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VOICE-OVER: Today at the

National Press Club, Gerardine Kearney, Federal secretary of the Australian Nursing

Federation. Her focus today is

on the future of that system,

and why it needs urgent reform.

Gerardine Kearney with today's

National Press Club address. (Bell rings)

Ladies and gentlemen, welcome

to the National Press Club this

afternoon and welcome to today's National Australia Bank

address from Gerardine Kearney,

Federal secretary of the

Australian Nursing Federation.

Gerardine Kearney has been

involved in nursing for nearly

30 years and just about all

that time a very active member

of the Nursing Federation.

She's been a branch president,

was assistant Federal secretary before becoming the Federal

secretary last year, and I'm

sure her name's familiar to

most people interested in this

area, and as you've just heard, given demographic circumstances

of the present time, she's

talking today particularly

about aged care in nursing

homes - subjects which are dear

to many of our hearts as we get

older. Please welcome, Ged


Thank you, thank you very

much and thank you Ken for that

introduction. It is indeed a

great pleasure and an honour to be here at the National Press

Club and a privilege to have

the chance to speak directly to

you and to so many Australians

right across the country. I'm

also very pleased to have the

Minister for Ageing, the

Honourable Justine Elliott here

today and she has taken time

out of a busy schedule and

she's also informed me she

might have to leave early, so

we'll forgive her for that.

Thank you for coming. Today I

want to talk to you about a

subject I know a lot of you

here and at home, many of you are retired and are retired and many with

elderly relatives to care for

will be very concerned about.

That is the need to stop

putting off the inevitable and

to start building an aged care

system that we can be proud of.

As Ken told you, I'm the Federal secretary of the Australian Nursing Federation.

We're the union that represents

people who look after our

grandparents, our parents, grandparents, our parents, our

neighbours and our friends in

nursing homes. I'm a qualified

nurse, as are all the elected

officials who speak on behalf

of our members at the ANF. In

fact, if you're ever in our

office to negotiate an

agreement and you happen to

cough, you'll probably be diagnosed and offered some treatment before you're

threatened with a walkout or a

stop work meeting, because we

actually do care actually do care about people

and especially, especially the

elderly people that we have the

privilege and joy to care for.

Our members don't work just for

the money, although I have to

say it would be nice to get

paid for some of the overtime

we seem to volunteer for so

readily. But let's face it, if

it was money that motivated us,

we'd certainly be doing

something else. The people

that work in nursing homes are

registered nurses and

registered nurses have degrees.

There are enrolled nurses who

have diplomas or Certificate 4

and there are personal carers

and assistants in nursing, most

of whom have Certificate 3

qualifications. They don't

choose their work because the

hours are easy and the holidays

are long. They choose are long. They choose their

work because our patients and

our residents need care 24

hours a day, seven days a week,

52 weeks a year. Unlike

others, it's not easy for our

members to take industrial

action. Too many people depend

on them in their time of need.

care. They do it, we do it because we

care. Think of your parents,

think of your grandparents,

your favourite aunt. Think of

the lady at the end of the

street who pushes her shopping

trolley along to the

supermarket every day. Our

elderly people are beautiful,

they are dignified, they are

courageous and it's an absolute

privilege for us to help them

and to be part of their lives.

Our nurses and carers often

spend many years with their

residents and naturally form

attachments with them, and

often when tragically they pass

away, there are, of course,

tears and lots of fond memories

to be shared. We're not just

talking about an important

industry here, we are talking

about an important part of life

itself for the cared, for the

families, and for those who

care for them. This is worth

trying to get it right. Now

it's for these reasons that the

ANF is determined, determined

to improve Australia's aged

care system. Now a lot of

Australians with relatives in nursing homes would know what

goes on in a regular day, but

many don't. The day starts

very early, usually before 7am

when the morning shift comes

in. For the registered nurse

in charge of a ward of, say, 50

or 60 residents and they have

five or eight assistants in

nursing or personal carers to

supervise is absolutely go, go,

go from the minute they set

foot at work. The assistants

are feeding residents, changing

sheets, helping them dress, sheets, helping them dress, the

RNs are dispensing drugs, checking temperatures, talking

to families. As our nurses

say, when they get a new

resident, they get a new

family, as well. They get

families with all the tensions

and regrets of having to place

a loved one in a nursing home.

