5 March 2019

Bendigo Aged Care Study supports a Minimum of 3.5 hours per day of Skilled Nursing Care for Residents in Nursing Homes

A study initiated and compiled in Bendigo by Val Hardy, a former Director of Nursing of the Anne Caudle Centre, has been presented to the Aged Care Royal Commission during its Bendigo Community Forum by Dr. Simon Perrin, a retired medical practitioner.

The Hardy Study was undertaken in the 1980's and supports recent calls for a minimum of 3.5 hours of skilled nursing care per patient per day in Residential Aged Care facilities.  The findings of the Hardy Study were corroborated 30 years later in the 2016 Willis Study commissioned by the ANMF.

Staffing skills and levels have declined significantly since the Hardy Study and there are currently no minimum requirements for nursing training or time available per patient per day.  Dr Perrin said that today's residential aged care patients are frailer and have more complex nursing needs than those studied 35 years ago.

Dr. Perrin believes the Hardy Study accurately recorded the actual hours of direct patient contact required when exclusively trained Enrolled and Registered Nurses provided such care in Residential Aged Care facilities, as was the case in the 1980's.

The Hardy Study audited the direct personal and nursing care time provided to 6,000 nursing residents across a variety of Victorian nursing home facilities over a two-year period.  The full range of patient dependency included those requiring minimal assistance, to those needing full assistance as bed bound patients.

The Hardy Study found that nursing workloads could be broadly categorised into five levels of care as determined by the level of patient dependence or acuity.  The Study found the nursing time required by staff, all of whom had undergone a minimum of 12 months training, was:

Level 1:   Up to 1 hour per day for a resident with a good level of independence;

Level 2:   1 to 2 hours per day for a resident with a reasonable level of independence;

Level 3:   2 to 3 hours per day for a resident with a moderate level of independence;

Level 4:   3 to 4 hours per day per resident with a poor level of independence; and

Level 5:   a minimum of 4 hours per day per resident with a dependent level for most normal functions.

A resident at Level 3 was described by the Hardy Study as "needing to be motivated toward most activities; moderately disabled by physical or mental state; needs direct basic nursing care assistance; needs restorative care program; needs psychological support".  Dr Perrin said 'this is today's entry level for subsidised nursing home care'.

In 1984, 60 per cent of Levels 3, 4 and 5 residents were in the high dependence groups of 4 and 5. This suggests that today 60 per cent of subsidised nursing home residents would meet the high dependency of Levels of 4 and 5.

Dr Perrin stated 'the corollary is an absolute minimum of 3.5 hours per day per resident of skilled personal or nursing care would be required in current aged care facilities and should now be considered the lower end of any mandated nurse patient ratio for subsidised Australian Aged Care facilities. This is consistent with recent Aged Care Workload Studies performed in Europe and United States'.

Contact:  Dr. Simon Perrin - 0418 993 179