a facility is making ongoing efforts to comply and is effectively managing risks and providing safe and quality care to residents.

However, at the same time, where there are concerns about the quality and safety of the care being delivered at a facility, the Commission will respond in a way that is proportionate to the assessed level of risk and the potential consequences for residents.

It is important to understand that in all circumstances the Commission’s focus will always be on ensuring the wellbeing of the residents receiving aged care at a residential facility and supporting providers to deliver safe and quality care.

Now, I should also add that the Department is in the process of:

• undertaking work to identify areas of RN workforce shortages by region; and
• identifying clinically appropriate alternative arrangements for having an RN on site 24/7 for residential facilities unable to meet the responsibility due to workforce shortages particularly in rural and remote areas.

These projects are intended to:

• refine the Government’s understanding of areas of RN workforce shortages; and
• build on the Commission’s guidance around appropriate alternative arrangements for when an RN is not available to provide future workforce support including any future exemptions policy should Government decide to extend the exemptions.

In the meantime, I’d encourage providers who aren’t immediately able to provide 24/7 RN care to read the Regulatory Bulletin, FAQs and watch the webinar recording; to help you understand the types of common alternative clinical care arrangements that could be implemented and how the Commission intends to regulate compliance with the new responsibility.

Now, before I move on to other topics planned for today’s session, I want to quickly highlight an important element of the 24/7 RN responsibility which is key to how it will operate on the ground in terms of reporting, payment of the 24/7 RN supplement and compliance. And this is the distinction between a residential facility and a residential care service in the context of this new responsibility.

While these terms are generally being used interchangeably across the sector to mean the same thing, it is important to note that changes to the Aged Care Act 1997 advise that the 24/7 RN responsibility applies to all approved providers of residential aged care services in respect of a residential facility.

So, for the purposes of the 24/7 RN responsibility, a residential facility is a building or complex of buildings inclusive of their immediate surrounds used for the purpose of delivering residential aged care.

Another way to explain this is that:

• a residential facility is simply a physical location or site through which an approved provider delivers residential care to residents; and
• that is not the same as the concept of a residential care service, which is the entity through which residential care subsidy is paid to an approved provider.

Importantly, linking the 24/7 RN responsibility to residential facilities directly aligns with the Royal Commission’s recommendation that at least one RN is present on- site, that is, at a physical location, and on duty to respond to the clinical care needs of the residents at the facility at all times.

So what does this mean in practice and how will it apply to different business setups?

First, for around 95% of residential care services - one residential care service is associated with one residential facility. However around 5% of residential care services are what we call co‑located services and split services.

Co-located services are residential care services that are located with one or more other service at a single residential facility. A good example is where what was historically called a hostel and what was historically a nursing home on a single site still occupy adjacent buildings and retain separate RACs IDs, but in practice today, these services operate together with shared staff and management.

For the purposes of the 24/7 RN responsibility co-located services are only required to have 24/7 RN coverage across the multiple services that make up the one residential facility. That is, the provider doesn’t need to have a separate RN coverage at each of the co-located services, provided that the overall coverage of at least one RN is sufficient to ensure that safe and quality care is delivered.

I should add for further clarity that we only consider co-located services as a single residential facility where they have the same approved provider.

We’re also aware that there are a very small number of services that have structured their business model so that care is delivered at multiple physical locations. These are considered split services for the purposes of the 24/7 RN responsibility and will be required to have at least one RN on-site and on duty at each site associated with the one service. This is because the different locations are considered separate facilities.

As most of you would be aware by now, a key part of the implementation of the 24/7 RN responsibility is the associated reporting that providers are required to do from 1 July. We can advise that all approved providers will be required by legislation to submit a monthly report in respect of each residential facility where they provide residential care.

A couple of key points to note here are that the reporting requirements apply regardless of whether or not a residential facility has an exemption from the 24/7 RN responsibility; and that providers must complete and submit their 24/7 RN report by the seventh calendar day of each month for the previous month. Submitting your report on time is particularly important as it impacts on your eligibility to receive the 24/7 RN supplement, which I’ll cover in coming slides.

Providers should already be aware through previous communication by the Department that reporting for the 24/7 RN responsibility will be done through a new system called the Government Provider Management Portal (or GPMS).