There's a lot to do. Sometimes

call bells are missed and the

right people can't be found and

a nursing home is a community

of people who often can't look

after their possessions so you

actually spend time hunting

around for lost vaubls. GPs

often don't want to visit

nursing homes so a lot of time

has to be spent finding a GP

who will, but the alternative,

of course, is a lot worse and

that is having to leave a

moderately sick 90-year-old on

a hospital trolley in an

emergency department for half a

day or even longer. Even in

the best funded, in the

best-run nursing homes, it only

takes one thing, one thing to

go wrong for things to go

seriously off-schedule. In

fact, our members tell us it's

only really manageable on a

good day. Nursing homes are constantly understaffed. All

it takes is for one worker to

call in sick or for one person

to be called away urgently for

family reasons and workloads

can become unbearable. If a

replacement worker can't be

found it's the other staff who

have to pull together to ensure

that the elderly residents get

bathed, dressed, their their

meals and get their

medications. The pressure is medications. The pressure is

unrelenting. This is made

worse by the fact that the

standard 8-hour day has been

slowly whittled down. Staff

now had to fit the same

workloads into 7.5, 6 hours,

5.5 and even 6-hour shifts.

When budgets get tighter they

just chop off another 30

minutes. It's the same all day

and again overnight when staff have people to have people to turn in bed,

when they have to deal with

incontinue innocence issues,

with medical -- incontinuenance

issues and on top of that, time

has to be found to fill in the

required paperwork. Despite

this the nurse and ancillary

staff do their job with the

care and dedication. This job is certainly not is certainly not for the

cynical or the detached. But

it doesn't have to be this way

and it hasn't always been this

way. Back in the days before

the Howard Government when

funding was directly linked to

care, things were done better.

As you can see, the nurses and

carers in our nursing homes have big have big responsibilities and

this includes providing

high-level, acute health care.

I'm not just talking about

giving people their pills which

is important enough. Our

members have to be able to

assess and often diagnose

serious problems. They even

make life and death decisions.

Putting on my nurse's uniform

for a while - which wouldn't fit me these fit me these days, I have to

say - let me give you an

example. Many elderly people

suffer from diabetes. It's one

of our nation's fastest growing

diseases. When a diabetes

sufferer has a hypoglycaemic

attack, that is their blood

sugar levels drop which often

happens in the morning before

they get their medication - the

symptoms for a qualified nurse

would be easy to spot. They're would be easy to spot. They're

sweaty, they have dialated

pupils, they have tremors and

headaches and it's easy

treated, but you need to know

which of their tablets to give

at that point. But more

importantly, which not to give.

This may sound simple, but only a qualified nurse has the education to assess the

symptoms and alter the normal

medication regime and manage the

the situation. If you don't

know what those symptoms are

pointing to, actually giving

the sufferer their usual

medication can make things

worse, potentially much, much

worse, even put them in a life-threatening situation.

This is the sort of knowledge

and skills that we need to have

if we are to deliver quality

care in our nursing homes.

It's essential to be It's essential to be able to

recognise not just diabetes,

but if your patient's having a stroke, or if they've broken

their bones or a myriad of

medical conditions. And where

possible, even more importantly, these things

should be prevented. But in

too many cases, the right mix

of staff just isn't available.

Sometimes because they haven't

been trained properly, staff

giving out medications don't

even understand the medicines

they're being asked to give,

let alone the effect they have.

It's not fair on patients, and

it's not fair on their carers,

and increasingly, increasingly residents' families and

children simply will not accept

it. Understaffed, it. Understaffed, overwhelmed,

insufficiently supported, our

nurses and carers are sometimes

asked to choose which crying or

bewildered resident to help

first. Ladies and gentlemen,

in the 21st century with all

the wealth our nation has

accumulated, our aged care

nurses and carers should not be

asked to be performing a form

of triage. They shouldn't have

to be choosing whose pain is

worse, or whose urgent need is

much urgent of all. They

shouldn't have to be muddling

along, cutting corners and

stretching resources that extra

inch further until they're at

breaking point or actually

snap. Our aged care nurses and

carers are doing a heroic job.

They're doing it on our behalf

for people we love. But

they're battling against a

system that just isn't

supporting them. Our

Government, our providers of

age care, our society, we

ourselves are letting them down

and in the process, we're

letting our elderly people

something about down. And it is time we did

something about it. The time

to start is now. We have

little choice, because if we

don't start now , we all know

the rapid ageing of our

population means we will soon

be swamped. Australia today

has some 2,800 residential aged

facilities providing care to

more than more than 160,000 elderly

people. 70% of whom receive

high-level care and 55% of whom

are 85 years and older. By

2020, just over a decade away -

the number of residents is

projected to be more than

250,000. That's a 56%

increase, and the highest area increase, and the highest area

of growth will be among

residents aged 95 and over.

