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2019-2021
THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA
SENATE
AGED CARE AMENDMENT (REGISTERED NURSES ENSURING
QUALITY CARE) BILL 2021
EXPLANATORY MEMORANDUM
Circulated by authority of
Senator Rex Patrick
AGED CARE AMENDMENT (REGISTERED NURSES ENSURING QUALITY
CARE) BILL 2021
OUTLINE
The Bill amends the Aged Care Act 1997 to require all approved aged care facilities to
have at least one registered nurse on duty at all times within an aged care facility. The
registered nurse will be required to provide care and supervise the provision of care to
residents of an approved aged care facility.
Currently in Australia, there is no nationwide requirement that nursing homes must
have at least one registered nurse on duty at all times as confirmed by the recent
Royal Commission into Aged Care Quality and Safety. This inconsistent approach
leads to variations on the level of care and quality afforded to residents and negatively
impacts the working lives of staff providing that care within Australia.
Nursing home residents are older, frailer, and have high rates of complex
comorbidities and polypharmacy1. There are also large numbers of cognitively
impaired residents (i.e. dementia)2 and residents with mental ill health3. This means
that there is a need for staff with strong clinical knowledge and skills in gerontology,
the physiological processes of ageing and their implications for wellbeing in later
life4. Registered nurses are well placed to holistically care for residents with needs
across each of these domains5.
Many residents of aged care facilities are not receiving the level of care they require,
this is largely due to the increased levels of underqualified staff trying to provide care.
And in many instances without the supervision of qualified registered nurses. This
puts residents at unnecessary risk of illness, injury and preventable death.
Nurses provide safe, person-centred and evidence-based practice to support and
improve the health and wellbeing of residents and, in partnership with the person,
promote shared decision-making and care delivery between each individual resident,
nominated partners, family, friends and health professionals. Registered nurses are
1
Australian Institute of Health and Welfare (AIHW). People using aged care [Online]. Canberra:
Australian Government. 2021. Available: https://www.gen-agedcaredata.gov.au/Topics/People-
using-aged-care (Accessed 12 August 2021).
2 Harrison SL, Lang C, Whitehead C, Crotty M, et al. Trends in Prevalence of Dementia for People
Accessing Aged Care Services in Australia. J Gerontol A Biol Sci Med Sci. 2020;75(2):318-325.
3
Australian Institute of Health and Welfare (AIHW). Depression in residential aged care 2008-
2012 [Online]. Canberra: Australian Government. 2013. Available:
https://www.aihw.gov.au/reports/aged-care/depression-in-residential-aged-care-2008-
2012/contents/table-of-contents (Accessed 12 August 2021).
4
Dementia Australia. Response to Counsel Assisting's submissions on the future of the aged care
workforce (Royal Commission into Aged Care Quality and Safety) [Online]. Melbourne: Dementia
Australia. 2020. Available: https://agedcare.royalcommission.gov.au/system/files/2020-
09/AWF.600.01628.0001.pdf (Accessed August 12 2021).
5
Australian College of Nursing (ACN). Position Statement: The role of registered nurses in
residential aged care facilities Position statement [Online]. Sydney: ACN. Available:
https://www.acn.edu.au/wp-content/uploads/position-statement-role-rn-residential-aged-
care-facilities.pdf (Accessed 12 August 2021).
educated to a minimum standard and are bound by their professional standards and
code of conduct to provide person-centred care; a core tenet of nursing practice6.
Person-centred care helps to ensure better outcomes7, satisfaction with care8, that each
individual resident is cared for in accordance with their unique needs and
preferences9.
The amendment will mean that all approved aged care facilities in Australia must
have at least one registered nurse on duty at all times.
Financial Impact
The Bill will have no financial impact.
6
Nursing and Midwifery Board of Australia (NMBA). Code of conduct for nurses [Online].
Melbourne: NMBA. 2018. Available: https://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Professional-standards.aspx (Accessed 27 July 2021).
7
Brownie S, Nancarrow S. Effects of person-centered care on residents and staff in aged-care
facilities: a systematic review. Clin Interv Aging. 2013;8:1-10.
8
Poey JL, Hermer L, Cornelison L, Kaup ML, et al. Does Person-Centered Care Improve Residents'
Satisfaction With Nursing Home Quality? J Am Med Dir Assoc. 2017; 18(11):974-979.
9
Ho P, Cheong RCY, Ong SP, Fusek C, Wee SL, Yap PLK. Person-Centred Care Transformation in a
Nursing Home for Residents with Dementia. Dement Geriatr Cogn Dis Extra. 2021;11(1):1-9.
