Aged-Care Facilities

I seek leave to make a brief explanation before asking the Minister for Mental Health and Substance Abuse a question on the subject of the Controlled Substances Act.

The Hon. J.M.A. LENSINK: In May 2006 the government released a discussion paper in relation to the administration of drugs of dependence in high and low care aged facilities. Indeed, I asked a question in relation to high care facilities on 31 May 2007. It has been brought to my attention that a number of low care facilities have significant concerns because of their staffing levels. I have a copy of a letter from the Chief Executive Officer of Aged & Community Services SA&NT Inc., who has written to the minister in the following terms:

The industry...has two primary concerns: the increasing shortage of...RNs and ENs expected into the future, and the ability of small stand-alone residential aged care facilities, in both rural and metropolitan settings, to comply with the proposed regulations. Such facilities are typically 40 places or less and not necessarily on shared sites which have an adjacent high care facility or hospital that would employ nurses 24 hours per day. In a recent survey of ACS members, some 50 facilities responded with genuine concerns about their ability to comply with the proposed legislation.

He then goes on to raise issues of financial viability due to increased wages and says:

Members have recently advised ACS that they have been advertising for nursing staff for over 12 months without success. He also raises potential solutions that would have a regime of exempting facilities and credentialling skilled care workers.

He then goes on to raise issues where, indeed, the government's proposal may conflict with the commonwealth regulations under the Aged Care Act, including the issue of self-administration of drugs of dependence by residents. He says that, if both low and high care facilities are defined as health services, residents would be prohibited from the choice to self-administer, and this may put the facility in conflict with standard 3 within the Aged Care Act.

My questions to the minister are:

1.Has the government reached a decision on the proposed changes? If not, why has it taken close to two years to reach a landing on this decision?

2.Will the minister meet with representatives of low care stand-alone facilities so that they may express their concerns to her directly?

The Hon. G.E. GAGO (Minister for Environment and Conservation, Minister for Mental Health and Substance Abuse, Minister Assisting the Minister for Health) (14:46): No, a decision has not as yet been reached, and I am happy to provide a little background to that in a moment. However, to answer the last question first, in terms of meeting with representatives from low-care facilities, I have already met with a number of them, and we continue to consult with them. I will provide a little contextual information.

The controlled substances legislation applying to the management of drugs of dependence in residential aged-care facilities was reviewed, as I understand it, following a question about whether the definition of a health service in the controlled substances regulations of 1996 could be interpreted to include both high and low-care residential aged-care facilities and also because of workforce issues in the aged-care industry. The issues that were identified to be considered by the review are quite complex, which is part of the reason why the review has taken so long.

It included the Australian government's policy on ageing in place, which has made the distinction between high and low care by a facility less meaningful. Whereas the past practice was that they were clearly identified to be different facilities, policy has changed that and one is less able to distinguish between the two. Also, the current legislation has different requirements for high and low-care facilities.

Enrolled nurses who have undertaken a diploma course or the diploma post-enrolment program have increased their level of knowledge and understanding about medication, and the Nurses Board supports their increased involvement in medication administration. So, there have been some changes there as well. The evolution of the scope of practice of enrolled nurses since the legislation was enacted needs to be reconsidered in light of these practices. Another matter is the safety of the administration of drugs of dependence, in particular, of residents in residential aged-care facilities, by unregulated workers.

As we know, the trend has been for patients suffering from more complex physical conditions to continue to be accommodated in aged-care facilities. A couple of decades ago, a person in an aged-care facility who became ill would automatically be admitted to a public hospital for treatment. So, the complexity of care has shifted somewhat. There have been two periods of consultation: in 2004 and also in 2006. So, consideration of these matters goes back even longer than the honourable member has mentioned. Stakeholders were advised of the proposed changes to the legislation in December 2006. The changes being considered would result in:

•residential aged-care facilities being recognised as a separate class of health care facility;

•no differentiation between the requirements for low and high care in residential aged-care facilities in relation to the administration of drugs of dependence;

•registered and enrolled nurses being permitted to administer drugs of dependence in both low and high-care residential aged-care facilities rather than administration being restricted to registered nurses in high-care areas;

•unregulated health care workers not being permitted to access or administer drugs of dependence, including Webster-paks, which are those packs where pharmacists distribute to a container and the care worker distributes from the container to the resident.

The Controlled Substances Advisory Committee was consulted about the proposed changes to the legislation in December 2006. The council did not see any reason to differentiate between an enrolled nurse's role in a residential aged-care facility and other types of health services; so that was its view. The council saw the main issue as the competence of the enrolled nurse to administer drugs of dependence.

If an enrolled nurse was competent to administer the drugs of dependence, the legislation should support that, regardless of the type of health service in which the enrolled nurse was working. The council suggested that consultation should occur with health services outside the aged-care industry, with a view to proposing changes to legislation relating to the administration of drugs of dependence that would cover enrolled nurses working in a wide range of different health care settings. Health services outside the aged-care industry have been consulted. As I have said to the honourable member, I have met personally with a number of them. They were consulted about whether they supported the proposed changes to legislation that would result in enrolled nurses in all types of health services being able to administer these drugs of dependence.

The current requirement under the Nurses Act would be expected to apply, in that an enrolled nurse would be working under the supervision of a registered nurse and enrolled nurses should not undertake any duty they were not competent to do. The results of the consultation with health services outside the aged-care industry are now being considered, along with those within the industry. I have asked the aged-care industry to provide additional information. The majority of their clients are low-care clients, so I have asked them for additional information in relation to concerns they have raised with me.

I am expecting information about the anticipated impact of the proposed change which might result in the prohibition of care workers administering and dispensing drugs of dependence, particularly in low-care facilities. Any proposed changes to the controlled substances legislation will be referred back to the Controlled Substances Advisory Council. It is a complex issue, which affects a lot of people. It is in the context of a great deal of change, and we need to ensure that any changes are good changes which are considered thoroughly.