Aged care is going through a period of tremendous upheaval, with COVID, the royal commission and the relentless pace of reform heaping further pressure on an already-struggling sector.
The Albanese government has a mandate to deliver on a new model of aged care, and it is pleasing to see that, in some respect, it is rolling up its sleeves.
The government has thrown support behind an aged care wage raise before the ongoing Fair Work Commission work value case (although the scope of that support is still unclear).
Also under way are: the extension of an initiative that means Pacific Islanders will be able to work within the Australian aged care sector; the prioritisation of foreign worker visas for people who have skills that benefit the aged care sector; and the extension of government surge workforce contracts to the end of 2023.
Finally, the government is rolling out a key plank of its promised reform: the requirements for onsite 24-7 registered nurses (RNs) at all residential aged care facilities and the implementation of a minimum number of care minutes per resident.
No-one argues that more nurses and more care minutes are anything but valuable for improving care outcomes in aged care. However, the question remains, how can providers and government increase RN numbers and care minutes in the face of workforce constraints and aggressive competition for labour from adjacent public health and disability sectors?
Well, a good start is always genuine engagement between government and industry on workforce solutions.
In this vein, it was disappointing to see the Aged & Community Care Providers Association (ACCPA), which represents the vast majority of the aged care sector employers, was excluded from the Jobs and Skills Summit.
This, even though aged care workers and registered nurses are among the most sought-after positions in the nation, and that the aged care sector makes an oversized contribution to the Australian workforce when compared to its relative size. Why was ACCPA not at the table?
The Senate Community Affairs Legislation Committee recently heard that one in five providers (operating about 500 aged care homes) would, on current rostering, be unable to meet the RN24-7 requirement during night shifts and on weekends. Smaller metropolitan facilities and those in regional and rural areas would struggle most of all.
That is a lot of new nurses we need to find to fill that gap (just more than 1,400 part-time RNs by ACCPA’s estimation).
There simply aren’t enough nurses in Australia to fill care sector demand and, with unemployment now sitting at 3.4 per cent nationally, those RNs who do exist are taking positions in better-paid sectors such as public health and disability.
It is worth noting here that the Victorian government’s recent promise of a free degree to nurses prepared to sign up to its public hospitals for two years is simply the latest development in the ratcheting up of sweeteners to nurses offered by public health sectors across the states and territories.
By contrast, aged care is not funded to pay its workers properly, let alone competitively.
While exemptions will be available, it is not clear how easy these will be to access and on what terms. What we are left with, in any event, is regulation that won’t work in the short to medium term, at least because it can’t be effectively enforced.
The Department of Health knows this and is even publicly anticipating that “a reasonable proportion of services will be non-compliant with the requirements”.
So, providers will be (unfairly) punished for failing to meet minimum RN and care-minute requirements.
Everyone loses here and, most importantly, consumers will miss out on the extra care they have been promised and, indeed, will come to expect.
In fact, the Aged Care Quality & Safety Commission has also been told by the government to expect “an increase in both new and unique complaints” on the basis that “consumers and their families/ representatives will be highly sensitive to services’ compliance with these new requirements.”
More work is needed from government here, including active engagement with the sector on workforce solutions.
Thanks to Andreas Geronimos, solicitor, aged care, seniors living and disability for his contribution to this article.