With so many aged care reforms looming in the near future, it’s easy to lose track of the daily responsibilities that aged care providers currently have. Earlier this year, for instance, the Aged Care Quality and Safety Commission released an updated Regulatory Bulletin about the requirement for providers to have a Registered Nurse on duty 24/7.

In case you missed, it, we have incorporated the Commission’s latest advice into this short summary that will get you up to date on what you need to know about the 24/7 RN requirement.

Overview of the 24/7 RN Requirement

Residential aged care providers must ensure that “at least one registered nurse is on site, and on duty, at all times at the residential facility”.

For the purposes of the 24/7 RN requirement, a “registered nurse” is a person who is registered under the Health Practitioner Regulation National Law in the nursing profession as a registered nurse (RN). This means that enrolled nurses do not meet the requirement.

An RN is considered “on site” when they are physically present at the residential facility and “on duty” if they are working and can respond in person to the clinical care needs of consumers at the facility when required.

Exemptions

Residential aged care providers may be eligible for an exemption from the 24/7 RN requirement for up to 12 months if:

• their facility is located in a Modified Monash Model (MMM) 5–7 location; and
• their facility has 30 or fewer operational places; and
• they have taken reasonable steps, by having alternative clinical care arrangements in place, to ensure that the clinical care needs of their care recipients will be met during the exemption period.

The MMM is a measure of remoteness and population size, where MMM category 1 is a major city and MMM 7 a very remote location. Only facilities located in small rural towns or remote areas will be eligible for the exemption.

Facilities with more than 30 operational places or that do not have alternative clinical care arrangements in place will not be eligible for the exemption.

How to Apply for an Exemption

Eligible providers can apply for an exemption from the 24/7 RN requirement using this online form. For more information about the application process, email exemptions@health.gov.au.

Sector Average of Care Requirements

In addition to the 24/7 RN requirement, targets have been implemented to ensure that each resident receives a minimum amount of care each day.

As of 1 October 2023, residential aged care providers must ensure that each resident receives a sector average of 200 minutes of care daily, where at least 40 minutes of care must come from an RN. After 1 October 2024, this requirement will increase to 215 minutes of care for each resident daily, with at least 44 minutes being required to come from an RN.

Residential aged care providers with an exemption to the 24/7 RN responsibility are still mandated to meet the minimum daily RN care minutes responsibility and must also submit related monthly and quarterly reports.

How Will Compliance Be Monitored and Enforced?

The Aged Care Quality and Safety Commission will monitor compliance with the 24/7 RN and RN minutes of care requirements and take action to enforce compliance where necessary.

However, in its regulatory bulletin, the Commission said that it “recognises that the aged care sector is affected by external pressures which may present challenges to approved providers in attracting and retaining a suitably skilled and competent workforce.” The Commission added that:

“In short, a provider that is non-compliant with a specific responsibility but can evidence its ongoing efforts to comply, its provision of safe and quality care to consumers at all times, and its effective management of risks to consumers, is unlikely to be subject to escalated enforcement action by the Commission in the absence of other concerns about compliance or performance.”

How Will the Commission Monitor Compliance?

The Commission says that it monitors compliance and “detects risks to consumers by using multiple sources of intelligence”. These include:

• complaints about services
• Residents’ Experience Surveys and other consumer feedback
• monitoring, investigation and management of non-compliance
• provider reporting (e.g. serious incident notifications, quality indicators, financial information, care minutes, 24/7 RN coverage)
• information from the Department of Health and Aged Care and other regulators.

Provider Reporting

Providers are required to supply monthly reports to the Department of Health and Aged Care in relation to the 24/7 RN responsibility. These reports must include:

• each time there was not an RN on-site and on duty for 30 minutes or more
• the reason for the absence of an on-site and on duty RN
• the alternative arrangements that were made to ensure clinical care needs were met during the time that an RN was not on-site and on duty.

 In addition to the required monthly reports, providers must submit quarterly reports detailing RN care minutes to ensure the minimum daily RN care minute requirements have been met.

The Department of Health and Aged Care will share reports with the Aged Care Quality and Safety Commission to monitor compliance with the increased responsibilities and will also use the reports to determine eligibility for payments to aged care providers under the 24/7 RN funding supplement.

24/7 RN Funding Supplement

Reports are considered in relation to the 24/7 RN funding supplement. Facilities that meet specific criteria will automatically be eligible for a monthly payment to aid with the additional staffing costs that come with the new 24/7 RN responsibilities. These criteria include that the aged care facility must:

• hold less than an average of 60 residents per day over a calendar month
• supply at least an average of 20 hours of RN coverage per day each calendar month
• accurately report RN minutes before the seventh calendar day of the following month.