Hopefully, most providers have already logged into the new GPMS system for the purposes of reviewing their Star Ratings and from Monday 3rd of July this year, organisation administrators will be able to log into GPMS and assign the new registered nurse role to staff who will be submitting the report.

If not, I strongly encourage you to set up your access soon so that you are ready well in advance of the commencement of the reporting requirement. You can find information on how to do this by visiting our GPMS web page using the QR code on this slide.

Now, we have heard concerns from some providers that the reporting appears too onerous and that it creates unnecessary administrative burden for the sector, including for providers with an exemption.

The reasons we are collecting data from all providers are threefold:

• First - it is to ensure we get a full picture of the extent providers are meeting their obligation to provide 24/7 RN care. This information will also help support the Commission’s regulatory activities relating to the 24/7 RN responsibility.
• Second - we will use the data to determine eligibility for the payment of the new 24/7 RN supplement for eligible residential facilities which I’ll cover in coming slides.
• And third and perhaps most importantly, the data collected will help inform any refinements to the policy on the 24/7 RN responsibility to better target workforce supports in the future.

Please be assured that there has been user testing undertaken to ensure that the reporting is designed in a way that allows us to collect data for the reasons I just described, while at the same time minimising providers’ administrative workload on this requirement.

We will take you through some screenshots to show you what the reporting involves, but before we do so, I want to outline some of the key reporting requirements including:

• that providers must confirm for each day of the reporting month whether they have 24/7 RN coverage, that is they have an RN on-site and on duty at all times at each residential facility.
• Where there are any gaps in 24/7 RN coverage, providers only need to report every period of 30 minutes or more that an RN was not on-site and/or on duty. For example, if a facility only had two 30-minute periods that were not covered by an RN, then they would only need to report on those two specific periods.
• For each period of absence, providers will also need to indicate the reason an RN was not on-site and/or on duty; and
• lastly, indicate the alternative arrangements that were made to ensure clinical care needs were met while an RN was not on-site and/or on duty or that alternative arrangements were not made for each such period.

We have commenced contacting providers who we understand may be running co-located services and following confirmation of whether or not they are co-located, we will provide further information on how to do their reporting including which service within the facility will become the reporting service that is responsible for submitting the monthly report.

I’d like to remind providers to please ensure that your contact details in NAPS are up to date to avoid any delays in this process. I’ll now hand over to Danaye to take you through the new 24/7 reporting functionality in GPMS and what providers need to do to ensure accurate reporting on how they are meeting the new responsibility. Over to you Danaye.

Danaye Mylonas:

Thanks Mark and good afternoon, everybody. Lovely to see so many of you who are interested in finding out a little bit more about the 24/7 reporting solution. As Mark said we have undertaken user testing of this solution so the screenshots that I am going to take you through this afternoon I hope you’ll agree are both user friendly and intuitive and very much focused on minimising administrative burden for providers as well.

So the first thing to point out here, this is the landing page. So, for those who have logged in across March and April into the GPMS portal you will already be familiar with this screen and you will have a Star Ratings tile. From the 3rd of July there will be a new tile for those users who have the RN submission service user role and that will then display this tile here that you can see up on the screen - the 24/7 Registered Nurse Reporting.

So on to the next slide. Once you click on that tile you’ll be able to then see on the left-hand side a list of services. So if you are a user with permissions for multiple services you will see a list of those services down on the left hand side. If it’s just one service that you’re responsible for, you will only see the one service on the left-hand side. You will need to select that service and on the right-hand side you can see there the edit button will appear. You’ll see a couple of statuses and it's important here to note that any previous submissions you will see listed below in the completed report submissions. On the 1st of every month a new, open report submission record will be created that will have a status of ‘Not started’, and that’s the record that you’ll be editing. In this example we’ve already got an ‘In-progress’ submission that you can complete on a daily basis if you choose to. And I’ll take you through that in the screenshots. But every month, your report will be there and it will clearly indicate the due date which is the seventh day of the next month.

So, once you click on the ‘Edit’ button you’ll  go through to the next screen where you will see some instructional text. This page has static text and it gives you an overview of what you need to do to complete the report successfully. So, after a couple of months of submissions you’ll be very well familiar with this and you’ll be able to continue and complete your submission. But it covers the reporting requirements and how to complete the reporting fields as well. We will also have system user guides available. As a reminder, the Department, as part of its standard release schedule, publishes system user guides so everything will be documented if you need to reference support materials in the future.

