Staff Ratios – Royal Commission Research Paper

I have read with interest late last week the very freshly released Royal Commission research paper (1) into aged care staffing requirements, and the shortfall in funding needed to raise the staffing mix and levels to appropriately care for the average residential aged care service consumer.  

The following excerpt from the recommendations paints a picture of what residents, families, advocates, and indeed some providers have been saying for some time – the level of service provision (staffing) in residential aged care in Australia is substandard.  

My conclusion is that because that level of provision is so strongly associated with the operating funding mechanism, the funding mechanism for care is equally substandard:

“more than half (57.6%) of Australian residents receive care in aged care homes that have unacceptable levels of staffing (1 and 2 stars).

To bring staffing levels up to 3 stars would require an increase of 37.3% more staff hours in those facilities. This translates into an additional of 20% in total care staff hours across Australia.

We have not limited our analysis to determining the additional resources required to bring facilities up to an acceptable level. We have also provided an indication of the additional resource requirements that are required to deliver staffing levels consistent with good practice and best practice care.

For all residents to receive at least 4 stars (what we consider good practice) requires an overall increase of 37.2% in total care staffing while 5 stars (best practice) care would require an overall increase of 49.4% in total care staffing.” (2)

As you are probably well aware, I am the CEO of Braemar Presbyterian Care (“Braemar”). To put our services into perspective, since I joined Braemar in March 2017 we have been increasing hours per resident per day to a level that is close to the current national average as recorded by the StewartBrown benchmarking service (3) reporting.  And, as far as is reasonable, we have been improving our subsidy income to match the staffing.  But that recurrent income is not enough.  

According to this research paper, prepared for the Royal Commission into Aged Care Quality and Safety, less than 3 star level of staffing is unacceptable, while a 4 star staffing is good practice, and 5 star staffing is best practice.  Yet 57.6% of residents receive less than 3 star (unacceptable) staffing and only 1.4% receive best practice staffing.

How is this translated into the care of our elders? 

The difficulty lies with the recurrent care funding mechanism.  The daily combined revenue available for payment of salaries and care related goods and services is about $270 per day maximum.  There are very few residents at a maximum level of subsidy, but even for those most frail people, who could alternatively be residing in a hospital, the funding mix could not be more different.

That $270 per day in an aged care facility is a long way short of the $850 to $1,050 per day for accommodation only in a hospital, that is, no active health intervention happening.  

Therefore, the number of staff available to care, and the skill mix (professional qualifications or otherwise), are both much more limited in an aged care service than in a hospital.  The Commonwealth funds aged care, and (largely) the States fund hospital care (through Commonwealth Medicare arrangements).  

Sadly, the two are incompatible, and our elderly citizens miss out.  

Could there be a better funding mechanism?  Do we need to pay more privately for the care of family members?  

I am certain the answer to both questions is yes, but over the years the inclination from Government has only been to minimise its funding commitment.

I have undertaken my own research into this vexed problem of finding an appropriate staff ratio and mix, and, along with other recommendations, estimated the overall cost of achieving that staff mix. (4)

How closely does likely cost extrapolated from this most recent Royal Commission research paper compare?  Allow me to share the following:

This next question is …    How can we provide anything less than best practice for the care and accommodation for our elderly vulnerable and frail elderly?  

We have to work out how we are going to fund the delivery of this staffing and care.  


I am excited to see these research outcomes.  But, why have we waited until a Royal Commission to eke out and confirm these earlier findings?

Nice chatting!

Wayne L Belcher | Chief Executive


1 Eagar K et al, ‘How Australian residential aged care staffing levels compare with international and national benchmarks.’ (Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, 11 October 2019).

2 ibid, 34-35.

3 StewartBrown, ‘Aged Care Financial Performance Survey: Sector Report (2018 Financial Year)’ (2018).

4 Belcher, Wayne L, Minimum What Ratios? see: http://wlbelcher2019.local/staff-ratio-review/

5 Belcher Wayne L, ‘Minimum What Ratios?’ (Braemar Presbyterian Care, 2018) see: http://wlbelcher2019.local/wp-content/uploads/2018/06/180605-Minimum-What-Ratios-WBelcher.pdf, 6.

6 Eagar K et al, above at 1, 5; Aged Care Financing Authority, ‘Seventh Report on the Funding and Financing of the Aged Care Industry’ (Department of Health, 2019), 82.

7 Eagar K et al, above at 1, 22.

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