The minimum threshold of RN care required to be eligible for funding has been set to an average of 20 hours daily per patient to accommodate facilities that are still transitioning towards the increased responsibility requirements.

The lower temporary threshold allows for some margin of error during the transitionary period and gives providers the opportunity to adjust towards becoming compliant. This threshold will be reviewed during 2024 and may be updated accordingly.

However, it should be noted that receiving funding under the 24/7 RN supplement does not equate to being compliant under the 24/7 RN responsibility, and facilities must work towards meeting the new requirements.

What Is the Commission Looking For?

The Commission understands that there will be occasional “gaps” where a home cannot have an RN on site and on duty. Their main concern is not whether or not a home has met the requirement to the letter of the law, but rather the evidence of “risk to consumers”. The Commission will determine this risk by monitoring the:

• volume and pattern of the reported gaps in coverage, such as when shifts are partially or not filled
• total care hours, type of staff coverage, and shifts (care minutes)
• number and care needs of consumers
• reasons for the reported gaps and the alternative clinical care arrangements in place
• patterns of serious incident notifications and assessments of approved providers’ responses
• complaints about staffing and clinical care
• previous monitoring including findings from site visits
• the approved provider’s history of non-compliance with the Quality Standards
• quality indicator data including on residential workforce turnover (available from 21 October 2023).

The Commission wants to see that providers have made “alternative clinical care arrangements” to ensure that consumers are not put at risk during occasional gaps in 24/7 RN care. The commission will assess the effectiveness of these arrangements by examining factors such as the volume of gaps in care and the types of alternative care plans in place.

Examples of “Alternative Clinical Care Arrangements”

According to the Commission, these are some of the “alternative clinical care arrangements” that a provider can put in place to ensure that consumers are properly cared for in the absence of a 24-7 RN:

• On-call arrangements, typically on-call clinical advisory or on-call attendance arrangements (this may include on call agency arrangements and on-call ambulance arrangements).
• Supporting staff at the facility to obtain additional qualifications (such as enrolled nurses attaining higher qualifications, and care workers and assistants in nursing gaining medication competencies and advanced first-aid certification) to mitigate gaps between the scopes of practice of facility staff.
• Workforce planning and management to meet clinical care needs (such as scheduling RN shifts in accordance with the regular clinical care needs of consumers).
• Co-location with or proximity to healthcare facilities such as a hospital, where there are clinical escalation pathways in place to ensure that a consumer is transported directly to the hospital/clinic for further assessment and treatment as necessary where there is no RN on-site and on duty at the residential facility.

The Commission wants to see detailed evidence of these arrangements documented in the provider’s clinical governance framework and relevant policies and procedures.

“The evidence must detail associated policies, procedures and supporting documentation, including clear protocols for how staff are made aware of and will reliably activate the arrangements as required. Providers should be able to evidence at any time how they ensure that the clinical care needs of consumers at their facility are met when an RN is not on-site or when there is a lack of clinically trained staff available.”

What Happens if the Commission Finds Evidence of a Risk to Consumers?

Where there are serious risks to consumers, the Commission will:

• undertake performance assessment and monitoring, including requests for further information, interviews, site visits, and re-accreditation audits under the Quality Standards; and
• respond to non-compliance, which may include engagement with approved providers on their response, further monitoring or cautioning of approved providers, directing an approved provider to take specific action/s, and/or taking enforcement action such as issuing a notice or imposing sanctions under the Commission Act.

More Information

• Aged Care Quality and Safety Commission: RB 2023-19 Workforce-related responsibilities
• Department of Health and Aged Care: Care minutes and 24/7 registered nurse responsibility guide
• Department of Health and Aged Care: Frequently asked questions: 24/7 registered nurse responsibility
• Department of Health and Aged Care: 24/7 registered nurse responsibility: provider readiness checklist
• Department of Health and Aged Care: 24/7 registered nurse in aged care homes (fact sheet)
• Department of Health and Aged Care: 24/7 registered nurse supplement for residential aged care

Authors

Mark Bryan

Mark is a Legal Content Consultant at Ideagen CompliSpace and the editor for ACE. Mark has worked as a Legal Policy Officer for the Commonwealth Attorney-General’s Department and the NSW Department of Justice. He also spent three years as lead editor for the private sessions narratives team at the Royal Commission into Institutional Responses to Child Sexual Abuse. Mark holds a bachelor’s degree in Arts/Law from the Australian National University with First Class Honours in Law, a Graduate Diploma in Writing from UTS and a Graduate Certificate in Film Directing from the Australian Film Television and Radio School.

Michael Dreiling

Michael is a content and data administrator at Ideagen CompliSpace. He is currently studying Commerce and Design at the University of New South Wales.