But to complete the submission you select ‘Continue’.

And if we then move onto the next slide. You will then be provided with a list of days in that month. And there are two options in there. The first is if you had a nurse on-site for the entirety of the day you would verify by selecting ‘Always on-site’.

If you don’t have a nurse on-site and there are periods during the day of 30 minutes or more where there was an absence of a registered nurse, then it’s selecting the ‘Not on-site’ button.

So, if we move to the next slide and I’ll give an example of the screen display where you select ‘Not on-site’. If you are selecting ‘Not on-site’ there is an option that is displayed for you to select the ‘Time from’ and the ‘Time to’ with 15-minute interval blocks to select from. There is the ability if you need to override and reflect a different interval, to select the little clock icon and edit the time directly into that field.

Then the next option is to select a ‘Reason’ for absence. So, it’s a drop-down list and also any ‘Alternate arrangements’ that were in place for the absence period. We’ve introduced some system smarts as well so that if you do need to add additional periods, you can select the ‘Plus’ or, you can select to ‘Copy’ the previous row if the absence and alternate arrangements are the same and then all you need to do is amend the ‘Time from’ and ‘Time to’. So it reduces the additional effort that you need to put in there. If you make a mistake, you can also delete that as well.

Once you’ve selected the From/To and selected those two fields – ‘Reason’ and ‘Alternate arrangements’ - you can select ‘Save’.

We then move to the next slide and you’ll be able to see what that submission looks like. So, you can see here on the first day of the month there was an absence, so there was not a nurse on‑site for the full period, and you can clearly see the period and then also the reason and the alternate arrangements that were in place. But for the other dates you can see there that there was a nurse on-site.

It is important to note - and I do want to reiterate -  you can complete this on a daily basis if you wish to. So at the conclusion of every day, you can submit on a daily basis, or you could choose to do this periodically during the month or at the end of the month as well. But the capability is there depending on how you’ve structured your organisation and your administrative functions in terms of reporting and the frequency of this. The key thing I do want to point out is you will not be able to finalise the month submission until that month end has closed. So that’s built-in in terms of a verification step.

So you can see that successful completion means that the box is blue and you’ll be able to clearly see that. If you then submit ‘Continue’ because you have completed all of the days in the month, you will be taken to a ‘Summary’ screen and you’ll be able to view the coverage over that reporting period, the number of reported hours and also any absences as well. And then it’s important to acknowledge the declaration that the information is true and accurate. You can go back if there’s been any mistakes that you need to correct. Otherwise, you’re selecting ‘Agree and Submit’. And once you’ve selected the ‘Agree and Submit’ button, if you’ve submitted that within the legislated period which is the seven days, you’ll have a green tick box so that you know that that submission has been successful and that if you’re eligible for the supplement, that will then be passed through to Services Australia to support the calculation of that supplement. If you have submitted the report after the time frame you will still get a confirmation that it’s been successfully submitted but that box will be red.

We’ll move to the next slide.

Over to you Mark. I think that’s all and as a final reminder, we will have system user guides that are available. They are published over the release weekend as per the Department’s standard release activities. There will be detailed system user guides with all of the steps and more of the alternative pathways as well. Thank you.

Mark Richardson:

Thanks Danaye. That was great. And just to add to what you said I guess as well as user guides, short videos and also some frequently asked questions as well. So, look we’ve had some questions about what counts as on-site and on duty for reporting purposes. We can advise that for the purposes of the 24/7 RN responsibility:

• an RN is considered on-site when they are within the confines of the residential facility or the immediate surrounds.
• On duty means that the RN must be available to provide care to residents and clinical oversight of the care provided by other staff as needed.
• Both of these conditions must be met for an RN to count towards meeting the responsibility.

For the purpose of the responsibility, an RN is also considered to be on duty when taking breaks during a continuous period of work if those breaks are prescribed in their employment conditions. However, we note that the particular employment conditions and staffing arrangements at each residential facility to meet the 24/7 RN responsibility are matters for the relevant approved provider.