They are going to need the

highest level of care that we

can give them. The high care

proportion of residential aged

care is going to need to almost

triple in the next 25 years to

keep up with demand. Ladies

and gentlemen, the numbers of and gentlemen, the numbers of

residents are going up. Their

needs are going up, but the

capacity of the system to care

for them is falling, because

the proportion of nurses with

the necessary high-level skills

is going down. We need staff

with the right mix of skills in

order to create a high-class

residential aged care system,

but we are not getting it. In

fact, between 2003 and 2007,

the proportion of registered

nurses in our nursing homes

fell from 21% to just 17%. The

proportion of enrolled nurses

fell from 14.12.5%, but the

proportion of carers and

assistance in nursing increased

from 57 to 64%. All of these

nurses, carers and assistants

in nursing have valuable roles

and all do a magnificent job

under very trying

circumstances. But our

residential aged care system is

compromising the standard of

resident care by reducing the

average qualifications of its

staff. And in some cases, I'm

very sorry to say they do not

get even the minimum standards

of care. We sadly have all

seen these reports in our

newspapers and on the TV news.

The projections are that by

2020, the ratio of age care

residents per registered nurse

will double. That's right -

double. I have just one word

to say about this, enough. You

know, my mum used to say to me

"Ged, when I'm too old for you

girls to look after me, just

hand me over to the nuns ".

Well, you know, those days are

over, because the nuns are in

nursing homes. I tell you, the

world is getting older and the

age care system needs are now

big and complex. We've

comprehensive research across recently undertaken some

the country to give us a

snapshot of what every day

Australians think about aged

care and what needs to be done

to fix it. Now I'd like to

share some of those results

with you. First of all, the

overwhelming majority of

Australians, in fact 92% of

them, consider aged care to be

an important issue for all of

us. 70% believe our nurses are

good, or excellent, which is

very encouraging. But 9 out of

10 Australians are also

concerned that the number of

nurses in age care is falling.

They're also very concerned

about the quality of aged care.

Only 16% rated that the quality

of aged care in this country is

good or excellent. 33% believe

it's poor and 51% believe it's

only fair. What the research

overwhelmingly want the shows also is that Australians

Government to Government to urgently address

aged care. Nine out of ten

people said they believed the

Government should help improve

pay and conditions for aged

care staff. We agree. But

there needs to be big and

sophisticated solutions. For

the last quarter of a century,

our country has undergone huge

change. We talk a lot these

days about national reform

agendas and lots of economists

are making big names for

themselves designing those

reforms. But this reform, this

reform is one that really

matters. It matters in a truly

significant way to every single

person in this country. So

far, it has really been

overlooked. It's now time for the reformers to put their

names to the cause of the

elderly residents in our

nursing homes. We must demand

that they do so. To achieve

this, we have launched a

national political and media

campaign. It's aptly named

'Because We Care'. I think you

all have campaign packs, or

there are some out the door.

There are no actors in our

campaign. All the people you

see are real-life aged care

nursing staff. They are caring

for real-life people. There are people in nursing homes

just like your mum, like your

dad or your aunty or your uncle

looking around, just like some

of you maybe in the not too

distant future. We have already raised

already raised the awareness of

the really worrying issues

surrounding aged care which

we've brought to the attention

of our ministers and members of

Parliament and the good news is that the Federal Labor

Government is aware of this

important issue, and does seem

to be listening to us. It's

recently adopted party platform

has pledged to address wage

disparity between aged care and disparity between aged care and

hospital sectors, to improve

training, to introduce minimum

staffing levels and to ensure a

proportion of funding for aged

care is set aside to improve

wages and conditions. Now,

we've got to hold 'em to that

pledge. Today, I want to offer

a way forward for Australia's

residential age care system.

It certainly is not the whole

solution, because as I said,

the system is big and complex.

But this is a crucial set of

changes that has to happen.

There are four parts. First,

we need to ensure our nursing

homes have the right fix of

staff to get the job done.

Since 1997 when the Howard

Government changed the funding

system, there have really been

no effective controls over

staffing beyond the bearest

minimum. The Federal

Government currently funds the operators of nursing homes and

in addition to this, charges

are levied on residents, but

there's no requirement for the

operators to spend that money

on direct care or even staff

wages. It's led to a worrying

decline in the number of

registered enrolled nurses, and

that must be reversed. Now the

evidence suggests that staffing

to resident need is the best

way to lift the quality of care

and provide the most flexible

care outcomes, and we currently

have a proposal with the

Government to develop a

staffing tool that does just

that, but we know that will

take a lot of time and a lot of

money and for this reason, on

behalf of the nurses, personal

carers and residents in our

nursing homes, I am proposing

the following skills mix

ratios. At nursing homes

during the busy morning shift,

there must be one registered

nurse or one enrolled nurse for

every seven residents working

with a team of personal carers.

