Executive Summary
This report assesses staffing and care-minute compliance at Marran Court, a hypothetical 120-place residential aged care home operated by a single-site not-for-profit provider in outer-suburban Melbourne. It measures current performance against the mandatory care-minute responsibilities and the 24 hours a day, 7 days a week (24/7) registered nurse (RN) requirement that now govern residential aged care in Australia, and it sets out a costed remediation plan. Against a casemix-adjusted target of 218 total care minutes per resident per day, including 45 RN minutes, the home currently delivers 203 total minutes and 38 RN minutes, shortfalls of 15 and 7 minutes respectively. RN cover reaches 97.5 per cent of hours in the reporting month, leaving 18 uncovered hours that must be reported to the Department of Health and Aged Care. Closing these gaps requires an estimated 6.7 additional direct-care full-time equivalent (FTE) positions, of which 3.1 must be registered nurses. The home is meanwhile paying an agency premium of about A$514,000 a year for cover that adds no permanent capacity. Quality indicator performance is mixed, and the two unfavourable results, falls with major injury and antipsychotic use, are consistent with thin overnight RN oversight. The report recommends a funded recruitment and governance program to reach full compliance within six months.
Introduction and Scope
Australia’s population is ageing. The Australian Bureau of Statistics projects that the number of people aged 85 and over will more than double over the coming decades, increasing demand for high-acuity residential care (Australian Bureau of Statistics, 2023). The Royal Commission into Aged Care Quality and Safety found that chronic understaffing and inadequate registered-nurse coverage were central to poor and unsafe care, and it recommended mandated staff time and a minimum registered-nurse presence (Royal Commission into Aged Care Quality and Safety, 2021). The Australian Government responded with two enforceable obligations: a 24/7 RN requirement in force since 1 July 2023, and mandatory care-minute targets, calculated for each home from the acuity of its residents under the Australian National Aged Care Classification (AN-ACC) funding model (Department of Health and Aged Care, 2024; Eagar et al., 2019).
This report has three aims: to measure Marran Court’s compliance with those obligations for the most recent reporting period; to quantify the workforce gap and its cost; and to set out a remediation plan and recommendations for the Board. Marran Court is a hypothetical 120-place home with an average daily occupancy of 112 residents and a moderately high-acuity casemix. Residents are considered in aggregate throughout, consistent with the person-centred and dignity obligations of the Aged Care Quality Standards, and no individual resident data are used (Aged Care Quality and Safety Commission, 2019). All figures are modelled estimates constructed to be internally consistent and calibrated against published national patterns. Medical and lifestyle staffing sit outside the care-minute definition and are out of scope.
Regulatory and Funding Framework
Since 1 October 2022, residential aged care has been funded through AN-ACC, which classifies each resident by care need and sets a facility-level care-minute target from the resulting casemix (Eagar et al., 2019). From 1 October 2024 the sector-wide average target is 215 total care minutes per resident per day, of which 44 must be delivered by registered nurses; individual homes carry higher or lower targets according to acuity (Department of Health and Aged Care, 2024). Care minutes count direct care provided by registered nurses, enrolled nurses and personal care workers. Separately, the 24/7 RN requirement obliges a home to have at least one registered nurse on site and on duty every hour of every day; homes report coverage monthly and must record the reason and mitigation for any gap.
The Aged Care Quality and Safety Commission regulates against these obligations and the Aged Care Quality Standards, and can apply sanctions where a home fails to meet them (Aged Care Quality and Safety Commission, 2019, 2024). Registered nurses practise to the standards set by the Nursing and Midwifery Board of Australia, which frame the clinical assessment, delegation and coordination that only an RN can provide (Nursing and Midwifery Board of Australia, 2016). Marran Court’s casemix generates an individualised target of 218 total care minutes per resident per day, including 45 RN minutes, marginally above the sector average and the benchmark used throughout this report.
Compliance Assessment
Table 1 brings the core compliance metrics together. Each variance is delivered performance less the mandated target or, for the roster gap, the additional staffing required to reach it.