We can advise also that if an RN goes off-site during a mandated break, meaning beyond the building or complex of buildings including its surrounds, and the RN can’t be counted towards meeting the responsibility, then the provider must report this period of break of 30 minutes or more if an RN was not on-site and on duty.

In some circumstances the same individual may work within a facility in more than one role. In order to count towards the 24/7 RN responsibility an individual needs to be engaged by the provider as an RN as their prime purpose for that shift being to provide care to residents and oversight of care provided by other staff.

We will publish a few scenarios in the care minutes and 24/7 guide in the coming weeks to help you understand whether an RN counts as on-site and on duty particularly where they work in more than one role. I should add that the guidance in the 24/7 RN and care minutes guide will be refined over time.

As you’re aware, the Government announced during the October 22-23 Budget that a new supplement will be available for 1 July 2023 to support residential aged care facilities with up to 60 residents on average over the month to have an RN on-site and on duty 24 hours a day, seven days a week.

At the time, the Government committed $473.3 million to fund the new supplement from 1 July 2023 to coincide with the commencement of the 24/7 RN responsibility. This has now increased to $622.9 million as part of the forward estimates process.

To align with the Fair Work Commission’s decision to increase wages for direct care workers by 15% from the 30th of June this year, the Government has announced an additional $178 million (including $43 million in indexation) as part of the 23-24 Budget to help fund the costs of delivering 24/7 RN care.

When summed together, the Government has committed approximately $801 million over four years from 2023-24 to fund the supplement to help providers meet the cost difference between the amount of RN time required under the care minutes responsibility and the 24/7 RN responsibility.

Put another way, the supplement is intended to help providers of smaller residential facilities with up to a monthly average of 60 residents per day meet the costs of employing extra RNs to provide 24/7 RN care that are not already covered by the AN-ACC subsidies they receive.

As you can see on this slide, a residential facility must meet a few other criteria in addition to meeting the occupancy threshold of an average of 60 residents over the month to be eligible for the payment of the supplement. These include:

• completing the 24/7 RN report by the seventh calendar day of the following month as I mentioned before
• ensuring the report is completed correctly, and
• Lastly, meeting at least the specified level of RN coverage – averaged each day over the month – to be eligible for the supplement. I’ll provide a little bit more detail on this threshold shortly.

As I said before, the supplement is designed to help providers cover the costs of delivering 24/7 RN care, therefore meeting the eligibility criteria for a payment of the supplement should not be confused with compliance with the legislated 24/7 RN responsibility as these are two separate matters.

I want to also point out that to receive the supplement each month it is important that each service submits their correctly completed 24/7 RN report before they submit their monthly claims.

The sequence of this is important because of the way the Services Australia system is built to calculate and process any supplements that providers may be eligible for. If the report is received by the seventh day of the month and before the service submits their monthly claim the supplement will be calculated and paid with the current month’s claim.

Where a correctly completed report submitted after the monthly claim has been processed but by the seventh calendar day deadline, any eligible supplement payment will be paid as an adjustment in the subsequent claim month.

Also, please note the payment of the supplement will be incorporated into the existing advanced payment process for subsidies and supplements.

Advice of a supplement payment will be included in the monthly payment statement from Services Australia. We have included a QR code at the end of this presentation where we can find a link to Services Australia support materials that will be updated in July to reflect the display in the payment statement.

I also mentioned earlier the distinction between a residential facility and a residential care service in the context of the 24/7 RN responsibility is key to not just how the responsibility operates but that it also impacts the payment of the supplement and reporting.

Just like how the responsibility applies at the facility level, eligibility for payment of the supplement, including calculation of the average of 60 residents per day over the month and reporting of the 24/7 RN coverage will also apply at the facility level.

This means for co-located services that form a single residential facility and are operated by the same provider we will:

• combine the average number of residents at each service for the month;
• check that reporting for the 24/7 RN responsibility has been completed correctly by the nominated service responsible for reporting on behalf of the residential facility; and
• if eligible, each service will receive a proportion of the relevant amount of RN supplement based on their occupied bed days.

To put it a different way, if co-located services that form a single residential facility have a combined total of more than 60 residents per day on average over the month the facility as a whole will not be eligible for the supplement, even if the individual services have less than 60 residents on average.

