Content warning: This post contains mentions of suicide and serious illness.

We’ve all heard the phrase “respect your elders” and for the most part, most of us agree with the premise – even when we were kids trying to stomach nan’s vegetable soup. Despite our distrust of cabbage, we appreciated the care that our loved ones gave us unconditionally.

The seniors in our community are our parents, our grandparents, our favourite primary school teachers and neighbours who still hand-write Christmas cards.

But while some Australian states like Victoria have legislated nurse-to-patient ratios for public health facilities, including nursing homes, private for-profit and not-for-profit government-run nursing homes are operating with dangerously inadequate staffing, meaning many residents are spending their final years in sub-standard conditions.

Advocacy bodies like the Australian Nursing and Midwifery Federation say that, while the nurses and aged care staff in these facilities are doing the best they can, even the hardest-working team cannot function without enough members, making work very stressful for many nurses and carers.

What Are The Problems?

Currently, the law requires that nursing homes to “maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met”, which is largely open to interpretation.

But figures show that aged care residents are receiving around 2 hours 50 minutes of care per day from nurses and carers, despite evidence showing a minimum of 4 hours and 18 minutes is vital to ensure residents’ general medical, emotional and social needs are met on a day-to-day basis.

While this is an increasingly important issue, it’s not a super new one. A few years ago, Lateline reported on the aged care crisis, highlighting some alarming case studies: people being left in their rooms unwashed and unfed, often for hours in soiled pads, without being given any attention.

At the time, aged care lecturer Maree Bernoth told Lateline that it’s getting worse. “The stories are more heartbreaking and more incredible… It’s not just traumatised relatives complaining. Repeated surveys find that 20 to 50 percent of nursing home residents are malnourished. The AMA says there’s not enough doctors to visit residents. The Nursing Federation says there’s not enough properly trained carers. Palliative Care Australia says only one in five residents receives proper palliative care.”

And, just last month, Four Corners published its largest-ever crowd-sourced investigation into the state of aged care in Australia. The report showed graphic first-hand experiences and accounts the mistreatment and, in some cases, abuse of residents.

The program also featured accounts from former care staff, including aged care consultants, personal care assistants, and dementia clinical nurse assistants. They recalled feeling “confronted” and “distressed” by what they’d seen at work, and explaining their choice to speak as a bid to raise awareness and inspire action.

The impacts of this chronic understaffing are huge: missed medications, malnutrition, infections and, as you can imagine a huge psychological impact on residents. Over the last 13 years, understaffing in aged care homes has seen a 400 percent increase in preventable deaths of elderly Australians with hundreds dying from falls, choking and suicide.

Understandably, the public’s reaction to the publication of the Four Corners investigation was profound. Minister for Senior Australians Ken Wyatt said he was “appalled by the lack of care” and then federal government acknowledged concerns raised as part of the investigation immediately. Prime Minister Scott Morrison has since announced his government will establish a Royal Commission, focusing on the quality of care provided in residental aged care settings. Exact dates and details of the commission have not been announced, but we can expect the first-hand experiences of families of residents and staff to shed more light on this important – and, until now, overlooked – issue.

What Needs To Happen?

According to advocacy groups, staff need public support to see ratios legislated at a minimum level– not only for current residents but for those of us who’ll rely on public and private nursing facilities in the future. Data and research drawn from 200,000 of its members by HESTA, a superannuation fund for people working in health and community services,  predict that we will need almost one million aged care employees by 2050.

To support both residents and aged care teams, these groups argue more staff are needed. Ideally, the right mix of qualified nurses and support workers to be able to monitor and care for all residents.

Many private facilities blame a lack of funding or budget problems for low staffing numbers, but the facts show that, last year, they racked up $1bn in profits. From 2003 to 2016, there was a 13 percent reduction in trained nursing staff working full-time in aged care facilities while there was a 40 percent increase in residents needing high levels of care.

The good news is that, with guidance from advocacy groups who specialise in aged care and with a vested interest in nurse- and carer-to-patient ratios, we can provide a voice to the thousands of older people who are being under-serviced.

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Want to help? Head to the Australian Nursing and Midwifery Federation campaign site to add your name to the list of supporters, find your local MP and a letter template here, tweet about the issue and tag #ANMF in your posts, share these resources on social media to help inform others about the issue.