These questions to ask about staffing in residential aged care are part of a series written by nurses, doctors and experts with experience in aged care. The series aims to make you and your parent’s journey into residential aged care easier. They are written from the perspective of your parent asking the questions, but you can do so on their behalf if required.
1. Are registered nurses employed on-site at all times?
Most people living in residential aged care facilities have high care needs. If you have been assessed as needing 24-hour nursing care, then the home should provide this. Check if registered nurses are on-site at all times.
2. How many registered nurses are there on each shift, including nights, weekends and evenings?
Remember, residents will be there 24 hours a day 365 days a year. So should the staff. Residents’ care needs do not disappear because it’s nighttime. Just having a registered nurse ‘available’ or ‘on duty does not necessarily mean they are on site. The best practice is that registered nurses should be on-site and on duty all the time. This prevents unnecessary delays in treatment and ensures direct clinical supervision.
3. What is the nurse to resident ratio for each shift?
You should know how many registered nurses enrolled nurses and AINs (assistants in nursing – however titled) are employed on each shift. Observe if there are enough staff around to supervise people and help them eat, go to the bathroom, socialise and move around. What is the ratio overnight or on the weekend? You wouldn’t visit a hospital and expect to have to contact the nurse by phone.
4. Is there a Director of Nursing?
A director of nursing (however titled) is a registered nurse who provides clinical leadership for the home. There may be a ‘manager’ but are they a registered nurse? A generic manager does not necessarily have the skills and expertise to manage a clinical team and assess the complex health needs of residents.
5. Will medications be administered by a registered nurse?
How are residents’ needs met for ‘as needed’ or ‘when required’ medications such as pain relief? Registered nurses should be on-site to clinically assess pain, give pain relief and monitor its effect. This can only be done safely by a registered nurse.
6. Are there any plans to change the staffing arrangements in future?
The current staffing arrangements might not be the same in future. Ask if there are any plans to reduce staffing. Make sure your contract specifies the level of staffing that will be provided and whether this includes 24 hours on-site registered nurses.
7. Will residents be cared for by the same staff so they get to know them?
It’s important that staff get to know each resident’s needs and preferences. Residents are reassured by familiar faces. Ask some staff how long they’ve been working there. High turnover indicates staff are unhappy with their work.
8. How will changes to my health be managed?
Most people in residential aged care facilities have complex healthcare needs. It is important to have skilled registered nurses to optimise health and identify deterioration. Also to provide timely interventions preventing unnecessary hospitalisations for conditions that can be more appropriately managed at the facility.
9. What minimum training do the AIN/care workers/care service employees have?
These workers are unlicensed. They provide most of the care but their level of training is determined by the home’s operator. Ask what basic training they receive.
10. What ongoing training programs are offered to staff and what qualifications do they possess?
It’s important that staff have had training on keeping people safe, clinical care and compassionate care. There are no minimum training requirements for workers once they are employed, so it is important for you to know what training they are offered.
You may find these questions to ask about staffing in residential aged care useful when:
• Searching for a high-quality residential aged care facility
• Reviewing the quality of your current residential aged care facility
• Deciding between two residential aged care facilities that appear similar.
By law, residential aged care facilities are not required to have registered nurses so it’s important to ask the right questions if you need nursing care.
Many staff wear similar uniforms. Just because someone looks like a nurse does not mean they are. Here are the differences:
A Registered Nurse (RN) has undertaken a minimum three-year Bachelor of Nursing course. They can undertake nursing procedures, manage pain medication and help prevent unnecessary hospital admissions.
An Enrolled Nurse (EN) works under the direction of an RN. Both are registered by a regulatory body. Registration ensures professional standards are maintained and protects the public.
Assistants in Nursing (AIN)/Care Workers/Care Service Employees (CSE) are unlicensed. They provide most of the care in residential facilities and communities but their level of training is variable.
Some useful links:
10 questions to ask about staffing in residential aged care PDF article download link –
Carer’s Circle article on 10 questions to ask about allied health in residential aged care –
Carers’ Circle article on the Aged Care Royal Commission and what you need to know – https://carerscircle.com.au/2021/03/14/aged-care-royal-commission-what-is-it-and-what-do-i-need-to-know/
Aged Care Reform Now – a grass roots organisation that is advocating ofr reform of the aged care system including better staffing in residential aged care – https://agedcarereformnow.com.au/
Fixed aged care – a campaign by the NSW Nurses and Midwives Association and the Australian Nursing and Midwifery Federation to support the request to change the law so that a Registered Nurses should be onsite at all times in aged care facilities – https://fixagedcare.com.au/
This article was originally published as a leaflet on 10questions.org.au. Reproduced with permission.
Photo credit: Nurse taking care of an old woman on Rawpixel