Sep 02, 2020

Home care has more risks than residential, royal commission hears


The Royal Commission into Aged Care Quality and Safety resumed its examination of Australia’s home care system on Tuesday.

The NSW Ageing and Disability Commissioner, Robert Fitzgerald AM, appeared with Kathryn McKenzie, who is director of operations at the same organisation.

Commissioner Fitzgerald said that by 2050, 3 million Australians will receive aged care support in the home, but he told the royal commission home care poses greater risks for older people than residential care.

“The highest risk for older people in the aged care system is within the home,” he said, despite “all of the attention” on residential care.

“The risks that occur at home are quite substantial because there is not the line of sight that you normally see in residential services.”

Home care monitoring “doesn’t exist”

Associate Professor Gillian Caughey, principal research fellow at The South Australian Health and Medical Research Institute told the royal commission information about quality indicators is not collected at all for home care services.

“It currently doesn’t exist,” Associate Professor Caughey said.

Her team has developed a set of quality indicators, and she told the royal commission they could be implemented within a period of six months.

Casual workers lack support, oversight in home care

The royal commission examined the issue of casual workers providing home care services with a panel consisting of: Fiona Macdonald, senior research follow, School of Management RMIT University; Andrew Stewart, John Bray Professor of Law at the University of Adelaide; and Jim Stanford, economist and director of the Centre for Future Work.

Dr Stanford and Dr Macdonald were the authors of a report for the NDIS on ‘Precarity in job instability on the frontlines of NDIS support work’, research which they said also applied to home care services.

Dr Stanford said when casuals are employed in care services there are several significant risks, including how the quality and qualifications of the service providers are ensured, how the time of the workers is organised to ensure that they have sufficient time to perform the duties they’ve been contracted to do, and the capacity of the client or customer to “organise” the whole process.

Dr Macdonald said the “absence of a support” also posed a serious risk both to the care recipient and the worker.

“The absence of… a relationship providing support and oversight supervision, absence of access to training, absence of peer support mechanisms, absence… of any support for decision making when encountering changes in care needs, unpredictable issues, things that happen all the time,” Dr Macdonald said.

“Isolation of the worker… is a really big one for workers performing that work and… it can be seen to lead to intentions to leave, due to the sense of not being able to provide appropriate supportive care,” Dr Macdonald said.

Employees deliver higher quality care

Dr Macdonald said home care staff are employed as contractors because “it’s cheaper”. “People engaging contractors can get more hours of care for their money,” she said.

However, the absence of general employee protections also posed risks, both to the care recipients as well as the workers, she said.

The absence of paid leave and superannuation, the need for workers to provide their own equipment, as well as the cost of them running their own businesses, in the end would mean they are being paid less than the award rate of $22–$23 an hour, she said.

When asked if some some workers enjoyed the flexibility of contract work, Dr Macdonald said contractors are working “very, very fragmented working hours, short shifts, with lots of unpaid time in between on work-related travel.” These workers are usually seeking other jobs or have multiple jobs, she said.

“They’re actually patching together little jobs, multiple little jobs.”

Counsel assisting the royal commission, Peter Gray QC, said a “better off overall test” for home care workers could be applied, to which Professor Stewart agreed.

“That is something that we might expect to find in the aged care legislation, not made a part of the Fair Work legislation,” Professor Stewart said. “There’s no reason why that couldn’t be done.”

For lower skilled workers, Professor Stewart said there was a “strong argument” for engagement as an employee because it’s “far more compatible” with achieving high quality care, because employees can be “closely directed in the work they do”.

Dr Stanford said his research showed that “a more stable work relationship was positively correlated with better quality of care that those workers could deliver to their clients.”

“It’s safe to say that the evidence is consistent that the more stable is the job, the higher quality is the care that those people are going to provide,” he said.

The “correlation between job stability and quality of service that’s delivered is quite robust.”

Improved communication no substitute for stronger regulation

Mr Gray asked if having a care manager to help facilitate communication on online platforms would be sufficient in reducing the risks in home care.

“I don’t think facilitating communication in the sense that a market will somehow efficiently match suppliers and demanders and make sure that quality is rewarded is at all an adequate response to the need for more, I’d say, deliberate and intense regulation of the quality and protection for the clients involved,” Dr Standord said.


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  1. The government simply got it wrong… again.

    In their rush to destroy residential care they came up with a utopian idea of ageing at home but they had absolutely no idea of the enormous cost, per hour, per day, significantly more expensive than residential care and the second factor, they had no idea that Australian families that have always previously helped the parents and grandparents with daily living chores around the home would so greedily abandon their responsibility to care.
    I find it embarrassing how this generation has shirked its caring responsibilities.

    How could anyone expect to have safe care when a random and mostly untrained and unfamiliar person drops by an elderly clients house? There is absolutely no checks and standards of service? Forget that. People need to go back to ringing Pop and Nan, take them shopping, mow, clean and simply care.

    The federal government needs to rethink its attack on the residential care sector because if its funded properly there is no better alternative.

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