Now let’s take a look at the specified level of RN coverage that must be met by a residential facility to trigger payment of the supplement, provided that all other criteria are met in regards to occupancy and compliance with reporting.

We can advise that from 1 July the RN coverage threshold will be set at an initial average of 20 hours a day over the month.

Facilities that are close to meeting the 24/7 RN responsibility won’t be financially penalised while they are attempting to recruit a full complement of staff to meet the responsibility. This will be of particular importance for facilities on the smaller end of the scale and those in rural and regional areas which have difficulties engaging a sufficient number of staff without additional financial support.

I should also add upfront that this is an interim threshold only. Consideration will be given to whether the threshold should be tightened around three months into the commencement of the 24/7 RN responsibility as well as an ongoing basis to ensure that remains reasonable. This is because the Government’s expectation is that providers wherever possible work towards providing full 24/7 RN coverage as intended by the new responsibility.

Again, I want to reiterate that meeting the RN coverage threshold of an average of 20 hours per day or being eligible for payment of the supplement in general, should not be taken as an indicator that the responsibility to have an RN on-site and on duty around the clock has been met. Compliance with the legislated responsibility will be determined by the Commission.

As I mentioned earlier, the data we collect will be shared with the Commission to support their regulatory activities including targeting of providers that may be at risk of not providing safe and quality care to residents.

In terms of Star Ratings, 24/7 RN coverage information will be published on the My Aged Care website for all services, where Star Ratings are displayed. We anticipate this information will be published in December with specific details around publication format still under consideration.

The supplement rates, as I’m sure that many of you would be aware of by now, differ between MMM 1 to 4 areas and MMM 5 to 7 areas in recognition of the additional costs of attracting RNs to work in rural and remote areas and decreases as the number of residents increase and eventually tapers off to zero for facilities with more than 60 residents per day on average over a month.

Some providers have asked why services with more than 60 residents aren’t eligible for the supplement. As I said earlier, the supplement is designed to meet the difference between the costs to deliver RN care minutes and the costs to provide 24/7 RN coverage. The supplement is to make up the difference for smaller services that would not have enough AN-ACC funding to provide 24/7 RN coverage.

The previously published supplement rates have been updated to align with the 15% Fair Work Commission wage uplift following the pre-Budget announcement on the 4th of May 2023.

In addition, we have updated our previously published rates with more information about how the average occupancy over the month is worked out. Put simply it is calculated based on the number of occupied bed days for each claim month which will vary due to the number of days in each month. That is 28, 29, 30 or 31 days. For example, the number of occupied bed days for months with 31 days will be more than those with 30 days as can be seen in the table on this slide.

However, in the interests of time I won’t go through the numbers in the table on the slide today but I would encourage you, that is providers that are potentially eligible for the supplement, to visit our website using the QR code seen here for more information on the rates payable from 1 July this year.

I should also point out that from 2024-25, additional AN-ACC funding will be provided to support services to deliver an additional 15 minutes of care – that is 215 minutes – per resident per day. When this happens, the RN supplement will reduce, and only be available to facilities with 50 residents or less.

To protect the integrity of the Commonwealth’s expenditure and the accuracy of information published with the residential aged care Star Ratings system, the Department is now monitoring the care minutes reporting data submitted by residential aged care providers.

The Department is also in the process of establishing a compliance program to ensure that data on care minutes and the 24/7 RN responsibility submitted in the Quarterly Financial Reports and the GPMS portal is validated against other information sources.

It is planned the inspections activity will commence from July 2023 in line with the commencement of the 24/7 RN responsibility and mandatory reporting of care minutes from 1 October this year.

Facilities subject to inspection will be selected using the assessment site identification tool, a tool developed by the Department – which produces a mix of risk-based and periodic inspection targets.

The inspections will check care minute and 24/7 RN reports against a provider’s records. That is staff rosters, payroll records, timesheet records and records of staff absenteeism and how care minutes are calculated as direct care and non-direct care.

Inspection output will be a report with findings and recommendations. If the provider does not have adequate procedures in place an action plan can be agreed with management to remedy the deficiency. This can include providing educational material to the provider about their responsibilities.