Table 1: Care-minute and registered-nurse compliance, Marran Court, latest reporting month
| Compliance metric | Target or mandate | Delivered | Variance | Status |
|---|---|---|---|---|
| Total care minutes per resident per day | 218 | 203 | -15 | Below target |
| RN care minutes per resident per day | 45 | 38 | -7 | Below target |
| 24/7 RN on-site coverage (reporting month) | 100% (720 hrs) | 97.5% (702 hrs) | -18 hrs | Non-compliant, reported |
| Total direct-care roster gap | 0 FTE | 6.7 FTE | +6.7 FTE | Shortfall |
| Registered nurse roster gap | 0 FTE | 3.1 FTE | +3.1 FTE | Shortfall |
| Agency premium (annualised) | Minimise | A$513,760 | n/a | Cost pressure |
Note. Figures are modelled estimates for a hypothetical home. Sector-average targets are 215 total and 44 RN care minutes per resident per day (Department of Health and Aged Care, 2024).
Care minutes
The total care-minute shortfall is small per resident but large in aggregate. The additional direct-care time required each day is (218 – 203) × 112 = 1,680 minutes, which is 1,680 / 60 = 28.0 care hours per day. Over a week this is 28.0 × 7 = 196 hours. At one FTE of 38 hours per week this is 196 / 38 = 5.16 FTE of worked time. Applying an availability loading of 1.30 to cover annual leave, personal leave and training gives 5.16 × 1.30 = 6.7 employed FTE. The registered-nurse component is calculated the same way: (45 – 38) × 112 = 784 minutes per day, or 13.1 hours per day, which is 91.5 hours per week and 91.5 / 38 = 2.41 FTE, and 3.1 employed FTE after the same loading. The RN gap is therefore about half of the total gap in FTE terms, reflecting how registered-nurse time, the scarcest and most regulated input, drives the compliance position (Twigg et al., 2015).
24/7 registered nurse coverage
Coverage is measured against every hour in the month: coverage = hours with an RN on site / total hours = 702 / 720 = 97.5%. The 18 uncovered hours fell on night shifts when a rostered RN could not be replaced; an enrolled nurse remained on site with an on-call RN available by telephone. Although this mitigation is reasonable, it does not satisfy the requirement, and each gap has been reported to the Department of Health and Aged Care. Because the requirement is absolute, 97.5 per cent coverage is a non-compliance rather than a near-pass, and it is the highest-priority item in the remediation plan.
Roster gap and agency cost
Marran Court currently buys agency cover to fill vacant shifts. The avoidable cost is the premium of agency rates over the fully on-costed rate of a substantive employee: premium per hour = A$94 – A$56 = A$38, a premium of 38 / 56 = 67.9 per cent. At 260 agency hours per week this is 260 × A$38 = A$9,880 per week, or A$513,760 a year. This spending buys no additional permanent capacity, and sector benchmarking shows that agency reliance of this kind is both a financial and a continuity-of-care risk, because rotating staff are less familiar with residents (StewartBrown, 2024; Fair Work Commission, 2022). Redirecting this premium toward permanent recruitment is central to the plan.
Quality Indicator Performance
Compliance with staffing inputs matters because it drives care outcomes. Table 2 reports Marran Court’s results under the National Aged Care Mandatory Quality Indicator Program against national benchmarks published by the Australian Institute of Health and Welfare. For every indicator listed, a lower value is better.
Table 2: Selected quality indicators, Marran Court versus national benchmark, latest quarter
| Quality indicator | Marran Court | National benchmark | Assessment |
|---|---|---|---|
| Pressure injuries (% of residents) | 7.2% | 8.8% | Favourable |
| Physical restraint (% of residents) | 18.4% | 20.5% | Favourable |
| Unplanned significant weight loss (% of residents) | 12.1% | 13.6% | Favourable |
| Falls resulting in major injury (% of residents) | 3.4% | 3.1% | Unfavourable |
| Antipsychotic medication use (% of residents) | 19.6% | 18.9% | Unfavourable |
| Polypharmacy, 9 or more medicines (% of residents) | 39.5% | 36.7% | Unfavourable |
Note. National benchmarks are indicative figures from the National Aged Care Mandatory Quality Indicator Program (Australian Institute of Health and Welfare, 2024).
The home performs better than the national benchmark on pressure injuries, physical restraint and unplanned weight loss, which indicates sound day-to-day personal care. Two results are unfavourable. Falls resulting in major injury (3.4 per cent against 3.1) and antipsychotic use (19.6 per cent against 18.9) both sit above benchmark, and both are sensitive to registered-nurse oversight: falls risk is managed through timely clinical assessment and review, and antipsychotic use should be minimised through regular medication review rather than relied upon as a substitute for staffing (Australian Institute of Health and Welfare, 2024; Nursing and Midwifery Board of Australia, 2016). The pattern is consistent with the RN shortfall identified in Table 1, where thin overnight cover reduces the clinical review capacity that keeps both indicators down.