During the afternoon shift, one

registered nurse or one

enrolled nurse for every eight

residents working with a team

of personal carers, and on the

night shift, one registered

nurse or enrolled nurse for

every 15 residents. These

staff ratios are already being

used in public age care

facilities in Victoria, and

they work. So I believe if we

can achieve these skills mix

ratios across the country, we

can really improve the quality

of care for our older

Australians, so they get the

right care at the right place

at the right time. Second, we

need to lift the skill levels

across the board from nurses to

carers. Currently, 35% of

carers in age care do not have

any formal training. This has

to change. Everyone working in

age care must have a minimum

qualification of a Certificate

3 and this must be regulated.

Aged care is a people industry

and so the quality of their

education is crucial. Then, we

want to ensure that personal

carers, the Certificate 3s are

given the chance to study and

move onto Certificate 4 or

diploma and if they want to

have the ability and the chance

to go on and study a degree in

nursing. Our proposal,

therefore, gives all age care

staff a well-structured career

path. What our Because We Care

campaign has proved to us is

that our aged care staff do

care about their elderly

residents. They really love

their job, but we need to give

them more and they deserve it.

So third, to get more people

into the industry and to hold

onto the wonderful people we

already have, we need to

increase pay. Today, nurses in

the aged care sector earn

between 10 and 30% less than

nurses working in a public

hospital. The difference can

sometimes be as much as $300 a

week. That's right, $300 a

week. Really, you have to ask

yourself why one nurse would

get paid $300 a week less than

another nurse. It's no wonder

this disparity is making it

harder and harder not only to

retain, but to attract nurses

into age care. We estimate

that over the 4-year budget

cycle, the cost of achieving

wages par ity would average out

at approximately $188 million a

year. We know that's a lot of

money, and makes many a

Treasury bureaucrats hair curl,

but it's a necessary step,

absolutely necessary step to

attracting more and better

qualified staff to age care.

As more and more of our older

age care nurses leave the

sector, we have to do something

to attract the younger nurses

to come up and fill the gap.

to come up and fill the gap.

And fourth, we need

transparency and accountability

of fund sog the system operates

at peak efficiency. We can't expect the Federal Government

to provide extra funding for

aged care if it's not going to

be used properly. We want to

make sure that any extra

funding, the funding makes

available in the next Budget in

2010 and beyond to aged care

providers flows through to our

aged care staff so they can

deliver the very best care for

their elderly residents. As I

said earlier, the ANF has

launched a major public

campaign around these issues,

the Because We Care campaign

and over the coming months we

will be doing all we can to

draw the attention of the public to the condition of

their elderly relatives'

nursing homes and we will be

asking our Government to do

something about it in the next

Budget. Now, the people you

see in our Because We Care

campaign are real people. Our

pin-up girl is Louis el

McKenna, she is a director of nursing and has been in the

aged care industry for 40

years. There's Alba Vinyollo.

Her beautiful face is on the

cover of our packs. She's an

assistant in nursing from Frank

was the lovely face you saw on

the invitation to today. Frank

is a personal carer and he's

studying to be a registered

nurse. They're the carers.

What about the lovely old

people they care for? Well,

there's Malcolm. You can

actually see Malcolm if you've

got your packs on the cover of

the DVD that we've given you.

Now Malcolm was actually a

resident of the nursing home

where we filmed the DVD, and

his wife and his son were very

keen to be involved in the

filming when they heard about

what our campaign was about.

They wanted to share their

story with us. They wanted to

tell you about Malcolm, because

you see Malcolm can't. Malcolm

is one of the 60% of nursing

home residents with dementia.

He can't tell us why his nurses

and carers are so important to

him. He can't tell us what a

difference they make every day

to his life. He can't tell us

what his life would be life

without them, but his family

can and they wanted to share

that with you. Ladies and

gentlemen, this is what our

aged care system is all about.

It's all about the people who

work in it and the people they

care for. So we need to keep

people like Lucille, Alba and

Frank in our nursing homes so

they can look after people like

Malcolm. They'll make sure

they're there to help your

loved ones when you can no

longer do the job for them. We

can't escape the implications

of an ageing population anymore

than we can escape the ageing

process ourselves. Having an

adequate age care system isn't

going to be easy or

inexpensive. But we're not

being honest if we think we can

just muddle along as we have

been. Fixing it is the Federal Government's responsibility.