So that completes the presentation on the 24/7 RN responsibility and the associated reporting obligations and supplement to help providers meet the requirement. I’ll now hand over to Steph who will provide an update on the workforce initiatives.

Stephanie Kaiser:

[Visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Aged Care Workforce’, ‘Program Update’, ‘Presenter: Stephanie Kaiser, A/g Assistant Secretary’, ‘1 June 2023’]

Good afternoon. I’m Stephanie Kaiser. I’m the Acting Assistant Secretary of the Aged Care Workforce Branch in the Department of Health and Aged Care. Thank you for attending this webinar today. I’ve seen quite a few questions about workforce. I know it’s top of mind for people so I just want to provide an update today on our key workforce programs that can help you to attract and retain the workers that you need. And I’ll also highlight some valuable training initiatives to support the workforce.

The Department has a number of key workforce initiatives to build, train and support the aged care workforce. Over the next few slides, I’ll cover the wage increase, nursing scholarships, transition to practice program, clinical placements program, how we’re supporting overseas workers, the workforce advisory service as well as things the Government is doing in the research and innovation space.

So firstly, the Fair Work Commission decision. As I’m sure many of you know the Government has invested $11.3 billion to fund the 15% pay increase for aged care workers and this will contribute to the largest ever wage increase for some employees working in the aged care sector. These wage increases are really important because they recognise the value of the aged care workforce and the complex work that they do. These wage increases will help you to attract and retain more people to work in the sector.

Around 250,000 aged care workers are expected to benefit from these wage increases including of course, registered nurses. Based on the current award rate a 15% increase will provide a registered nurse on a Level 2.3 award wage an additional $196.08 a week which would be equivalent to more than $10,000 a year. I also note that the Fair Work Commission has not ruled out further increases for direct care workers in the sector over and above the 15% and will be deciding on further increases that should be provided to other staff including cleaners, gardeners and administration staff.

As you can see from this slide, the $11.3 billion in additional funding is made up of funding to a number of different aged care types and most relevant for today’s purposes there is an $8.5 billion increase in funding for residential aged care over four years. This includes increasing the Australian National Aged Care Classification price from $216.80 to $243.10, and introduction of a new $10.80 per resident per day hotelling supplement and increasing the new 24/7 registered nurse supplement that Mark spoke of before.

Next slide please.

Further information on the wage increase can be found on the Department of Health and Aged Care’s website. A webinar was recently held on the 16th of May for residential aged care providers to provide information on the impacts of the Budget. The slides of the presentation can be found on the Department of Health and Aged Care’s website under ‘Aged Care Webinars’.

We’ve heard from workers that having career pathways and opportunities to grow their skills and expertise is important to making aged care a more attractive place to work. The Government is investing in a number of programs to improve career pathways for the current and the future nursing workforce.

Providing more nursing students with an opportunity to experience a high-quality clinical placement in aged care will expose more nursing students to the opportunities and benefits of working in aged care. Providers will benefit from having a nursing student undertake a placement as this exposes the student to the aged care sector and to the provider.

If the student has a good experience during their placement, they may seek casual employment with the provider whilst they finish their studies. They may also seek full time employment after they have completed their study. That’s why the Government is funding the new aged care nursing clinical placements program which aims to deliver up to 5,250 new high quality clinical placements to nursing students across the country. This program has just commenced and it will run until December 2024.

Students will be supported during placements by Clinical Facilitators and by access to an online resources hub. Providers who would like to participate in the program can contact one of the 5 suppliers who have been contracted to provide this program on behalf of the Government. More information about how to contact these suppliers is available on the Department of Health and Aged Care’s website.

The Aged Care Transition to Practice Program supports new aged care nurses with training and mentorship. Providers will benefit from having their nurses in the program as these nurses will be provided with additional training and mentoring. Once the nurse completes the program, they will be better equipped to work in the aged care environment and this may also help with their confidence and assist with retaining these nurses in the workforce into the future.

This program is also an opportunity for providers to recruit more nurses who have recently graduated or have not worked in aged care before. Nurses who take part in the program receive specialist training in aged care and gerontological nursing. The program is open to aged care nurses who are:

• newly graduated registered nurses
• newly graduated enrolled nurses or
• experienced nurses who have recently transitioned to the aged care sector.

