Operational Health

This episode maps out the next six episodes. It separates the numbers that often get conflated (and confusing!) . It frames churn as a symptom of a deeper demand-supply problem and sets out why people leave and stay. Throughout the literature there are repeated links between staffing, both in regard to numbers and perceptions, and resident safety. Craig also discusses the impacts of standards, leadership, wages and reform. We know the factors associated with retention far better than which interventions fix it, and that retention alone cannot close the staffing gap.Aged Care Research and Industry Innovation Australia. (n.d.). About workforce retention. Retrieved July 18, 2026, Australian Government Department of Health and Aged Care. ·      (2023, October 1). Mandatory care minutes boost care levels for older people in Australia [Media release].·      (2024). Nursing supply and demand study 2023–2035. Australian Government. ·      (n.d.). Professional FrameWork to build and strengthen the aged care workforce. Australian Government.·      (2024) (nursing model, early-career retention scenario).Australian Government Department of the Treasury. (2023). 2023 intergenerational report: Australia's future to 2063. Australian Government. Australian Institute of Health and Welfare. (2026). Residential aged care quality indicators: January to March 2026(GEN 001). AIHW.Australian Primary Health Care Nurses Association. (2023, June 21). Aged care nurses underutilised despite workforce shortage - survey [Media release]. Committee for Economic Development of Australia. (2022). Duty of care: Aged care sector in crisis. CEDA.Dawes, N., & Topp, S. M. (2022). Senior manager leadership competencies for quality residential aged care: An Australian industry perspective. BMC Health Services Research, 22, Article 508.Fair Work Ombudsman. (2025). Changes to minimum pay rates in the Nurses Award. Australian Government.Harbinson, S., & Chapman, M. (2025). Unlocking loyalty: Nurse retention in healthcare. Asia Pacific Journal of Health Management, 20(3), Article i5435. Kelly, C. (2024, February 16). Staff leave in their thousands, data shows. Australian Ageing Agenda.Ma, N., Sutton, N., Yang, J. S., Rawlings-Way, O., Brown, D., McAllister, G., Parker, D., & Lewis, R. (2023). The quality effects of agency staffing in residential aged care. Australasian Journal on Ageing, 42(1), 195–203. Morris, N., Jaffer, S., Rich, S. A., Syme-Lamont, K., & Blackberry, I. D. (2025). Equitable care for older Australians: A comparative analysis of aged care workforce shortages in metropolitan, rural, and remote Australia. International Journal of Environmental Research and Public Health, 22(5), Article 656. Nhongo, D., Holt, A., Flenady, T., Rebar, A., & Bail, K. (2023). Nurse staffing and adverse events in residential aged care: Retrospective multi-site analysis. Collegian, 30(2), 343–349. O’Keefe, B., Yuen, E., Perlen, S., & Hutchinson, A. M. (2025). A systematic, integrative review exploring supports that promote the retention of employees working in the aged care sector. Australasian Journal on Ageing, 44, Article e70070. Roche, M. A., Duffield, C. M., Homer, C., Buchan, J., & Dimitrelis, S. (2015). The rate and cost of nurse turnover in Australia. Collegian, 22(4), 353–358. Southern Cross University. (n.d.). Improving staff retention in the health & welfare sector [Research impact case study]. Southern Cross University.Tan, J., Divakar, R., Barclay, L., Bayyavarapu Bapuji, S., Anderson, S., & Saar, E. (2025). Trends in retention and attrition in nine regulated health professions in Australia. Australian Health Review, 49, Article AH24268.Thwaites, C., McKercher, J. P., Fetherstonhaugh, D., Blackberry, I., Gilmartin-Thomas, J. F.-M., Taylor, N. F., Bourke, S. L., Fowler-Davis, S., Hammond, S., & Morris, M. E. (2023). Factors impacting retention of aged care workers: A systematic review. Healthcare, 11(23), Article 3008.

