As of 1 July 2023, 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). Here’s what you need to know.

Overview of the 24/7 RN Requirement

As of 1 July 2023, 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”.

For the purposes of the 24/7 RN requirement, a “registered nurse” is a person who is registered under the Health Practitioner Regulation National Law in the nursing profession as a registered nurse (RN). This means that enrolled nurses do not meet the requirement.

An RN is considered “on site” when they are physically present at the residential facility.

An RN is considered “on duty” if they are working and can respond in person to the clinical care needs of consumers at the facility when they need it.

Some residential aged care providers may be eligible to apply for an exemption from the 24/7 RN requirement.

Exemptions

Residential aged care providers may be eligible for an exemption from the 24/7 RN requirement for up to 12 months if:

• their facility is located in a Modified Monash Model (MMM) 5–7 location; and
• their facility has 30 or fewer operational places; and
• they have taken reasonable steps, by having alternative clinical care arrangements in place, to ensure that the clinical care needs of their care recipients will be met during the exemption period.

The MMM is a measure of remoteness and population size used to define whether a location is a city, regional, rural, remote, or very remote. Locations are categorised from MMM 1 – MMM 7, where MMM 1 is a major city and MMM 7 a very remote location. Only facilities located in small rural towns or remote areas will be eligible for the exemption.

Facilities with more than 30 operational places or that do not have alternative clinical care arrangements in place will not be eligible for the exemption.

How to Apply for an Exemption

Eligible providers can apply for an exemption from the 24/7 RN requirement using this online form. For more information about the application process, email exemptions@health.gov.au.

How Will Compliance Be Monitored and Enforced?

The Aged Care Quality and Safety Commission will monitor compliance with the 24/7 RN requirement and take action to enforce compliance where necessary.

However, 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.”

How Will the Commission Monitor Compliance?

The Commission says that it monitors compliance and “detects risks to consumers by using multiple sources of intelligence”. These include:

• complaints about services
• Residents’ Experience Surveys and other consumer feedback
• monitoring, investigation and management of non-compliance
• provider reporting (e.g. serious incident notifications, quality indicators, financial information, care minutes, 24/7 RN coverage)
• information from the Department of Health and Aged Care and other regulators.

What Is the Commission Looking For?

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 will determine this risk by monitoring the:

• volume and pattern of the reported gaps in coverage, such as when shifts are partially or not filled
• total care hours, type of staff coverage, and shifts (care minutes)
• number and care needs of consumers
• reasons for the reported gaps and the alternative clinical care arrangements in place
• patterns of serious incident notifications and assessments of approved providers’ responses
• complaints about staffing and clinical care
• previous monitoring including findings from site visits
• the approved provider’s history of non-compliance with the Quality Standards
• quality indicator data including on residential workforce turnover (available from 21 October 2023).

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.

Examples of “Alternative Clinical Care Arrangements”

According to the 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 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 under the Commission Act.

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)