There are three suppliers who are contracted to deliver this program on behalf of the Government and information about these suppliers and how to contact them is also available on the Department of Health and Aged Care’s website. As at 1 May, 318 people have already completed the Aged Care Transition to Practice Program.

And then there are also some scholarships available for nurses and allied health professionals. These scholarship opportunities are available through the Australian College of Nursing and funded by the Australian Government. They provide an opportunity for the aged care workforce to improve their skills and expertise. Scholarships are available for personal care workers, nurses and allied health professionals working in aged care. Individuals are eligible if they are studying or intending to enrol in a graduate certificate, graduate diploma or master’s degree. The Aged Care Scholarships will allow for up to 400 additional scholarships per year for three years for personal care workers and nurses to complete qualifications and in addition there will be up to 100 allied health scholarships per year for three years which will be for allied health professionals to focus on dementia related qualifications. There are also guaranteed places for First Nations workers.

A round is currently open. It opened on the 2nd of May and it will close when all places have been filled. So, I really encourage you to support your workers to access these scholarships. More information is available on the Australian College of Nursing’s website.

Next slide please.

Migration has a role to play in relieving workforce pressures in the aged care sector where roles cannot be filled by local workers.

The Government encourages the use of employer sponsored visa programs by aged care providers to access direct care staff from overseas where there is evidence of genuine local labour shortages.

The occupation of Registered Nurse (Aged Care) is currently included in the Medium and Long-term Strategic Skills List which permits access to the full suite of Skilled visa programs.

The occupation of Enrolled Nurse is included on the Short-Term Skilled Occupation List, which underpins eligibility for a more led range of Skilled visa options.

The Temporary Skill Shortage visa is the most common pathway used by employers to engage workers with occupations on the skilled occupation list from overseas to fill specific vacancies.

Other options to consider include the Skilled Employer Sponsored Regional Provisional visa and the Employer Nomination Scheme visa.

Visa applications related to health and aged care occupations are being given priority processing by Government. You may be aware that the Government has also recently introduced an Aged Care Industry Labour Agreement to help streamline the recruitment of other direct care workers to the sector. The Labour Agreement will allow aged care providers to use temporary and permanent sponsored skill visas to fill vacancies in personal care occupations.

If you’re interested to learn more about this, the Department of Home Affairs will be hosting a webinar for aged care providers on the 15th of June. And aged care providers located in rural and regional Australia may also be eligible to source overseas workers through the Pacific Australia Labour Mobility Scheme. Personal care workers from the Pacific are eligible to participate in the PALM Scheme if they have completed or are in the process of completing, an Australian– recognised Certificate III in Individual Support (Ageing).

So when we move on to the next slide there is some information about accessing the Business Industry and Regional Outreach Officer network which is funded by the Department of Home Affairs. This is also known as the BIRO network and the role of the BIRO network is to raise awareness and understanding of the skilled migration program and to provide a local contact point for information on skilled migration initiatives and processes. There are BIROs servicing every state and territory. In addition the Victorian and Tasmania BIRO is responsible for providing dedicated support to the aged care sector.

The BIROs are unable to provide specific advice about individual cases. If you need this type of advice it may be best for you to speak to a registered migration agent.

This slide has some useful web links and email contacts where you can access some further information about the migration topics covered today.

Moving on to Aged Care Research and Industry Innovation Australia and the Workforce Advisory Service. The Government is supporting the sector through research and innovation. Flinders University was selected to establish the new Aged Care Centre for Growth and Translational Research now known as ARIIA, with funding of $34 million over three years. ARIIA was officially launched on 5 August 2022. It will provide a significant contribution to increased investment in aged care research and innovation through the implementation of a number of key project outcomes including annual investment in research priorities co-designed with industry. The first year priorities were dementia care, restorative care and rehabilitation, mental health and wellbeing and social isolation, as well as the establishment of a knowledge and implementation hub to ensure that relevant examples of innovation and research are translated effectively and made accessible across the aged care sector, and facilitating and supporting workforce capability improvements through the development and marketing of educational materials and engagement programs aligned with the sector need including advances in and use of new technology.

ARIIA’s research grants round 6 is currently open and they’re seeking applications from organisations who have a project that will contribute to the betterment of aged care sector through improved service delivery, adoption of technology and quality care.

