Government releases 155-page Final Report on 24/7 RN alternative arrangements: "No changes"

The Australian Government has released the University of Wollongong's Centre for Health Service Development's Final Report on 'Alternative Arrangements for Residential Aged Care Staffing', outlining the key elements and principles that must be in place when alternative arrangements to mandated 24/7 RN requirements are implemented.

"Providers should be pleased the Wollongong University has affirmed the robust clinical models that are already in place and this [report] is now providing a framework to validate that," said David Reece (pictured), CEO of Not For Profit AdventCare, which is based in Victoria and part of the Seventh-day Adventist Church. AdventCare has implemented alternative models at its Warburton home, 75km east of Melbourne.

The 155-page report was commissioned to provide evidence-based alternatives for aged care homes unable to meet 24/7 RN coverage requirements, and to recommend alternative skills mixes for 24/7 RN arrangements for specialised aged care, including for the homeless, Aboriginal and Torres Strait Islanders, and low acuity residential aged care. 

Handed to the Government in November last year, it listed five foundational elements that must be met when alternative arrangements are in place:

• Residents receive safe, quality care at all times regardless of the geographic and contextual factors;
• All aged care staff work within their professional and individual scope of practice;
• Staff rights to safe and appropriate workloads are met;
• Partnerships with local health services are optimised to ensure that the often complex and chronic health needs of residents are met; and
• Arrangements must be fit for purpose in the local context and able to be effectively and efficiently operationalised.

The report also gave five key principles (see main image):

• Protocols / procedures and a robust clinical governance framework must in place to address emerging clinical concerns
• Recognise the crucial clinical role of enrolled nurses (ENs) in residential aged care
• Transition to 24/7 RN coverage throughout the approved exemption period
• Embrace opportunities to utilise virtual care services when an RN is not available on-site and on duty

The Final Report recommended 'no changes' to the skills mix responsibility introduced on 1 October 2023 or the 24/7 RN responsibility introduced on 1 July 2023 for specialised homeless, Aboriginal and Torres Strait Islander services, or 'low acuity' residential aged care. David said regional homes with fewer than 60 beds that do not meet the 24/7 RN requirement do not qualify for the 24/7 Registered Nurse Supplement for Residential Aged Care but are facing significant additional costs.

"Having access to the 24/7 Registered Nurse Supplement for Residential Aged Care is essential to help fund it," he said.

Small regional homes achieving 70% of the 24/7 RN requirement could receive 70% of the supplement, he suggested. Last month, 9% of staff costs, or $30,000, was spent on agency staff at AdventCare's Warburton home.