Introduction by Croakey: Poor pay, insecure work, limited career prospects and the relentless pressure of a sector in continual crisis mode have fed a vicious cycle of substandard service in the beleaguered aged care industry, and there will have to be a reckoning that goes far beyond the skilled migrant pipeline to put it on a sustainable path.
Ahead of this week’s highly anticipated Jobs and Skills Summit in Canberra, there has been much debate on measures to address the workforce shortfall in aged care, which has been put at some 35,000 extra staff per year.
It is a sector that is increasingly pivotal with population ageing, but also suffers from the legacy of privatisation – casual, poorly paid and undervalued work – as well as the taint of revelations from the recent Aged Care Royal Commission. The sector is also under a cloud as the epicentre of Australia’s earlier COVID-19 fatalities.
In this piece for Croakey as part of our Jobs and Skills Summit coverage, policy analyst Charles Maskell-Knight takes a look at what reforms are already in hand, and how much more needs to be done to address the crisis in aged care.
Charles Maskell-Knight writes:
The Issues Paper published by the Commonwealth Treasury for the Jobs and Skills Summit this week very helpfully sets out the background to the care workforce problem.
It observes that:
“The most significant structural shift of the past 20 years has been the rise of the services sector.
The growth in the health and care economy has been an important part of this trend.
- The health care and social assistance sector has more than doubled in size over the past 20 years, rising from 10 to 15 percent of the workforce and now employs more than two million people. Employment in the sector is projected to grow by 15.8 percent over the next five years.
- Labour shortages in the care workforce are already acute and expected to worsen with a projected shortfall of 286,000 care workers by 2050. Low pay and challenging conditions, partly as a result of high workloads and staff absences related to COVID-19 and influenza, have led to higher staff turnover.
- The care workforce is also highly feminised. Around nine in 10 aged care workers are women and a high number of workers come from migrant backgrounds.
- There may also be scope to improve productivity in these sectors, which is lower than for international peers.”
The paper then identifies as one of the issues for discussion: ‘How do we navigate workforce shortages in the care economy while supporting our frontline workers?’
The Aged Care Royal Commission considered workforce issues in some depth. It presented a vision of a more numerous, better-paid, better-educated, better-regulated workforce with an improved career structure and more secure employment.
Dystopian dilemmas
Between the Morrison Government response and election commitments from the new Albanese-led Labor majority, action is in train to implement a number of these measures.
Regarding increased care time and a 24/7 nursing presence in aged care (recommendation 86), related legislation is presently before the Senate, with the Albanese Government giving its full support for reforms in this space, where Morrison had only offered partial endorsement. This legislation, pertaining to nursing presence in aged care, will pave the way for subordinate laws providing for increased care time.
On increased pay (recommendation 84), Labor has committed to boosting award wages based on work value, as determined by the Fair Work Commission.
In a pre-COVID world these two measures should have had an impact on shortfalls in the aged care workforce.
However, in the dystopian “living with COVID” Australia of 2022, they are likely to prove inadequate without other action.
An attractive proposition
There is a steady stream of news articles about aged care services facing intractable staffing shortages, leaving shifts unfilled and beds empty, with credible estimates of an annual shortfall of over 30,000 staff.
There are many reasons for this deficit.
High levels of community COVID infection mean staff are likely to get sick and miss shifts; the health sector is under just as much pressure and is attracting staff from the lower-paid aged care system; those left behind face an increased workload and, under pressure, are more likely to seek an exit.
Another important factor is aged care’s historic reliance on imported labour. While the entry gate to Australia which was slammed shut in 2020 has now re-opened, there are long delays in processing visas.
Even if the gate was open, however, it is implausible that the tens of thousands of people a year needed to address aged care workforce shortages could be found, given the global scarcity of care workers. And importing unskilled workers with no experience in aged care will do nothing to improve the quality of care, even if they can somehow be directed to the aged care sector.
While wages reflecting work value will remove the handicap aged care facilities face in attracting staff, it will not offer an advantage. Government and the sector need to focus on measures to make aged care a more attractive option for workers.
Training and conditions
A workforce equipped with with the education and skills to deal with the problems they face in the workplace are more likely to stay in the sector. Workers who are confronted with challenging situations they do not have the training to manage are going to seek other jobs.
Professor Hal Swerissen has suggested a system of paid traineeships for aged care workers to complete a Certificate III. The Jobs and Skills Summit should adopt this idea, but go beyond it to examine options for government to meet the costs – both tuition and workplace replacement – of existing staff undertaking Certificate III or Certificate IV training.
Of course, this should only happen after a rigorous review of courses, curricula and delivery to make sure they are providing high quality training.
Improving non-salary working conditions, most critically job security and rostering, must also be a key element of any aged care workforce reforms.
Employers need to engage staff on a permanent basis, rather than relying on casuals or agency replacements. This is important not only for staff retention, but goes directly to quality of care, given evidence that higher levels of agency staff lead to poorer outcomes.
Split shifts may be convenient for employers and some staff, but should not be imposed on staff who do not find them convenient. Home care staff should not be required to travel between clients on their own dime.
The Jobs and Skills Summit is an opportunity for the sector to commit to improving staff conditions.
Ultimately these measures will only be successful if large elements of the sector undergo a cultural change.
Providers need to regard delivering high quality care as their primary focus – not delivering a return on investors’ capital.
They need to regard their staff in the same way they regard their buildings: a resource that needs to be developed and maintained, not just exploited.
Unfortunately, this transformation is outside the scope of a Jobs and Skills Summit.
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20
Previous Croakey coverage of the Jobs and Skills Summit
The physio will see you now. Why health workers need to broaden their roles to fix the workforce crisis: By Professor Henry Cutler
Five ways the Jobs and Skills Summit can help address our healthcare needs: By Kylie Woolcock
