Aged care providers in regional areas like Pioneer House are struggling to remain viable and require government subsidies, The Royal Commission into Aged Care Quality and Safety heard this week.
This was echoed by Chair of Pioneer House Allan Codrington, along with Deputy Director of Nursing Tania Sargent who explained the difficulties facing regional aged care facilities on day one of hearings in Mudgee.
It heard that Pioneer House was as early as the beginning of 2018 Pioneer House experiencing difficulties with staffing its shifts and keeping up with the work required to provide quality care.
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Mr Peter Gray QC presented a case study of Pioneer House intended to test the workability of a series of proposals that ask if it's possible to address the issue of sustainability of not-for-profit aged care providers, particularly in rural areas.
The case study focused on three key issues: targeted support of aged care providers and upskilling of board governance and management capability; Intervention powers of Government departments - eg Department of Health - in cases where complex needs are not able to be met and initiatives designed to attract and retain talent to rural areas like Mudgee.
"I know that's a bit long winded but I'm a bit passionate about some of these things. Sorry."Pioneer House Chair, Allan Codrington
Staffing and recruitment
In a January 2019 meeting, staff were informed of the financial pressures that Pioneer House was facing and it was proposed to make changes to the roster to reduce one Assistant in Nursing (AIN) on the morning and evening shift.
Chairman of Pioneer House, Allan Codrington passionately explained that more should be done to address skills shortages regional aged care facilities.
"This is something that myself and the board thought about for a long time and it's happened in other areas...If we could offer them more money...more incentives to move from somewhere else to Mudgee, make them feel more secure that they were being well paid, and we think the government could do that," Mr Codrington said.
"I heard mention about more training, but most people in this room would assume that a registered nurse is a 100 per cent qualified to work in any facet, whether it be hospital, aged care or whatever. We've got to try and attract nurses and enrolled nurses from - and probably an easier or higher elevated position back to aged care, and we need people that want to dedicate themselves to looking after the aged and to get that is not easy,"
"You've got to bring them from places where they probably were - where they're comfortable..we've joined a government policy to bring visa nurses in that have been trained elsewhere, upskilled to a certain extent, but we don't know how much,"
"We found we've had to put a buddy system in with other registered nurses to take those around and pre-train them to work to the standard that we want them to work, but you're relying on other registered nurses or our deputy DONs to try and upskill those people to aged care,"
"I know that's a bit long winded but I'm a bit passionate about some of these things. Sorry."
Compounding the issues Pioneer House was facing at the time, in late 2018 Pioneer House accepted admission after a period of respite of a resident on a permanent basis whose pseudonym is Mr UI. Mr UI was living with dementia.
Mr UI later became a permanent resident and in late August, 2018 Pioneer House arranged for a consultant from Dementia Support Australia (DSA) to assist in the care of Mr UI.
Deputy Director of Nursing at Pioneer House, X Sargent described the situation as difficult.
"During his time as a respite resident he did have some challenging aggressive behaviours. Some of those behaviours did impact other residents. He - he also wandered, you know, excessively into other people's spaces, personal space," Ms Sargent said.
"I think they [DSA] certainly provided us with strategies to try with him and some helped some of his behaviours at times, but not fully,"
"I think because he was such a priority in the challenging behaviours that needed to be addressed, staff - we would have put someone one-to-one there but it may have meant somebody else in the facility - another area did not have as many staff as they should have."
Every time you ask me a question like that I say money.Pioneer House Chair, Allan Codrington
Mr Codrington was equally passionate about highlighting the need for more government support to address aged care shortcomings.
When asked what changes could be made to the system to assist rural providers in training RNs if it's necessary under a buddy system, Mr Codrington answered simply.
"Every time you ask me a question like that I say money. The more money that the government can put forward to our facility to endeavour to do that, we - we actually pay the facility where these people come from," he said.
"We've got to pay 10 grand, we've got to guarantee them; sometimes we've got to find accommodation until they settle,"
"So it's always about money,"
"If there was more assistance and a regional loading and, look, do I know that that's going to work? No. But the suggestion we need is - we need some way of when we advertise for an EN or a registered nurse we want them to come to Mudgee and we want to be able to offer them something more than where they want to be, if that be the city or near the beach or whatever,"
"So if there was a regional allowance and it helped to get people, that may prove a failure but coming up with ideas that will work is very difficult."
The three-day Mudgee hearings came to an end on Wednesday afternoon. The public are able to re-watch the broadcasts at any time and read transcripts.
The royal commission will continue to accept submissions until April 30, 2020.