Elderly people are being sent in record numbers from nursing homes to be treated in hospitals, prompting Victorian minister Martin Foley to say Australia's aged care system was "broken".
Victorian government figures obtained by Fairfax Media show a dramatic 25 per cent jump in the number of residents being transported from nursing homes to hospital in the past 12 months.
More than 14,000 people made the trip in the last financial year, up from 11,200 the previous year.
The bulk of the transfers happen during the week, with the number plunging on weekends, which, according to the nurses' union reflects a serious lack of staff on hand in many nursing homes on Saturdays and Sundays to make clinical decisions.
Critics say a reduction in expertise in nursing homes increases the likelihood that residents will be sent to hospital because poorly trained staff are not equipped to make clinical decisions to treat residents within nursing homes.
Mr Foley said that, "the aged care system, both in terms of residential aged care and retirement villages, is broken and the Federal Government must act immediately".
In the past financial year, people over 65 accounted for 40 per cent of all inpatient admissions to public hospitals in Victoria. Nursing homes are funded by the Federal government, but hospitals get their money from the state government.
"It's time Malcolm Turnbull stopped cost-shifting and worked with the aged care sector to protect older Australians and put the safety of patients and workers first," Mr Foley said. "This can only happen if the issues of levels and qualifications of staff are addressed."
But Federal aged care minister Ken Wyatt hit back, saying funding for residential care was growing at 5.1 per cent per annum over the next four years.
He added that, "all Australians have the right to hospital care when required".
The hospital transfer figures come in the midst of a debate on the quality of aged care in Australia, and accusations that nursing homes are in crisis.
Australian Nursing and Midwifery Federation state secretary Lisa Fitzpatrick said the jump in residents being sent to hospital was a symptom of the sharp reduction in qualified nursing staff at residential aged care facilities.
"They reduce their staff then they rely on the public sector by sending people to hospitals," Ms Fitzpatrick said. "And they still get paid the same by the Federal government."
In 2003, trained nurses made up 36 per cent of staff in nursing homes, but by last year that had fallen to just 24 per cent. They have been replaced by "personal care workers," who generally have a Certificate III qualification.
However, not-for profit nursing home lobby group Aged and Community Services Australia said the system was working, and older Australians "need to be able access hospital services".
Nursing homes were "not funded to provide for the hospital-level care needed," said chief executive Pat Sparrow." It is only appropriate ... that residents can access those essential services they require through hospitals."
Meanwhile, one of the biggest and most profitable national nursing home providers, Bupa, has begun a redundancy round that could significantly reduce the number of nurses in their facilities across Australia.
Bupa, a for-profit company which runs 26 nursing homes in Victoria and more than 70 across Australia, said inadequate government funding was to blame for the increase in hospital admissions.
"Where the care cannot be delivered in the aged care home, due to inadequate funding, people will increasingly need to be unnecessarily transferred to, and cared for in, the more-costly hospital setting," it said in a recent submission to government.
"This is a very poor outcome for the resident, their family and the health and care system more broadly."
Bupa also says tighter Federal budgets are to blame for a looming redundancy round which will see it merging the "Clinical Manager" and "Care Manager" roles across its network. It will not say how many positions will be made redundant, but chief nurse Maureen Berry said the cuts were because "government funding for care per resident ... is tightening".
However, she said, "with 44 years of nursing experience, I'm confident the proposed change to our management structure ... will not impact the level of care residents receive".
Ms Fitzpatrick, whose union has been trying to negotiate a pay rise with Bupa for the past 18 months, said the cuts would leave one staff member in charge of 24 residents at some of Bupa's Victorian facilities.
"The result of getting rid of nurses is not improved patient care, it's increased profits," she said.
"I urge people with loved ones living in a Bupa nursing home, or considering choosing a Bupa nursing home, to ask management for the specific numbers of nurses and carers on each full shift, and how many patients they are responsible for."
The union is running a wave of stop-work meetings this week in pursuit of wages that "match industry standard rates" paid at other private nursing home companies.