They must act. This is a big

test for Australia, because we

can't kid ourself s that we're

the caring compassionate and

egalitarian society we'd like

to be unless we treat our

elderly citizens with the

dignity, respect and care

they've earned. Thank you very

much everyone for listening,

and I urge you all to get

behind our campaign, Because We


Thank you very much. As

usual we have a period of

questions. Thanks for that

very compelling appeal on

behalf of age care residents,

but I wonder, you say there

hasn't been much focus on the

economic side by the great

economic reforms, but in fact

we've had at least three

reports, the Hogan report, the health commission reform report and yesterday the Productivity

Commission report, all of which

suggests that we've got to

rethink the ban on

accommodation bonds for

high-care residents. Wouldn't

that freeing up that source of

funding at least contribute

quite significantly to the care

of 70% of age care residents,

given that we've also got the

Council on the Ageing, Catholic

Health Australia are also

calling for it. Why not think

about that? Why shouldn't age

care people at least contribute

to their funding if they can

afford to do so? Thanks, Mark.

There have been an awful lot of

reports in age care and we

understand that another

Productivity Commission report

is about to commence and I

think that's the problem -

there's a lot of reports and we

don't see much action,

particularly for the nurses and

the residents themselves. For

your question about bonds, we

admit that funding the system

is very, very complex and there

are lots of options being put

doesn't believe that bonds are forward. The federation

the way to go, but what we're

talking about here today is

that funding of the system is,

yes, it's a very big question

and we have to focus on that

and we have to have that debate

and we have to start doing

something . There are lots of

things we believe are wrong

with the way the system is funded, the indexation for

example. But what we're talking about today is about

making the system safe for the

people who work in it and the

people they care for. Our

4-point plan is about the nurses and the residents in the

system. If we don't do

something to retain and attract

nurses, it doesn't matter how

you fund it, it doesn't matter

how many millions of dollars

you pour into the system, if

there's no-one there to do the

caring, if there's no-one there

to look after us, you might as

well pour the money down the

drain. We have to fix this

first. The money has to come

from somewhere, though. It

does, and I agree we have to

have that debate, we have to

talk about that. Actually, I

might follow on from that... if

you do want to spend the $188

million extra a year, have you

identified areas of savings in

age care? Are there areas of

waste that should be targeted

that you'd like the Government

to look at? That's my first

question, and the second I

guess is, you've said you must

get something to address this

problem in the 2010 Budget,

what happens if you don't? Will

you campaign against a Federal

Labor Government at the next

election? Your first part of

your question "Is there any

area of waste?" We're

constantly being told we have

to find productivity gains and

our members are telling us

they're stretched to the

maximum. It is like a tightly

strewn rubber band, one little

ping and the system will break.

We've had a review of the

paperwork. There's been lots

of different reviews as I said

before, but our staff are telling us they really can't

take much more. As I said in

my speech, it just takes one

tiny thing to go wrong and the

workloads become unbearable.

There's lots of talks around

things like improving IT which

I think would be sensible and

go a long way towards

streamlining some things, but

no I don't think much fat

really in the system. If we

don't get something in the 2010

Budget, then the ANF is in this

campaign for the long haul and

in the 2010 Budget and we will

keep campaigning until we get

what we can. But we are very hopeful that the Federal

Government will see sense and

see that something has to be

done soon, or we won't have a

workforce, we just won't have

an age care workforce going

forward. All those figures I

quoted, 56% increase in

residents by 2020. It's less

than a decade away. We have to

start focusing on this area and

we have to start now. Sister

Kearney - I haven't been called

that for a long time! You

mentioned that nursing staff in

aged care facilities are poorly

paid compared with the rest of

the profession which in itself

is poorly paid with respect to

the rest of the profession.

It's female-dominated, like

teaching, and you also

mentioned and dedication of

staff. When I was a school

teacher when people used to

mention dedication to me, they

generally meant they wanted me

to do more work for less money.

Duch do you think you need more

funding, but a cultural change

to recognise the medical

profession, especially those in

aged care facilities to be

properly remunerated? And do

you think that might improve

the staffing number? Thank you

for your question, I never

actually got to be a sister, I

was only ever a nurse. I think

you're absolutely right and

part of our campaign Because We

Care is about raising wares and

a great amount of what we are

doing is educating the

community about what's

happening in age care and we

hope we will be getting a great

deal of community support and

we have been getting a great

deal of community support,

particularly from families of residents and from consumer groups, and I think you're

right, it is a large part of

it. But right now, our problem

is they are underpaid, but

nurses in age care are even

more underpaid and that's

something we have to address.

You're a union leader, I've

got a pay question for you. OK.

