ANMF calls for care minutes to be scrapped as staffing gaps persist

Australia’s biggest nursing union says mandatory aged care minutes are failing to guarantee safe staffing on individual shifts and should be replaced with enforceable staff-to-resident ratios.

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One of the central workforce reforms introduced after the aged care Royal Commission is failing to guarantee adequate staffing on the floor and should be replaced with mandated staff-to-resident ratios, according to the Australian Nursing and Midwifery Federation. 

The ANMF’s national Pulse Check of the Aged Care Sector: The Real Impact of Reforms survey found almost half of residential aged care workers surveyed believed they did not have enough time to deliver care, despite substantial increases in reported care minutes across the sector. 

The survey of 3552 nurses and care workers found 49.03% of respondents reported insufficient time to provide care to residents, rising to 55.75% among respondents employed by for-profit providers.  

Nearly 40% rated overall staffing levels as poor or very poor, while 47.52% rated the ratio of nursing to care staff as inadequate. 

Mandatory direct care requirements increased to 215 minutes per resident per day, including 44 registered nurse minutes, in October 2024. 

The ANMF acknowledged national data showed reported direct care had risen from 187 minutes per resident per day in the first quarter of 2022-23 to 218.87 minutes by the fourth quarter of 2024-25. 

But it said the increase had not necessarily translated into additional workforce capacity or better care at facility level. 

“Minimum direct care-minute requirements do not appear to have translated into increased staffing presence on individual shifts where care is actually delivered,” the report said. 

“Instead, reported increases in care minutes appear to have been achieved, at least in part, through intensified workloads for existing staff, task compression, and the redistribution of duties.” 

The ANMF said this was contributing to rushed or missed care, fewer opportunities for relational and preventative care, and workforce fatigue and burnout. 

“This suggests that, in the current landscape, direct care-minute requirements are not fit for purpose and require reconsideration,” it said. 

“The current use of aggregated reporting of care minutes over quarterly periods obscures day-to-day staffing realities and creates opportunities for providers to meet targets on paper without always ensuring safe staffing levels.” 

The union is calling for care minutes to be replaced by mandated staff-to-resident ratios applied across individual shifts. 

ANMF federal secretary Annie Butler said the reforms had produced some improvements but had not solved the underlying workforce problem. 

“We simply can’t assume that aged care is fixed,” Ms Butler said in a statement accompanying the report. 

“The lived experience of frontline nurses and carers shows these reforms may have led to some welcome improvements, such as RN 24/7, but they certainly haven’t gone far enough to fix a broken system.” 

She said mandated care minutes were “simply not working”. 

“To make sure older Australians are receiving safe and dignified levels of care, the ANMF recommends transitioning from the current care minutes system to mandated staffing ratios and skill mix requirements,” Ms Butler said. 

“Mandated staff-to-resident ratios across all shifts would provide a clearer, more enforceable standard and importantly, reduce the potential for the manipulation of care minutes reporting by some providers.” 

The ANMF said ratios should strengthen the nursing component of the workforce, suggesting a benchmark skill mix of 30% registered nurses, 20% enrolled nurses and 50% personal care workers, or updated ratios based on new research. 

Enrolled nurse role shrinks 

The report also identified a marked decline in the contribution of enrolled nurses to residential aged care. 

Using government sector data alongside its survey findings, the ANMF said enrolled nurse care fell from 8.02% to 5.47% of total direct care between the first quarter of 2022-23 and the fourth quarter of 2024-25. 

It calculated enrolled nurse care had fallen by 3.02 minutes per resident per day – equivalent nationally to about 598,000 fewer EN minutes each day, or 9967 hours. 

The ANMF estimated that reduction was equivalent to approximately 1840 full-time enrolled nurse positions. 

At the same time, registered nurse care increased from 18.18% to 20.43% of total care, leaving the overall proportion of nursing care essentially unchanged, according to the report. 

The survey also found significant changes in the way clinical staff were being used. 

Almost two-thirds of respondents – 62.84% –  reported increased administrative duties for registered nurses, while 49.05% reported decreased RN involvement in direct care. 

Among personal care workers, 67.43% reported increased expectations to undertake hotel, food or domestic work, while 40.01% reported reclassification into “universal worker” models combining care and non-care responsibilities. 

The report said enrolled nurses had also experienced “role dilution, redundancies, and a shift of ENs toward non-clinical duties”. 

Violence widespread across workforce 

The survey also found workplace violence and aggression was pervasive across residential aged care. 

Almost all respondents – 96.43% –  said they had experienced and/or observed at least one instance of workplace violence or aggression during the previous 12 months. 

More than three-quarters reported personally experiencing verbal abuse, 69.68% physical aggression, 49.01% property damage or thrown objects, 36.44% racism, and 35.55% sexual harassment. 

Among respondents who had experienced verbal abuse, 32.12% said it occurred multiple times each day and another 32.12% said it occurred daily. 

Residents or clients were identified as perpetrators in more than 95% of reported experiences of verbal abuse and property damage, almost 98% of physical aggression, and almost 94% of sexual harassment. 

Family members and visitors were also identified as perpetrators in 54.44% of experienced verbal abuse incidents and 48.39% of racist behaviour. 

The survey found workers who rated staffing at their workplace as “very poor” were more likely to report experiencing violence and aggression. 

Respondents said inadequate staffing could leave residents unsupervised or result in rushed care, increasing the risk of aggressive incidents, while some described management responses that discouraged reporting. 

The report said workers described “a poor reporting culture, where resident aggression was framed as inevitable and unmodifiable”, with some perceiving managers as dismissive of concerns or blaming staff for incidents. 

“This lack of support contributed to significant under-reporting, as staff lost confidence that anything would be done or feared negative repercussions,” it said. 

Ms Butler said understaffing was leaving workers exposed to physical, verbal, and emotional violence. 

“It’s clear that serious systemic problems still persist, including poor staffing ratios, caring for large numbers of residents with minimal staffing and support, which is impacting the ability to deliver high-quality care, with understaffing also leaving nurses and carers open to physical, verbal and emotional violence,” she said. 

The ANMF is calling for nationally consistent workforce training on violence prevention and management, mandatory risk assessment, and care planning, stronger incident reporting, and national monitoring of workplace violence. 

The survey was conducted online over six weeks from October to December 2025 and was open to ANMF members and non-members working in aged care. 

Of the 3552 eligible participants who commenced the survey, 54.71% were from Victoria and 93.6% were ANMF or affiliated union members. Most respondents – 89.4% – worked in residential aged care. 

Read the full report on the survey here.