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The effectiveness of current workforce targets to improve the quality of aged care remains unclear.
Care minute targets for Australian residential aged care homes were introduced in October 2022 following recommendations from the final report of the Royal Commission into Aged Care Quality and Safety, and became mandatory in October 2023. For each of the 2600+ aged care homes nationally, specific care minute targets are assigned based on the assessed care needs of their residents. Targets include total direct care minutes delivered by registered nurses, enrolled nurses, and personal care workers, as well as separate targets specifically for care minutes provided by registered nurses.
The sector-wide average care minute target started at 200 minutes per resident per day and increased to 215 minutes per resident per day in October 2024, of which 44 minutes should be delivered by registered nurses. In addition to mandatory reporting of these minutes through quarterly financial reports from the homes to the government, care minutes were included in the newly developed national composite rating of aged care homes, the Overall Star Rating. Currently, care minutes contribute to 22% of an aged care home’s Star Rating and from October 2025, homes will need to meet their care minute target to achieve a minimum of three stars for their staffing rating.
In our recent analysis of the national Star Ratings data, we examined five quarterly periods from 2023 to 2024 and determined that the percentage of aged care homes that met or exceeded their care minute targets increased from 41% to 53%. We also found variation in how well homes met their targets. For example, government-operated aged care homes, and those which were smaller (60 or fewer residents) or in metropolitan or socio-economically advantaged areas, were generally more likely to meet or exceed their overall or registered nurse care minute targets. However, we found no evidence that meeting care minute targets was associated with residents’ experience (as measured by the Residents’ Experience Survey) or quality indicators from the National Aged Care Mandatory Quality Indicator Program (e.g., pressure injuries, restrictive practices, unplanned weight loss, falls and medication management).
The aged care workforce plays a critical role in influencing all dimensions of care quality. During the COVID-19 pandemic, workforce shortages in the sector more than doubled, resulting in increased workloads and elevated levels of distress and fatigue in staff. However, it remains uncertain whether care minutes is an adequate measure of appropriate care delivery and whether it reliably correlates with positive outcomes for residents. High quality aged care likely depends not only on meeting adequate care minute targets, but also on ensuring an appropriately skilled staffing mix to meet the increasing complexity of resident needs, maintaining continuity of care by reducing staff turnover, and providing a workforce that is well remunerated, safe and valued. Evidence-based approaches are needed to improve care quality and ensure the safety and wellbeing of older people, this includes understanding what elements of workforce most influence outcomes so they too can be targeted for improvement. Continued investment in efforts to enhance the evidence base and refinement of workforce targets and indicators is one way to optimise the aged care workforce.
National efforts to monitor workforce in aged care
In addition to minimum care minute targets reported publicly as part of the Star Ratings program, the National Aged Care Mandatory Quality Indicator Program has responded to national calls to monitor other aspects of workforce metrics. For example, staff turnover was introduced as a quality indicator to be nationally reported on in April 2023 and since its introduction, there has been a slight reduction in staff turnover reported, from 7% in April-June 2023 to 5.3% in October-December 2024.
Additionally, new workforce quality indicators were introduced in April 2025 to monitor the amount of care provided by enrolled nurses, allied health professionals, and lifestyle officers in aged care homes. These professions do not have care minute targets explicitly assigned to them, raising much national discontent and confusion. Allied health professionals play an essential role in enhancing care quality, yet their use in Australian aged care homes is considerably lower compared to international standards. For example, in Canada, two provinces (British Columbia and Alberta) have set standards of 22-24 minutes of allied health professional care per resident per day, while our aged care homes currently only provide 4 minutes per resident per day. Likewise, although up to 10% of an aged care home’s registered nurse care minutes can be delivered by enrolled nurses, their minutes remain low, at 13 minutes per resident per day, well below international recommendations of 25–56 minutes. Furthermore, the proportion of total care minutes provided by enrolled nurses is approximately 6%, which is below the recommended 20% from the Australian Nursing and Midwifery Federation.
Building evidence to guide workforce reforms
The need for a stronger evidence base to guide workforce policy decisions in the Australian aged care sector has been highlighted as one of eight key areas in the Professional Framework – to build and strengthen the aged care workforce. Further research is needed to fully understand the impact of workforce changes in aged care, such as the rise in the numbers of agency staff particularly in remote communities, which may disrupt continuity of care and potentially influence resident satisfaction and health outcomes.
Current workforce monitoring, which focuses primarily on care minutes, may not be enough to ensure optimal care outcomes. To address this, the integration of staffing data with national health and care data of older people through the Registry of Senior Australians (ROSA) aims to identify the optimal workforce components, such as the right balance of care minutes, skill mix and models of care, that are required to enhance care quality and resident safety. This evidence base will be pivotal in shaping workforce reforms that can drive better outcomes, reduce undesirable results, and improve both the physical and social wellbeing of residents in aged care homes. While targets for care minutes aim to improve staffing levels, it is important to ensure that the aged care workforce is supported with adequate training, supervision and strong clinical leadership that prioritises the individual needs of residents.
Professor Maria Inacio is the Director of the Registry of Senior Australians (ROSA) Research Centre and Matthew Flinders Professor of Health Services and Epidemiology at Flinders University and the South Australian Health and Medical Research Institute (SAHMRI).
Professor Gillian Caughey is the Associate Director of the ROSA Research Centre and Matthew Flinders Professor of Health Services and Pharmacoepidemiology at Flinders University and SAHMRI.
Associate Professor Stephanie Harrison is a Matthew Flinders Associate Professor in Health Services and Epidemiology at the ROSA Research Centre at Flinders University and SAHMRI.
The Registry of Senior Australians (ROSA) Research Centre is supported through the Australian Government Medical Research Future Fund (NCRI000109, 2024-2029) and its partners (South Australian Health and Medical Research Institute, Caring Futures Institute, College of Nursing and Health Science at Flinders University, ECH Inc, Silverchain, Bolton Clarke). Prof Maria Inacio is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (GNT119378). Prof Gillian Caughey is supported by an NHMRC Investigator Grant (GNT2026400).
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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