September 8, 2025
When news broke that one major aged care provider planned to cut 60% of its enrolled nurses in Qld, describing the move as “dangerous”¹, many of us in the caring space felt alarm, but not surprised. For years, aged care has been under pressure: not enough staff, not enough training and not enough recognition of what it really means to support people who are ageing, living with illness or dying and those close to them.
Endorsed enrolled nurses (EENs) have always been a crucial part of the team. They are well trained in clinical nursing and medication and act as a vital link between the few registered nurses (RNs) working in aged care and Certificate III or IV care workers. When EENs are removed, the load falls heavily on the RNs, often just one for an entire facility of residents and on care workers who have more limited skills and training.
On paper, Cert III in ageing includes a unit on palliative care. But grief and loss are electives, not core units. The same often applies to Cert IV. Short courses at this level do not prepare someone adequately for the complexity of sitting with death, supporting grieving families and recognising and responding at a complex level to dying.
In our work with carers and professionals, we hear over and over again:
“I didn’t know what was happening to Mum. It looked horrible, yet actually, she was simply actively dying but I didn’t know.”
If staff at the bedside do not know what the many faces of the dying process looks like and how to respond accordingly, how can they explain it to families? How can they feel comfortable and bring comfort to that person and those present? Without that high level of understanding and explanation, families worry, care workers can be overwhelmed and hospital transfers occur more than is necessary.
Professor Allan Kellehear reminds us that 95% of the time, people who are ageing, dying or grieving are not in front of a doctor or nurse. They are alone, home, with family or friends, or in an aged care facility supported by care workers. Only 5% of the time are they in front of a doctor or nurse. That statistic alone should shift our thinking: clinical staff cannot be the only answer.
Aged care workers are remarkable, compassionate, dedicated and hardworking. However, often they are being asked to step into situations far beyond their training and capacity. Less EENs is not a solution. It might be good on the budget but not the standard of care nor on the wellbeing of staff.
The result? Burnout among long serving staff, distress among families and residents and participants left without the care they need at the most vulnerable time of life.
Recent projections suggest Australia could face a shortfall of over 70,000 nurses by 2035², with more than 200,000 care workers missing across aged, disability and mental health by 2050³.
Removing EENs from the mix only makes that even more unsafe and risky. The general public has been under the misconception for decades that aged care facilities are staffed by qualified nursing staff and they aren’t and they haven’t been for years. Have a look at how many RNs and EENs are available after hours and weekends, You’re likely to find just one.
This is where end of life doulas can step in. End of life doulas are a non-medical and non-clinical role. Doulas do not diagnose, recommend starting or stopping medications of treatments. Nor do they prescribe, administer or manage medications.
What we do is equally critical:
As one senior palliative nurse shared with us in and end of life doula training: “By the time I’ve medicated residents and completed paperwork, I don’t have time to hold a hand.” Doulas can be the ones to hold the hand, to talk to the family and to bring calm into chaos.
In fact, doulas often describe their role as working to “do themselves out of a job”. To educate, inform and resource individuals and their families or those close to them so well, that by the end, they feel ready and supported, with the doula just a phone call away.
We do not dismiss the challenges facing government or providers. Budgets are limited. Demand is skyrocketing. Workforce shortages are real. But if solutions are only framed around budgets related to clinical care, we will miss the opportunity to strengthen care in other ways.
Just as pastoral care has been recognised as essential in aged care facilities, end of life doulas should become a recognised role. Even one doula across several facilities, or part of a care team in the community, could dramatically improve outcomes. Families would feel supported, residents would experience more dignity and choice and staff would no longer carry the burden alone.
This is not about criticising government or aged care providers. It is about facing the reality that the current system cannot do it all, and nor should it have to.
The truth is simple: everyone in aged care will die. Their families will grieve. To ignore that reality in training, staffing and planning is to miss the heart of what aged care is.
By including doulas in the mix, we can begin to close the 95% gap. We can ensure people are not only safe, but also seen, heard and comforted in their final chapters.
It is time to broaden the team. Bring more RNs and EENs, not less, embrace end of life doulas and adequately train and skills our precious care workers to be death literate, confident and comfortable. Because aged care is not just about keeping people alive. It is about helping them live and die, with dignity.
References
Julie Fletcher and Helen Callanan August 2025
