Rural care — where to now?
Aged care has received more than its fair share of bad press in recent years, owing largely to revelations from the Royal Commission (RC) into Aged Care Quality and Safety. In rural Australia, many of the issues exposed within the RC were pronounced, with the final report calling for greater funding and equitability of access in rural, regional and remote areas. Almost one year since the report was published, what is the current state of play within rural aged care?
Dr Rachel Winterton, Senior Research Fellow at the John Richards Centre for Rural Ageing Research, said that despite some positive reform, many of the challenges exposed within the RC remain since its completion. “There are still issues in terms of equity of access and service availability in rural Australia. At this point, we have only seen marginal improvements in that respect,” she said.
Meanwhile, the government’s viability supplement has not been enough to cover the lagging occupancy rates within some venues, particularly throughout COVID where some homes were forced to place a ban on new resident intakes. This has left many grappling with an ongoing financial deficit and the secondary challenges that brings.
A survey of 1200 nursing homes across Australia revealed that 69% of rural and remote aged-care homes were losing money in March 2020, a figure that dropped — but remained high at 52% — by March 20211. The statistics were similar in inner regional centres, decreasing from 62% to 56% over the same period1.
As a result, many facilities have struggled to meet the challenges inherent in delivering high-quality care within areas of geographical remoteness. Alongside the sector’s viability challenges, rural Australians have statistically poorer health than those that live in major cities, with 20% higher rates of chronic disease2. This exacerbates the issue of weak nurse-to-resident ratios — one of the key sticking points exposed by the RC, with more than half of Australian aged-care facilities (57.6%) classed as inadequately staffed3.
“The current funding and supplements rarely stretch far enough to cover recruitment and retention, so it is still difficult for rural providers to access the workforce they need,” Dr Winterton said.
Leading the way
Despite the challenges, Winterton highlighted that the sector is pushing new boundaries in its quest to improve standards.
St. Catherine’s aged-care home in Bathurst, New South Wales, provides one high-definition example, having taken matters into its own hands to drive positive resident outcomes throughout the pandemic.
Like many homes, St. Catherine’s grappled with staff shortages during the crisis — given the restrictions on aged-care personnel working across multiples facilities — but upheld positive resident and worker reviews throughout. It even saw former employees returning to their roles, having previously departed to work in other higher paying sectors, including disability support. Manager Angela Stocks attributed this to the centre’s strong workplace culture.
“Our team members have been the unsung heroes during this crisis. They have worked incredibly hard under challenging circumstances: long hours, wearing full PPE, amid high levels of risk,” she said.
“They have also made tremendous personal sacrifices. When there was a COVID outbreak in the local jail — where some of our employees’ partners worked — they moved out of their own homes and had no contact with their families, so as not to pose a risk to residents.”
Despite the long overtime hours and personal sacrifices, St. Catherine’s staff evaluated their workloads as ‘fair’ in annual appraisals conducted during the pandemic. “I really believe the onsite camaraderie and team environment is a key reason behind this outcome,” Stocks said.
Feedback from ‘boomerang employees’ who sacrificed higher salaries in other sectors to return to their aged-care roles at St. Catherine’s also supported this theory. “Returning staff have told us they love the environment here and get more satisfaction from their day-to-day work than they do in other support roles,” she said.
Looking ahead
While additional funding for recruitment is on its way to rural centres — via the Rural Health Outreach Fund (RHOF) — the St. Catherine’s story points to an alternative approach for the sector: increasing the ‘sum of its parts’, not just its staff numbers.
“Additional geriatricians and medical specialist services [as per the RHOF] will always be welcome within aged care, but I really believe the best way to get results is to create a supported environment where people are willing to come into work and go the extra mile when they get there,” Stocks said.
Dr Winterton agreed noting, “In rural areas especially, where there are fewer opportunities, people want jobs they can comfortably stay in.”
It may be a way to go until the sector is ‘deficit free’, but with homes like St. Catherine’s paving the way, there is increasing hope.
3 https://agedcare.royalcommission.gov.au/system/files/2020-06/AHS.0001.0001.0001.pdf
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