On 1 July 2023, the Government introduced a requirement whereby 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” (24/7 RN requirement). Providers are also required to report monthly on their compliance with this requirement. The first report is due by 11.59pm AEST Monday 7 August 2023. Here’s what you need to know.

When is the Report Due?

You must submit your report by 11.59pm AEST Monday 7 August. This is the first in an ongoing, monthly requirement to report.

What Do I Have to Report?

Your report must cover each day of the month that your facility was used for the purpose of delivering residential care (i.e. if your facility was closed for three days in July, then you don’t have to report on what happened on those three days). For most providers, the “reporting period” will be the entire month.

Your report must answer these questions:

• Was an RN on site and on duty at all times during the reporting period?
• During the reporting period, was there any period of 30 minutes or more when an RN was not on site or on duty (or both)? If so, specify when this occurred and the reason* why.
• For any period when an RN was not on duty, what alternative arrangements* did you make to ensure that the clinical care needs of consumers were met while an RN was not on site and on duty? If you made no arrangements, then report that you made no arrangements.

*The reporting system will only let you select one “reason” and one “alternative arrangement”. If there is more than one reason or alternative arrangement, select the main reason/alternative arrangement.

If you are exempt from the requirement, you must still report. You will not be required to report the matters listed in the dot points above, as these won’t be relevant to you, but you must report the fact that you are exempt.

How Do I Report?

Report online via the Government Provider Management System (GPMS).

FAQs

What does “on site and on duty” mean?

“On site” means that an RN must be within the confines of the residential facility or the immediate surrounds.

“On duty” means the RN must be available to provide care to consumers and oversight of the care provided by other care staff as needed.

Is an RN still “on duty” if they take a break?

Yes. An RN is considered to be on duty when taking breaks if:

• they remain on site during a continuous period of work; and
• those breaks are prescribed in their employment conditions.

If an RN goes off site during a break, they are not “on site and on duty”.

Do I have to report if I’m exempt?

Yes. If you are exempt from the 24/7 RN requirement, you must still log into GPMS and report the fact that you were exempt for the reporting period.

Can some of the RN hours be filled by an Enrolled Nurse (EN)?

No. The requirement is for an RN to be on site and on duty 24/7.

Do RN hours count if the RN was on duty in a different role (e.g. as care manager or general manager)?

It depends. For the purposes of the 24/7 requirement, the RN’s hours only count if the RN’s prime purpose for that shift was to provide care to consumers and oversight of care provided by other staff. E.g. if an RN worked a shift primarily to do administrative duties rather than care or oversight of care, they were not “on site and on duty” as an RN.

What are “alternative clinical care arrangements”?

According to the Aged Care Quality and Safety Commission (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 I report that I did not fully comply with the 24/7 RN requirement?

The Commission monitors compliance with the 24/7 RN requirement. 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.”

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 wants to see that homes have made “alternative clinical care arrangements” to ensure that, where there is an occasional gap in 24/7 RN care, consumers will not be put at risk.

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.

More Information

• 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
• Aged Care Quality and Safety Commission: RB 2023-19 Workforce-related responsibilities
• 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)