On the back of the Federal

Government's decision to pay a

Medicare rebate to nurse

practitioners, a group of

pharmacies has set up clinics

run by nurse practitioners and

they're charging $65 for a consultation with a nurse,

that's $3 more than the AMA

recommends doctors charge and

it's twice as much as the

Medicare rebate refunds doctors

for a visit. Are nurses worth

twice as much as doctors? And

are you expecting a Medicare

rebate when it comes in, next

year to be the same as a

doctors' Medicare rebate or

higher than a doctor Medicare

rebate? It is an interesting

situation. The fact people are

willing to pay $65 a

consultation to see a nurse

shows that access to health

care is a huge issue for

Australia, and I certainly

think that the Government's

health reform agenda is going a

long way to address that and we

were very pleased to see the

Budget initiates offering NBS

and PBS subsidies. I would

expect and I would hope that we

would at least get equity with

our medical brothers and

sisters for the service s that

we provide and that's something

that we'd certainly be working

for. There are working parties now working towards

implementing that Sue, and

that's certainly what we will

be expecting. Earlier today, the Prime Minister did a health

forum down at Canberra Hospital

and he heard from a few doctors

and things like that. As

obviously a stakeholder in this

whole health reform debate,

there's many different voices

floating around with how they

think the health system should

run. I was wondering if you

think that is going to be the

biggest barrier to fixing our

health system - the competing

voices, the turf wars, and

things like that? I don't think

it's going to be a huge

barrier. I think the tide has

turned around those turf wars,

as you called them. I think

there's a great of community

support for the Government's

reform agenda and we think that

the Government is absolutely

dedicated and is convinced that

this is the way to go and we

think, we're very excited about

the health reform pathways that

the Government's taking and

we're supporting them. Let me

ask you about some numbers,

some maths. Some of the

figures you quoted today are

quite startling. Given that

you're only talking about one

sector of nursing in these last

half hour or so, but when you

look at the picture overall and

you look at the numbers of

potential old people needing

care as against the number of

nurses who are entering the

profession, what are we looking

at? Surely there must be a huge

increase in recruitment to

nursing in general if you're to

get anywhere near the

objectives you're

describinging. That's a very

good question. We don't think

we'll be able to achieve those

ratios immediately. We're not

that silly. We think this is

probably long-term, but if we

are to have the right number of

nurses by 2020, then we have to

start doing something now. We

have to make the wages

comparable, workloads bearable,

we have to start now, so we

have to start working towards

that. In Victoria, where we

did have workload measures like

I'm describing, there was a

massive influx of nurses coming

back into the system. We also

thought that we are

haemorrhaging nurses... an extraordinary strategic is

something like 80% of new

graduates leave nursing in

their second year. The average

age of nurses is 55. We're

getting old so we have to stop

the haemorrhaging at the other

end. We certainly think fixing

wages and workloads the way

we've described will have a big

impact on the number of nurses

in the health system. I had

reason recently to visit the

psychiatric ward, to visit

someone there at Canberra

Hospital. These are sad and

disturbing places obviously and

one of the things that I hadn't

comments today when I started really reflected on until your

to think about aged care was

there was a number of people

there who appeared to be of the

age when I would have thought hopefully they could have been

looked after somewhere else. I

guess we all know dementia's a

problem, but there are many

other serious mental health problems people can suffer

right throughout their life.

What is the standard of care

that is offered to people once

they've reached that age that

they need age care, but they

suffer from other mental health

problems beyond

dementia? Beyond

dementia? Schizophrenia,

obviously bipolarity. A huge

majority... well, we do know

about 76% of all admissions to

nursing homes have very high

they have complex medical care level means. That means

problems, and that's why we're

saying we need the right mix of qualified staff in nursing

homes to be able to deal with

those complicated health care

issues. We also know sadly

that about 40% of all

residents, all residents admitted to nursing homes

actually pass away within one

year. And we are talking about

very high-level end of life

care and to assure, to ensure

they are getting very good care

we have to make sure we have

the people there with the right

skills and the right mix of

people there to ensure that end

of life is appropriate. That

is what our campaign is

absolutely all about, and I

think by and large... sorry, I

think by and large everybody

does their very best. The

majority of people working in nursing homes really do their

best to give the best care and

the providers do, as well.

But, you know, we need a little

bit more now. We need to

really start attracting people

to work in the sector or by

2020 we are going to be in

trouble. When everyone hears

about this issue of age care

nursing, one can't help but be

struck by the increasing

disparity between earning

levels for professionals or

employees in age care and also

in pre kindergarden child care

versus teachers in the

education sector. It seems to

me that the disparity not only

exists, but it's increasing.

