Rising aged care staffing levels fail to improve quality of care

A new study has shown efforts to increase direct care staffing levels in aged care homes are effective, but it’s not clear if it’s translating into an improvement in care quality for older people.

A team of researchers from ROSA and Flinders University analysed data from over 2,000 aged care homes across Australia, attempting to understand the degree to which staffing targets were being met, and whether having more care staff on the job directly benefits residents’ experiences.

Lead author, Associate Professor Stephanie Harrison, says staffing targets set in 2022 aren’t high enough to meet demands.

“Australia has set individual targets for total care and registered nurse minutes for aged care homes, based on the assessed care needs of their residents,” A/Prof Harrison said.

“These targets are a positive step, but these are the minimum levels of care that homes should be providing, and it remains unclear whether they are sufficient to drive meaningful improvements in care quality.”

The proportion of aged care homes meeting or exceeding their total care minutes target rose from 41% to 53% from January 2023 to March 2024. Government-run facilities were more likely to meet their targets, compared to for-profit and not-for-profits, with metropolitan and smaller organisations also performing better.

“The data suggests that location and facility size play a crucial role in the ability of an aged care home to provide adequate staffing levels,” A/Prof Harrison said.

“Government-run facilities were also more successful in meeting and exceeding care minute targets. As smaller, government-run facilities are replaced by larger, for-profit services, this is an important area to monitor.”

Despite the rise in care staffing levels, there was no association between care minutes and residents' quality measures.

The researchers say high-quality care depends on more than just staff numbers, as it requires a skilled, well-supported workforce with strong clinical leadership.

“This challenges the assumption that simply increasing staffing will automatically improve care quality,” A/Prof Harrison said.

"Monitoring staffing levels in aged care homes remains essential, but to truly improve the quality of aged care, we must also strengthen the evidence base and address the ongoing challenges facing the sector.”

“This means investing in workforce development, especially in rural and remote communities where staffing challenges are more pronounced. Recent initiatives to support the provision of aged care staff in rural and remote areas should be monitored to see if this helps to improve equitable access to care in these regions.”