The success of any aged care reform in the wake of the royal commission will depend on the sector’s ability to attract and retain a skilled and dedicated workforce.
The royal commissioners have recommended higher pay, better training, more defined career pathways, and a multimedia campaign to promote careers in aged care, but will it be enough to generate the foundational changes required?
Will these improved conditions in fact lead to aged care being a career of choice, rather than one of necessity?
With many home care workers already not getting enough hours of work, some are concerned an influx of new workers will further dilute the pool of work.
Mandated hours of care will help increase workers’ hours, but providers must also be on side, and willing to support aged care staff by providing the secure, full-time work that is essential in building genuine careers.
So long as aged care workers are not receiving the hours, pay, recognition and entitlements as every other worker in the industry, a career in aged care is never going to be something to aspire to.
Susan* left the corporate world on the promise of a new career in aged care. There was a push in the media to promote aged care careers at the time, and this message was reinforced while she completed her TAFE training course. She heard time and time again there was plenty of work in aged care.
However, the reality has been quite different.
Susan has now worked in the sector for several years, initially in residential aged care, and now in-home care. Yet she has only ever been able to find casual work.
Many aged care workers find themselves in similar situations, with no certainty about the hours they work from week to week, no sick leave or holiday pay, the constant worry their hours could be cut at any moment, and little prospect of their ‘career’ improving.
Now working in-home care, Susan also doesn’t get paid for travel time.
When I caught up with her by phone this week, Susan said it’s impossible for people to get a mortgage or loan for a car if they are casual workers and uncertain about how much pay they will receive each week.
Simply putting food on the table can also be a challenge in these circumstances.
“How do you balance the budget when you never know how much you will be paid from one week to the next? How do you deal with the fact that you can be dismissed with no notice or when you work in the community, you can have shifts cancelled with as little as three hours’ notice?”
“How can you have a career when you are employed as a casual?”
While casual work does suit some aged care workers, there are many who only take this option because it’s all that’s available to them.
Susan says what she is doing in-home care isn’t a career.
“If you have a full-time job, you feel more comfortable, settled. You know how much money you have coming in. You know you have sick leave.”
Lauren Hutchins, Manager Aged Care and Disabilities at the Health Services Union, told HelloCare that some providers offer contracts that only require a minimum of four hours work a week.
Usually, employees will work more than that, but it means the employer only has an obligation to provide four hours of work a week, and will decrease hours to that limit if budgetary restraints require it.
Aged care employees live with the “constant threat” hours will be cut, she said.
Many HSU members have two jobs just to make ends meet, and during COVID-19 we saw the disastrous repercussions of that, with staff spreading the deadly virus from one home to another.
The HSU believes aged care workers should only have one job in aged care, and they should receive the pay and conditions that make that possible.
“That’s best for staff and it’s best for residents,” Hutchins said.
The royal commission’s recommendation for minimum care hours will go a “huge way” to improving the situation, with staff’s hours determined by occupancy of the aged care home, not budget.
“It will remove the ability of providers to flex work up and down,” Hutchins said.
Susan says the psychological effects of casual work are profound, but workers are powerless to change it.
“If you complain, you will lose those shifts, so you don’t,” she explained.
Susan has seen workers waiting at the roster coordinator’s door so they can fill in any blank spots when the roster is released.
“People were desperate for work [at the residential aged care home where she worked]. People would ring up in the evening to say if anyone calls in sick can you please call me.”
“Yet [the provider] kept hiring more casuals.”
Carers themselves often sell themselves short.
“Just because we are carers, doesn’t mean we should be accepting substandard working conditions,” Susan said.
“We are just as entitled as other workers in this country to have secure employment and decent working conditions and pay.”
With a significant proportion of aged care workers coming from poor countries, many people working in aged care put up with the conditions because they are not aware of their rights as workers and they are afraid of losing their job.
Susan would like to have substantial guaranteed hours or a full-time contract, although that would mean a lower hourly rate of pay.
Working overtime to earn extra income is a thing of the past in aged care.
Anton Hutchinson, whose family has owned Canberra Aged Care for over 30 years, said aged care homes don’t roster staff on for more than 38 hours a week to avoid paying overtime.
With 52% of aged care homes operating at a loss as of the September 2020 quarter, the strategy is “hardly surprising”, Hutchinson said.
Though it has not been Susan’s experience, Patricia Sparrow and Sean Rooney, representatives of the Australian Aged Care Collaboration, a collection of Australia’s aged care peak bodies, told HelloCare that providers generally prefer to employ staff and use contractors to fill gaps in shifts.
“The challenge for providers is to balance the desire of staff to have certainty [about hours], and the desire of people receiving care to have flexibility.”
“Some providers may also recognise that their own staff are experts at delivering some types of care, and may contract expertise in to deliver other types of care relative to each client’s individually assessed needs.”
Sparrow and Rooney said one “innovative” model being trialled by some providers uses contractors who work across multiple providers so that the person receiving care gets to pick their carer, rather than just their provider.
“While this approach also has its challenges, it is not a model that should be obviously discouraged,” they said.
Staff stability could become an aged care quality indicator in the future.
But, not surprisingly, Sparrow and Rooney say workforce reform requires additional funding.
“Funding is what supports the employment of more care staff, better trained care staff, better paid care staff and better facilities for residents.
“Australia spends 1.2 % of GDP on Aged care compared to comparable countries who spend 2.5%,” they said.
Susan believes full-time workers “take ownership” of their jobs because they have higher levels of pride and commitment.
“If you’ve got equipment, you look after it [in a full-time job], because it’s your area and it’s good for you to. You keep your area clean and you know where everything is and if all the equipment’s functioning, it’s better for you, it’s better for the residents.
“If you’re casual, and you’re working from spot to spot, you’re not going to be back there for another two weeks.” It may be uncomfortable to admit, but there’s less incentive to put the extra effort in.
In its immediate response to the royal commission, the government promised $92 million to create over 18,000 places for aged care workers by mid-2023.
“Why are we calling for more people to work in aged care, when there are so many aged care workers not getting enough hours?”
“Where are they going to go?” she wondered, worrying about her work being even further diluted.
To those who say the smile on a resident’s face is all the reward they need working in aged care, Susan has a blunt message.
“If all you need is the smile on the resident’s face, then be a volunteer.
“You’re in paid employment and you are worth a lot more than a smile on your resident’s face. You deserve a decent wage.
“If you are so good you make your residents smile, then you really deserve a decent wage,” she said.
“We do it for a decent wage, and recognition, and we’re not getting it,” she said.
* Name has been changed.
I was working for HCA – shit company, last minute lifestyle, no support even though experienced and happy to upgrade skill from AIn to Reg Nurse this year study , not interested.
Though to be fair I did manage my mum inpallative for a few months until she passed.
New career, got a terrific job with Your Nurse in Sydney and studying online!!
We can do this , you find a way it’s what’s it’s meant to be xxxx Ruby orreal