One can't help but be drawn to

the rather simplistic

conclusion that it's squeaky

wheels qui get the oil. I

don't want to go to the

simplistic, but is there more

which the profession can do in

the way of skill

identification, career pathing,

profring career opportunity to

-- proffering career

opportunities to entry level

employees in your sector so

that you can increase the

weight, and the clot and the

power which you need to have as

you go to Government to

negotiate a better deal,

particularly a better wage deal

for people in this vitally

important age care and pre-

kindergarden child care

sector? Absolutely, we agree.

It's been a very difficult

sector to, I guess, bargain in.

There's nearly 3,000 nursing

homes. Traditionally it's been

a bit of a cottage industry and

small workplaces it's been very

difficult for us. That's why

we've taken a national approach

to campaigning around those

very issues. I think your point

about aged care perhaps not

being as sexy in some ways as

the louder, as the other

sectors of health care, I think

a lot of that's probably got to

do with workloads, poor pay,

the poor image in the media

aged care gets. You're right,

we have to fix those things ,

we have to fix workloads and

pay, we have to make aged care

an attractive place to work.

It's a very rewarding area to

work and the people who work

there love it and that's

exactly what our campaign is

about, doing exactly what you

said. I was struck by the fact

that you said up to 80% of

second year after graduation

nurses leave the profession.

Why is this? This has been

going on now for a decade or

two. Why hasn't the solution

been found? Is it simply money?

Is it pressure on them, or

what? I think there's lots of

reasons. The system is so stretched Mark that it's difficult to give the new

graduates support in their

first couple of years. We

really need to focus on those

first few years out and

particularly in aged care we

need to really focus on career

opportunities for nurses in age

care and I think if we are to

attract nurses, then part of

our campaign plan is to have a

properly structured career path

in age care and certainly,

fixing the wages and the

workloads will go a long way

towards keeping those younger

ones, certainly. You've

mentioned, we've mentioned

already the fact that aged care

nurses are underpaid compared

with the rest of the sector,

but how much do you think the

problem is due to perhaps

despite the dedication and

despite the attractiveness of

the career, many young nurses

may well be regarding nurses

and an incontinen, the

patient... do you think we

should be paying aged care

nurses more than in the general sectors? Absolutely,

absolutely. I agree, age care

has a bit of an image problem,

but people who, the workforce

that are there love it. It is

a very rewarding sector to be.

We think if we could get people

there and keep them there they

would love it. It is a

terrific place to work, really.

But you're dead right, perhaps

we should be aiming for more

than parity. The minister's

sitting there. But we'd be

happy with parity with the

public sector for right now,

absolutely. Are we getting to

the stage where a nursing home

is becoming a misnomer, because

there are so few nurses left

working in them? Is it true

there are some nursing homes

where there is not actually a

nurse on site all the

time? Unfortunately, yes. Our

members tell us that there are

requirements, for example, to

have a registered nurse

supervising but that definition

of supervision could be one

registered nurse who's

responsible for maybe three or

four campuses, and who is

actually on the end of a line

and, you know, it's very

difficult. I had one... I'll

tell you a story about one

assistant in nursing who came

up to me and she said that one

of her patients, one of her

residents seemed a little

unwell and the protocol is that

you call the registered nurse

and she was unable to really

track down the registered nurse

and ask the resident if she

would like to go to hospital,

should she call an ambulance,

and the resident said "No, I'm

fine". So she didn't call an

ambulance. When she got hold

of the registered nurse some

few hours later, because the

registered nurse was busy on

another campus, the patient was

actually having a stroke and

the assistant in nursing didn't

recognise the signs and

symptoms and by the time the

registered nurse got there -

and, of course, immediately

recognised what was happening,

it was really too late to do

anything about that. That poor

assistant in nursing felt

absolutely dreadful and they're

the stories that we get told

and they're the stories that we

really want to stop. We need

to stop that happening. We

need to have a registered nurse

a qualified nurse on every

shift in every nursing home in

every building, in every

facility. That's what we need.

You've talked about how

difficult it is to recruit

nurses, how difficult it is to

keep nurses. You've talked

about the low pay for nurses.

It seems to me, though, that

there's one particular element

that we're sort of forgetting,

that there's 50% of the

population that probably

doesn't consider nursing as a

career at all and that's men

when they're making a decision

at the end of high school.

What do you think can be done

to encourage men to take it up

as a profession? That's a very

good question. About 8% of

nurses are male and I guess we

probably should use them a bit

think that's not really more as role models, but we

crucial. We think that there

are plenty of people out there

in the population who could

become nurses. I don't think

attracting men to the

profession is necessarily the

answer. It's certainly one

factor that we could focus on

and maybe stop calling them

'Sister' was a good start. It

is something that perhaps we

could do. What we know is that

every year somewhere around

from university who have 3,000 people are knocked back

applied to do nursing. The

interest is there and the

Government has been fantastic

really in trying to boost the

numbers of undergraduate

nurses. They've put a lot of

incentives out to get nurses

back, they've done a lot of

work in trying to boost the workforce numbers and we're

just starting now to see the

benefit of that and I have to

really congratulate this

Government on the work they've

done for that. But still, a

lot of people are not getting

into courses and then, of

course, when they become nurses

we're losing them. So we would

like to concentrate more on retaining the ones that go

through the system right now. I

think that's the crucial part.

