Direct care staffing is growing, but is quality on the rise as well?

Direct care staffing levels in residential aged care are increasing; a team of Australian researchers set out to discover whether quality has risen as well. For the study — led by Flinders University researchers from the SAHMRI-based Registry of Senior Australians (ROSA) Research Centre — data from more than 2000 residential aged care facilities across Australia was analysed. In particular, the researchers investigated 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,” explained Associate Professor Stephanie Harrison — a lead author of the study and researcher in Flinders’ Caring Futures Institute and SAHMRI. “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.”

Through analysis of January 2023–March 2024 data, the study’s researchers observed that the proportion of residential aged care facilities meeting or exceeding their total care minutes’ target rose from 41% to 53%. It was also observed that government-run facilities were more likely to meet their targets compared with for-profit and not-for-profit facilities. Metropolitan and smaller facilities were also observed to be 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,” 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,” Harrison added. Crucially, the authors found no association between care minutes and residents’ experiences or quality measures, despite the rise in care staffing levels — something that, Harrison said, “challenges the assumption that simply increasing staffing will automatically improve care quality”.

These findings highlight the complexity of aged care reform, the researchers said, an area that needs further research to understand the right balance of care minutes, skill mix and models of care that will 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,” Harrison said.

“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,” Harrison added. “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.”

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‘Long-term care staffing: associations with facility characteristics, residents’ experience, and quality measures’ has been published open access in the July 2025 edition of Journal of the American Medical Directors Association and you can read it at doi.org/10.1016/j.jamda.2025.105686.

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