A Flinders University research team has looked at more than 2000 Australian aged care facilities. High-quality care relies on more than just additional staff.
While aged care homes across Australia are increasingly meeting mandated staffing levels, there is little evidence that these improvements are translating into better care for residents, a new study from Flinders University has found.
Since October 2022, the federal government has required aged care facilities to meet specific targets for direct care minutes, based on the assessed needs of residents. These include time spent with registered nurses and personal care workers. The goal is to raise standards and ensure consistent, quality care for older Australians.
Researchers from the Registry of Senior Australians (ROSA) Research Centre, based at the university’s South Australian Health and Medical Research Institute, analysed data from 2292 aged care homes across Australia.
Data from January 2023 to March 2024 revealed that the proportion of aged care homes meeting or exceeding their total care minutes target rose from 41% (938 facilities) to 53% (1213 facilities).
Despite the rise in care staffing levels, the authors found no association between care minutes and residents’ experiences or quality measures.
“This challenges the assumption that simply increasing staffing will automatically improve care quality,” said lead author and researcher, Associate Professor Stephanie Harrison.
The researchers emphasised that high-quality care depended on more than just staff numbers, as it requires a skilled, well-supported workforce with strong clinical leadership.
The findings highlight the complexity of aged care reform and the need for further research to understand the right balance of care minutes, skill mix and models of care to enhance care quality and resident safety.
“A holistic view to care quality is needed, beyond just meeting staffing targets. Adequate training, staff retention strategies, and tailored models of care that meet individual resident needs are all important for policymakers to consider,” Professor Harrison said.
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“Improving care means investing in workforce development, especially in rural and remote communities where staffing challenges are more pronounced. Recent initiatives to support the provision of aged care staff in rural and remote areas should be monitored to see if this helps to improve equitable access to care in these regions.
“Monitoring staffing levels in aged care homes remains essential, it provides vital data, but to truly improve the quality of aged care, we must also strengthen the evidence base and address the ongoing challenges facing the sector.”
Of the 2292 aged care homes analysed, 34% (772) were operated by for-profit organisations, 58% (1328) were not-for-profit, and 8.4% (192) were government organisations. The largest proportion (41%; 951) of facilities was small (≤60 residents); 35%; 791) were medium (61-100 residents), and 24% (550) were large (>100 residents). More than half (63%; 1436) of facilities were in metropolitan areas.
The findings have been published in the Journal of the American Medical Director’s Association (JAMDA).
Professor Harrison said the research focused on how well care staffing targets were being met, and whether this impacted residents’ experiences and quality measures.
“Since October 2022, Australia has set individual targets for total care and registered nurse minutes for aged care homes, based on the assessed care needs of their residents,” Professor Harrison said.
“These targets are a positive step, but these are the minimum levels of care that homes should be providing, and it remains unclear whether they are sufficient to drive meaningful improvements in care quality.”
Government-run facilities were more likely to meet their targets, compared to for-profit and not-for-profit facilities, with metropolitan and smaller facilities also performing better.
“The data suggests that location and facility size play a crucial role in the ability of an aged care home to provide adequate staffing levels,” Professor Harrison said.
“Government-run facilities were also more successful in meeting and exceeding care minute targets. As smaller, government-run facilities are replaced by larger, for-profit services, this is an important area to monitor.”
Noting that smaller, government-operated facilities in metropolitan areas were associated with meeting a higher percentage of their total care minute or RN care minute targets, the authors said “policymakers should consider the potential impact of the decreasing number of smaller, government-owned facilities on the care provided to residents”.
“Additionally, monitoring the allocation of resources to support facilities in rural and remote areas, including initiatives to attract and retain staff, would be valuable in assessing whether such initiatives improve equitable access to care in these regions,” they wrote.
They said future research should build on these findings by examining care minutes in addition to other key factors influencing care quality, such as staff training, turnover, skills mix, and models of care.
“This research highlights the value of nationally, publicly available data for research on long-term care,” they concluded.
“Policymakers should consider making additional routinely collected data from long-term care facilities available to researchers which could be used to address critical research questions and inform evidence-based recommendations to improve the quality of care.”
Journal of the American Medical Director’s Association, May 2025