Earlier on you mentioned that

you thought the syndrome of

turf wars was breaking down, or

had broken down to some extent.

I must say from outside the

business, many of us find it

hard to see that. Particularly

in the sector you're talking

about, greater freedom for particularly registered nurses

to do more of the things that

doctors oppose them doing at

the moment would go a long way

towards breaking down some of

the problems you're talking

about. Is there much sign that

is going to happen? I think the

turf war will probably always

be there, certainly in the

doctors' mind. They tell us

often they don't like the

reform agenda. I think it's

going to move along regardless

of what they think. Take aged

care, for example. As I said,

it's very, very difficult to

get GPs to go to residential

aged care facilities for many

reasons. GPs are very busy

people. If we could have nurse

practitioners who could

prescribe, nurse practitioners

could actually go into aged

care facilities and do a great

deal of that work that we now

rely on GPs for doing. In

fact, in some States, nurse practitioners are already

delivering such care to nursing

homes and it's been a huge

success. You keep elderly

people off emergency trollies

in emergency departments, out

of hospital, keep them better

in their nursing homes, and it

would blow the access problem

out of the water if we had

nurse practitioners in age

care. For some reason, this

would help our GPs we think,

this would take a lot of

pressure off them. They don't

like going into nursing homes,

they don't feel they're

remunerated properly for it. I

can't understand really why

they get cranky about it. All

the evidence is there. I think

the President has now asked two

questions that I planned to ask

immediately prior to me. Let

me go back to a variation on

the original one I was going to

ask you about. Earlier Ken

asked you about the time you

think it should take to

increase the skills ratio. In

a sense, I want to ask you the

same question - and I know you

said a long time - but the same

question in terms of the skill

levels the Certificate 3 minimum qualification. Do you

have any idea about when you

would like to see that be the

minimum requirement and

secondly, would you be

concerned in introducing such a

minimum standard that while

that might raise the standard

of care, it might also induce a

skills shortage? First part of

your question, a Certificate 3

course takes less than a-year

to complete. It's something we

would like to see start with

the advent of an accreditation

system. We think a way to mandate is to have a licensing

system for that level of work

and we think that would be a

good way to go. So certainly

national registration will be

in place in 2010, July, 2010.

Your point about it creating a

skills shortage, you know, I

don't think so. If we really

support them, if the industry's

prepared to support them and

the industry I have to say is

very supportive of skills

training. They do support

their staff where they can to

get these skills and we have

seen a huge increase in

Certificate 3 in the industry

over recent times. 65% do

actually have a qualification.

So I think the burden of time

wouldn't be a problem with a Certificate 3 of qualification

and tinge carers we talk to,

the assistants in nursing that

we talk to, they would

appreciate the ability to get a qualification and I don't think

it would create a skills

shortage. In fact, we believe

that it would raise the

standard or their standing

within the nursing family, as

we like to say, for them, and

it would be something that

would compel people to work in

the sector. In a week's time

when the pension rise goes

through, nursing homes will get

to keep 84% of that rise over

four years I think it adds up

to $700 million extra they'll

be getting. You only need $188

million to increase nurses wages. APPLAUSE

Should the Government require

that nursing homes boost your

pay out of that money that

they're getting from the

taxpayer? I didn't pay her to

ask that. Look, we understand

the financial constraints that

the aged care system is under.

We know there are difficulties

with capital costs. We do know

that the system, you know, is

struggling financially, but we

also know that in some States

the pay gap is much, much

smaller than in other States

and we do believe that there is

some capacity in the industry

to pay better wages and we

certainly will use the new Fair

Work Act to bargain for better

pay and conditions and we have

started to do that in the

sector, and that's certainly a

very good proposition. But we

certainly would like to work

with the Government still. We

still think because the wages

gap is so chronic now and so

endemic there is probably going

to need to be some assistance

from the Federal Government to

close that wages gap in the

very short-term. We really

have to do something now, very,

very soon to stop the exodus of

registered and qualified nurses

in the aged care sector. Thank you very much. APPLAUSE

Thank you very much. It's

been very good to have you here

today. I hope making you a member might encourage you to

come back some time and tell us

how it's going. Thank you

again. Thank you very much. Closed Captions by CSI