Australia's oldest state cannot hire its way out of its workforce problem, and neither can most of regional Australia. Using Tasmania as a metaphor for the national challenge, it examines: an ageing population, a shrinking local pipeline, and a global contest for workers that is intensifying, not easing. The data is sobering, but the conclusion is human. The real task is not filling vacancies on a spreadsheet, it is helping people belong, because belonging is what turns a workforce into a community, and a community is the only thing that makes people stay. Selected Bibliography.Australian Bureau of Statistics. Census of Population and Housing, 2021. ABS.National, State and Territory Population, December 2025. ABS.Overseas Migration, 2024-25. ABS.Net interstate migration, Tasmania, 2023-24. ABS.Labour Force, Australia, July 2026. ABS.Population, demography and projectionsAustralian Government Centre for Population. (2025). 2025 Population Statement. Commonwealth of Australia.Tasmanian Government. (2024). Tasmanian population projections, 2024 (medium series). Department of Treasury and Finance.Kocar, S., Horton, J., Denny, L., Seivwright, A., & Lester, L. (2022). Building Population Resilience in Tasmania. Institute for Social Change, University of Tasmania.Kocar, S., & Seivwright, A. (2022). What's in a place? Drivers of migration to and from Tasmania (Report 59). University of Tasmania.Eccleston, R., et al. (2026). Tasmania chapter, in Australian Politics and Policy.Skills, jobs and trainingSkills Tasmania. (2024). Tasmanian Skills Plan. Department of State Growth, Government of Tasmania.Jobs and Skills Australia. (2024). Employment Projections 2024-2027.Department of Employment and Workplace Relations. (2025). North and North West Tasmania Local Jobs Plan. Commonwealth of Australia.Commonwealth Department of Education. (2013-2022). Selected Higher Education Statistics.Nursing, aged care and rural workforceDepartment of Health and Aged Care. (2023). Nursing Supply and Demand Study 2023-2035. Australian Government.Morris, D., et al. (2025). Aged Care Workforce Shortages: rural and remote shortfall analysis.KPMG. (2026). Aged Care Market Analysis 2026.Jessup, B., et al. (2024). Towards a home-grown rural health workforce: evidence from Tasmania. Australian Journal of Rural Health, 32, 976-986.Jessup, B., et al. (2025). Place of origin and clinical placement among University of Tasmania pharmacy graduates. Australian Journal of Rural Health.Fortabong, R., et al. (2025). Rural Nursing Workforce Sustainability: a scoping review.Retention and attritionO'Keefe, V., et al. (2025). Retention supports in the aged care sector.Tan, A., et al. (2025). Trends in retention and attrition across nine professions. Ahpra.Thwaites, C., et al. (2023). Factors Impacting Retention of Aged Care Workers: a systematic review.Victorian Government. (2024). Victorian Health Workforce Strategy.ARIIA. (2026). About workforce retention. Aged Care Research and Industry Innovation Australia.Housing and education enablersKidston, C., et al. (2026). Housing affordability and the teacher workforce, Hobart.Hyslop, S., et al. (2023). West Coast Housing Study. UTAS Policy Exchange.University of Tasmania, Vice-Chancellor. (2024). A big year for higher education.Global and international supplyWorld Health Organization. (2025). State of the World's Nursing 2025. WHO.World Health Organization. (2022). Health workforce in India. WHO Country Office for India.World Bank. (2025). Indonesia Growth and Jobs Report. World Bank.Second Congressional Commission on Education (EDCOM II). (2026). Workforce Development Plan 2026-2035. Republic of the Philippines.Talent Corporation Malaysia Berhad. (2025). Malaysia Critical Occupations List 2024/2025.Skills England. (2026). Skills England Annual Skills Report 2026. Department for Education.World Bank. (2025). Unlocking Nepal's Growth Potential. World Bank.

Drawing the series together, this episode asks what aged care resilience means for boards. The test is not more plans, policies or dashboards, but whether the organisation can show its critical systems work when conditions deteriorate: operational assurance, not paper assurance. Five board questions frame it. Can care continue when workforce availability drops? Can staff recognise and escalate deterioration at two in the morning, not only in business hours? Can they reach the information needed for a safe decision? Does the board understand its ambulance transfer patterns? And have the arrangements it relies on actually been tested? If not, there are plans, but no assurance.References for the five episodes are available via downloadable pdf upon request.DisclaimerThis episode is for general informational and educational purposes only. It is general in nature and does not constitute clinical, legal, financial or regulatory advice. Australian aged care laws, regulations and guidance, and state and territory health systems, ambulance and emergency frameworks change frequently and many vary between jurisdictions. This content is current only as at the date of publication and may be superseded. It should not be relied upon as a substitute for current legislation, regulatory guidance, organisational policies or professional judgement, and should not be applied to any specific organisational context without appropriate assessment and independent professional advice.DisclosureThis episode was developed and produced by Nampart Pty Ltd with AI assistance. Nampart Pty Ltd reviewed, edited, corrected, modified and approved the script, source references and final output before publication, and retains responsibility for the editorial decisions and conclusions presented. AI tools are used in different aspects of its production, including some research, production of visuals, editing. The AI voice was created from recordings of Craig's own voice.

This episode examines what decides whether a deteriorating aged care resident is transported to hospital when an ambulance is called. Reviewing Australian studies, it argues transfer is system-dependent, not driven by diagnosis alone: staff confidence, GP and outreach access, handover quality, family expectations, organisational risk tolerance and paramedic scope all shape the decision. Evidence includes 53% of fall-related transfers judged potentially avoidable, extended care paramedics halving transport odds, and virtual emergency care avoiding many transfers. Costs fall unevenly across ambulance services, residents and facilities. It recommends stronger in-place capability, better handover, joint training, prioritising right care rather than fewer transfers.

"Safe care in place" is not the same as avoiding hospital; some transfers are necessary and correct. The real question is whether a provider has the assessment capability, staffing, information and escalation pathway to make and act on a safe decision when a resident deteriorates. Resources alone do not guarantee this: a Queensland trial found equipping facilities did not reduce hospital bed days. The strengthened Quality Standards require structured systems for assessment, deterioration communication, workforce planning, information management, advance care planning, and incident and risk oversight. For boards, the assurance question is whether these systems demonstrably function as designed, not whether transfers occurred. Care in place is only credible where the facility is genuinely ready.

Ambulance ramping and hospital exit block are commonly framed as emergency department problems, but residential aged care sits on both sides of the pressure. Aged care influences who is transferred to hospital and who can be safely discharged back. Australian evidence shows high transfer rates, a substantial "grey zone" of potentially avoidable transfers, and hundreds of thousands of patient days lost to people awaiting aged care or disability placement. Service models bringing clinical capability into facilities can improve decision-making, though fewer transfers is not automatically better. The Aged Care Act 2024 and workforce requirements shape, but do not directly resolve, this interface. Boards should treat it as an assurance question.

Aged care is not just a care sector but critical infrastructure in the health system: essential, heavily used, and under load. It must keep running when things go wrong, making crisis management a governance concern, not just operational. Chronic pressures, workforce, thin finances and tight capacity, erode its ability to absorb shocks: pandemics, heatwaves, floods, systems failure and cyber outages. Boards should know their critical functions, single points of failure and dependencies, plan for disruption, and test plans rather than shelve them, and connect outward to hospitals and ambulance services.