The Workforce Advisory Service is also available to providers and I encourage providers to access this service if they are having trouble with workforce shortages. Providers will be supported to explore the root cause of workforce issues and will have access to tailored recommendations to improve recruitment and retention. To support implementation of recommendations you will have access to free resources including best practice templates along with links to relevant programs that can be accessed to aid in addressing key workforce shortages.

I’d also like to highlight that the Department has been running a series of employer engagement webinars. We’ve recently hosted a number in partnership with the Department of Employment and Workplace Relations on attracting workers into aged care and expanding the aged care workforce through Australian apprenticeships. The recordings are available on our website and I encourage you to have a look to get more information on how to access relevant services and resources.

If you’re interested in knowing more about any of the programs outlined in the presentation today you should contact the suppliers directly. A link to each of the suppliers’ websites and information about the program is available on the Department’s website which you can access through the QR code on the presentation.

Thank you for your time today. I’ll now hand back to Mark for questions and answers.

Mark Richardson:

Great. Thanks Steph. Look we don’t have a lot of time, but we’ll try to go through some questions very quickly noting that as I said at the start, we will take all your questions and answer them after the webinar.

Danaye look I think the first question – and this is in no particular order in terms of how they’re coming up in Slido but I’ll read it out.

Q:        Will there be a new role that we need to assign to staff in the GPMS portal or will all staff be able to submit the report?

Danaye Mylonas:

Thanks Mark. There will be a new role. It will be available from the 3rd of July. There will be a number of new roles as part of the release that’s occurring that weekend. But the specific role for 24/7 reporting solution is the ‘RN submission – service’ role. I do want to acknowledge also there’s some questions that have come in around users having access issues to GPMS. The Department is aware of a small number of users who are still having access issues. They are mainly related to authentication software, so Vanguard or myGovID. They are being prioritised for resolution in the next month as well.

Mark Richardson:

Great. Thanks Danaye. So, the next question that I’ll read out is:

Q:        In small country towns the ability to fill the 24/7 RNs will be close to impossible not just in the first year but in years to come. I’m just wondering if there is any sensible thought around solutions?

Look I’ll answer that one. I guess that’s a great question. Hopefully we covered off on some of that during the presentation. I think there’s probably three parts. First of all, there are exemptions that Government has put in place. Won’t go through the details again but at a very high level as you’re aware that’s for facilities that are located in MMM 5 to 7 areas with 30 operational places or less. Secondly the Commission has been very clear about how they will regulate the new responsibility. Specifically what you need to do is make genuine efforts to comply with the new responsibility meaning that you need to have evidence and be actively trying to recruit and retain RNs. But also secondly if you don’t have an RN onsite 24/7 you need to be managing the risk in a way that’s safe for your residents and is providing quality care. So namely as I pointed out before – and you should go to the Commission’s website for access to the webinar that they conducted on this issue and also the bulletin – you should focus on putting in place appropriate alternative arrangements in those circumstances.

But the other thing that I touched on during the webinar was that we are doing further work in terms of identifying those alternative arrangements and what they may look like. That’s to build on the work that we’ve already done, being the Commission and the Department, and we’re doing that through the University of Wollongong. There’s been a bit of media about that so you may be aware of that. But importantly it is about trying to add to those alternative arrangements that we’re already aware of to build that out specifically I guess for areas where there are workforce shortages – and that’s remote and very remote parts of Australia – so that they can also have I guess access to quality care.

But look I think that pretty much brings us to the end. I apologise for the fact that we haven’t had enough time to go through all the questions that you’ve sent through. Thank you for attending today. It’s much appreciated. But just as a reminder too can you please fill in the survey. We genuinely are interested in what you think of our webinars so that we can improve on them. But look once again thank you for attending and we’ll see you next time.

[Closing visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Enquiries’, ‘General enquiries: ANACCOperations@health.gov.au’, ‘Useful resources’, ‘AN-ACC webpage’, with image of QR code, ‘24/7 RN and care minutes webpage’, with image of QR code, ‘AN-ACC funding and care minutes estimator’, with image of QR code, ‘Services Australia Health Professional Education Resources Gateway’, with image of QR code, ‘health.gov.au/aged-care-reforms’]

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