The aged care royal commission final report, lost amid the controversies in Canberra this week, confirms pretty much everything that the unions representing aged care workers have been telling us for years — in fact for decades — about the aged care workforce.
And as the commissioners explain, when they have been listened to, the resulting policy responses have been ineffective.
Whether the Morrison government’s response will be any more effective remains to be seen, but the radical nature of the workforce proposals compared to the status quo suggests an extraordinary and expensive challenge. Why is staffing so important? “The evidence is clear that the quality of care and the quality of jobs in aged care are inextricably linked.”
Size
Despite extensive understaffing in the sector, the aged care workforce is already large: 366,000 paid staff, 68,000 volunteers, 28,000 contractors — around 3% of the entire workforce. And it’s going to expand rapidly in coming years. Simply to maintain current (wholly inadequate) staffing levels, the equivalent of an extra 130,000 full time staff will be required in the next 29 years. The commissioners want an additional 80,000 workers by 2030 and an extra 180,000 by 2050 in order to properly staff the sector.
The problem is more acute for Aboriginal and Torres Strait Islander people, who access aged care services less than the rest of the community despite having greater needs, and who often cannot obtain aged care services (or assessments for those services) from other Indigenous people or in-language given the insufficient numbers of Indigenous aged care providers.
The commissioners recommend the establishment of a specific Aboriginal and Torres Strait Islander aged care commissioner to develop an aged care pathway for Indigenous people, and the development of a national Aboriginal and Torres Strait Islander aged care workforce plan.
Pay
Aged care workers are underpaid. The government knows it, and has tried to fix it by throwing more money at aged care providers but they haven’t passed that on in the form of better pay.
In 2018, the Aged Care Workforce Strategy Taskforce recommended a process to transition aged care workers to the same pay levels as their counterparts in the health system, but “there has been no discernible increase in aged care wage rates in the more than two-and-a-half years since the taskforce report was published”.
To fix it, the commissioners want the government, providers and unions to “collaborate on a work value case and equal remuneration application to the Fair Work Commission”, which is asking a lot of a government with a policy of deliberate wage stagnation.
They also want wage increases to become “an explicit policy objective of aged care funding” with the new aged care pricing authority developing a pricing model on that basis.
Staffing levels
Staffing levels have gone backwards, driven by the Howard government’s refusal to mandate minimum staffing ratios.
The commissioners noted that the Productivity Commission found that “the largely unregulated aged care sector provided an incentive to aged care providers to replace higher paid and skilled nurses with lower paid and semi-skilled personal care workers. This is what happened and the trend continues. This trend is the opposite of what should have occurred.”
They now insist that, as part of the new aged care standards, there be a minimum staff ratio: “200 minutes of care per day of which 40 minutes are provided by registered nurses by 2022, and 215 minutes of care per day by 2024, of which 44 minutes are provided by registered nurses. In addition, when fully implemented in 2024, the standard should require at least one registered nurse on site at each residential aged care facility at all times.”
For unions that pointed out the problems that would flow from the Howard government’s 1997 decision at the time, this is a sad vindication.
Professionalisation
The commission wants to turn aged care into a profession with career pathways and accreditation standards that extend to personal care workers as well as trained healthcare staff and nurses.
They proposed registration of personal care workers and a minimum requirement of an Aged Care Certificate III qualification, as well as English language proficiency — two requirements of course that will in the short term reduce the potential workforce for aged care.
How to achieve all this? As we reported earlier this week, commissioner Tony Pagone simply doesn’t trust ministers of bureaucrats to deliver any of this, while Lynelle Briggs wants some key institutions made independent of government but the Health Department to continue overseeing the sector.
Either way, they only believe workforce issues can be addressed with “a fundamental change in the culture, leadership and management of the Department of Health and Aged Care”.
Bureaucrats are poor at fundamental change. And governments are too. Many of these problems — most of them in fact — have been identified before, and not addressed.
What are the chances this time it will be different?
I am a Canberran and I am sick to death of being lumped in with the federal government and castigated for the many sins committed by the nation’s elected representatives who, from time-to-time deign to gather in the nation’s capital. We Canberrans are just as appalled, disgusted, occasionally pleased with the words and (in)actions of the members of the HoR and Senate as other citizens.
In fact the PM’s release on Monday of the aged care report took place at Kirribilli House and the A-G’s presser on Wednesday took place in Perth. So neither was “lost amid the controversies in Canberra this week.”
I expect better of Crikey writers. Using precise language is not that hard. I am already angry with the government and I’ll happily add some journos to my list. Just STOP IT!
The use of the metonym can be irksome at times, but I remind myself that nearly every fool that comes here is because non-Canberrans choose those fools to represent them.
Your 2nd paragraph perfectly illustrates the paucity of thought in the Bleakcity bunker.
Expecting better and use of precise language is a lost cause – never mind the quality, feel the quantity of verbiage.
I think a little clarification is on order on your statement that ‘bureaucrats are poor at fundamental change’. Firstly this is aimed at public servants given the context. In as much as this statement is accurate, it also applies to all the private sector bureaucrats in large companies who resist change.
This resistance is really the fear of change from senior people who have built their present position and status on the way things work now – and fear reform could destabilise them. This is especially the case if they are simply generic managers rather than actual experts in the area being managed. It is easy to just keep on doing what you have always done (systems, people, familiarity), much harder to work through change where – horror – things might go wrong and they would be held accountable.
I don’t think any of the private sector aged care provider bureaucracies will be embracing change either – especially as it may make profits less predictable.
The answer is often new people who have expertise in the area and a commitment to achieving outcomes.
A decade of financial cuts, deregulation and lack of oversight under the libs brings us to where we are. In a classic political manoeuvre (create a problem then fix it) Scomo will pretend to fix the ‘situation’ the libs allowed to happen in the first place with yet another enquiry. Nothing like a royal commission to take the heat off all their other problems.
What are the chances this time it will be different?
It will not be different without:
# De-commercialize both residential and home care services.
# Workforce is valued.
# trained and accountable to Federal Govt.
# Local communities connect directly with both residential / home care service providers.
# Govt funded ‘Advocacy’ terminated. Replaced by local Incorporated Community Care Groups. Funded by State Govt(s) / resourced by Federal Govt.
. . . and that’s the bare beginning. If the Commission’s recommendation are processed as ‘patches’ and dragged out over time. We will be back here in ten, fifteen years re-inventing the wheel. We must have a system that engages family with aged relative. Localized facilities, services, that re-inforce community engagement. Formalize local medical services that re-inforce community etc etc
Oh, and we really need to promote every service provider to employ a skilled individual to identify, instal and maintain emerging technologies applicable to aged clients individual needs. Personal care, interests, mobility, interactive, social etc etc Technological advancement will reduce costs, upgrade care requirements, maintain and foster interaction and liveability options? etc etc
An independent investigation into anything the Morrison government is connected with is bound to identify the same old problems, call for new solutions and in turn, for all practical purposes, be ignored by the Government except for a lathering of Circumlocutionous Redeterminative Acetophenetidinalic Platitudinarianisms. There, I think that is putting at the level the Physiopathetic Malpractitioner can readily appreciate.