Compliance Governance
Sustained compliance depends on treating measurement and response as a continuous cycle rather than an annual audit. Figure 1 sets out the governance cycle that links workforce planning to care delivery, mandatory measurement, regulatory reporting and board oversight, with monitoring feeding back into the next roster.
The cycle is deliberately closed. Monthly care-minute and 24/7 RN reporting, together with quarterly quality indicator reporting, feed a standing clinical governance committee that re-forecasts staffing and escalates breaches to the Board. This mirrors the national model of clinical governance, under which the governing body holds ultimate accountability for the safety and quality of care (Australian Commission on Safety and Quality in Health Care, 2021).
Remediation Plan
Table 3 sets out the remediation actions, sequenced by priority. The two high-priority actions address the enforceable breaches, the medium-priority actions address cost and the unfavourable quality indicators, and the ongoing action embeds the governance cycle in Figure 1.
Table 3: Remediation plan for staffing and care-minute compliance
| Priority | Remediation action | Lead | Timeframe | Target outcome |
|---|---|---|---|---|
| High | Recruit registered nurses to eliminate the 18-hour monthly coverage gap and lift RN time to target | Director of Nursing and People and Culture | 0-3 months | 100% 24/7 RN coverage; 45 RN minutes per resident per day |
| High | Recruit and roster additional enrolled nurses and personal care workers to close the total-care gap | Director of Nursing and Rostering | 0-6 months | 218 total care minutes per resident per day |
| Medium | Convert agency staff to permanent and build an internal casual pool to reduce agency reliance | People and Culture | 3-9 months | Agency premium reduced by about 40% (about A$205,000 per year) |
| Medium | Medication stewardship: scheduled GP and pharmacist review of antipsychotic and high-count regimens | Clinical governance committee and visiting pharmacist | 0-6 months | Antipsychotic use below 18%; polypharmacy trending down |
| Medium | Review and strengthen the falls-prevention program | Clinical governance committee | 0-6 months | Falls with major injury below 3.1% |
| Ongoing | Monthly care-minute and 24/7 RN reporting to the Board; quarterly QI review | Clinical governance committee | Ongoing | Sustained compliance and early warning of breaches |
Note. Timeframes and cost estimates are indicative for a hypothetical home.
Recommendations
- Treat the 24/7 RN gap as the first priority and recruit registered nurses sufficient to guarantee one RN on site every hour and to lift RN time to the 45-minute target, since this is the only absolute, non-negotiable breach.
- Recruit and roster the additional enrolled nurses and personal care workers needed to close the total care-minute gap of about 6.7 FTE and reach 218 minutes per resident per day.
- Redirect the A$514,000 annual agency premium into permanent recruitment and an internal casual pool, reducing both cost and the continuity risk that rotating agency staff carry.
- Strengthen medication stewardship through scheduled general practitioner and pharmacist review of antipsychotic and high-count regimens, targeting antipsychotic use below the national benchmark.
- Review the falls-prevention program and align it with registered-nurse assessment capacity, targeting falls with major injury below 3.1 per cent.
- Report care minutes, 24/7 RN coverage, the FTE gap and the quality indicators to the Board each month and quarter through the clinical governance committee, and re-forecast staffing against Table 1.
Conclusion
Marran Court meets much of its personal-care obligation but does not yet meet the two enforceable staffing requirements that now define compliance in Australian residential aged care. It delivers 203 of 218 required care minutes and 38 of 45 RN minutes per resident per day, and it reaches only 97.5 per cent of the mandated 24/7 registered-nurse coverage, a gap that must be reported and closed. Reaching the targets requires about 6.7 additional direct-care FTE, of which 3.1 must be registered nurses, and the home is already paying about A$514,000 a year in avoidable agency premium that could substantially fund those positions. The unfavourable falls and antipsychotic indicators are consistent with the registered-nurse shortfall, which reinforces that staffing inputs and care outcomes are linked rather than separate concerns. Governed through a continuous compliance cycle overseen by the Board, and funded in part by redirected agency spending, the home can reach full compliance within six months while improving the outcomes its residents experience.
References
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