NOTES ON CLAUSES
Clause 1: Short title
1. This clause is a formal provision and specifies that the short title of the Act
may be cited as the Aged Care Amendment (Registered Nurses Ensuring Quality
Care) Act 2021.
Clause 2: Commencement
2. This clause provides for the commencement of the whole of the Act to be the
day after the Bill receives Royal Assent as prescribed in the table.
Clause 3: Schedules
3. This clause states that legislation specified in the Schedule to this Bill is
amended or repealed as is set out in the applicable items in the Schedule, and any
other item in a Schedule to this Act has effect according to its terms.
Schedule 1--Amendments
Item 1--After paragraph 54-1(1)(b)
4. Item 1 inserts new paragraph 54-1(1)(ba) to provide that the responsibilities of
an approved provider, in relation to the quality of aged care, include ensuring at least
one registered nurse is on duty at all times in a residential facility where the type of
aged care is residential care or flexible care provided in a residential setting. The
registered nurse is to provide care to residential care recipients and supervise the
provision of care to residential care recipients.
5. The intent of the amendment is to ensure that at least one registered nurse is
on duty at all times in an approved aged care facility that provides residential care or
flexible care.
Item 2--At the end of section 54-1
6. Item 2 inserts new subsection 54-(3) to define the term 'registered nurse' to
mean a person who is registered in the nursing profession as a nurse under the
legislation applicable to their residential State or Territory.
7. For a person registered in a State or Territory, except Western Australia, they
must be registered under the Health Practitioner Regulation National Law as set out in
the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld), as it
applies in that State or Territory.
8. For a person registered in Western Australia, they must be registered under the
Health Practitioner Regulation National Law Act 2010 (WA) as far as that Act
corresponds to the National Health Practitioner Regulation National Laws set out in
the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny)
Act 2011
Aged Care Amendment (Registered Nurses Ensuring Quality Care) Bill 2021
This Bill is compatible with the Human Rights and freedoms recognised or declared
in the International instruments listed in section 3 of the Human Rights
(Parliamentary Scrutiny) Act 2011.
Overview of the Bill
The Bill amends the Aged Care Act 1997 to require all approved aged care facilities to
have at least one registered nurse on duty at all times within an aged care facility. The
registered nurse will be required to provide care and supervise the provision of care to
residents of an approved aged care facility.
It is expected that requiring aged care facilities to have a registered nurse present at all
times, will raise the level of care to residents, will attract and retain new graduate
nurses and increase the skilled workforce to provide the required supervision and
support. Importantly, having a registered nurse present in an approved aged care
facility will improve the quality of end of life care; improve communication between
the resident, family and other health care professionals; and promote preventative
health and address wellbeing risks that contribute to restorative care.
In some circumstances, a person with significant disabilities or intensive care needs
may be a resident in an approved aged care facility. The Bill will improve health
outcomes for all residents, irrespective of their care needs or other personal attributes.
Human Rights implications
This Bill is compatible with International Human Rights and in particular the right to
health. The Bill supports the right to health by ensuring residents within aged care
facilities are provided medical services and medical treatment in the event of sickness
so they may enjoy the highest attainable level of health.
This right is contained in the International Covenant on Economic, Social and
Cultural Rights (ICESCR).
Articles 12(1) and (2)(c) and (d) of the ICESCR state:
"1. The States Parties to the present Covenant recognize the right of everyone to the
enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the States Parties to the present Covenant to achieve the
full realization of this right shall include those necessary for:
(c) The prevention, treatment and control of epidemic, endemic, occupational and
other diseases;
(d) The creation of conditions which would assure to all medical service and medical
attention in the event of sickness."
Further, Articles 1 and 25(b) of the Convention on the Rights of Persons with
Disabilities states:
"Article 1 - The purpose of the present Convention is to promote, protect and ensure
the full and equal enjoyment of all human rights and fundamental freedoms by all
persons with disabilities, and to promote respect for their inherent dignity.
Persons with disabilities include those who have long-term physical, mental,
intellectual or sensory impairments which in interaction with various barriers may
hinder their full and effective participation in society on an equal basis with others.
Article 25(b) - Provide those health services needed by persons with disabilities
specifically because of their disabilities, including early identification and
intervention as appropriate, and services designed to minimize and prevent further
disabilities, including among children and older persons."
Conclusion
This Bill is compatible with international human rights and freedoms.