Written by Hal Swerissen, Emeritus Professor of Public Health, La Trobe University. This article first appeared in The Conversation.
In a country like Australia, we all expect that when we get old, we’ll be able to rely on a robust aged care system. But aged care providers can’t find staff and a crisis is brewing.
If the problem isn’t fixed, there are serious risks to quality and access to services for older people who need support. There are also broader social, economic and political consequences for undervaluing the rapidly expanding health and social assistance workforce.
Aged care employs around 420,000 people. Around 80% of those are front line staff providing care and demand for them is increasing rapidly.
The number of people aged 80 and over is projected to double by 2050. At the same time, informal family care is becoming less available. In the next 25 years, twice as many aged care staff will be needed.
Currently, about 1.4 million older people receive aged care services, including basic and more intensive home care and residential care.
Health care and social support job vacancies and ads are the highest of any industry. Between 30,000 and 35,000 additional direct aged care workers a year are already needed. By 2030 the shortfall is likely to be 110,000 full time equivalent workers.
Despite recent pay increases, it is difficult to attract and retain aged care workers because the work is under-valued.
The Australian workforce is undergoing profound change. A generation ago, manufacturing made up 17% of the workforce. Today it has fallen to 6%. By contrast, the health care and social assistance workforce has doubled from 8% to 16%.
Manufacturing jobs were mainly secure, full-time, reasonably paid jobs dominated by male workers.
By contrast, jobs in aged care are often insecure, part-time and poorly paid, dominated by women, with many workers coming from non-English speaking backgrounds.
Since moving to take over aged care in the 1980s, the federal government has over-emphasised cost constraint through service privatisation, activity-based funding and competition, often under the cover of consumer choice.
The result is a highly fragmented and poorly coordinated aged care sector with almost 3,200, often small and under-resourced providers centrally funded and regulated from Canberra.
This has led to high levels of casualisation, low investment in training and professional development, and inadequate supervision, particularly in the home care sector.
Aged care is facing a perfect storm. Demand for care and support staff is increasing dramatically. The sector is poorly coordinated and difficult to navigate. Pay and conditions remain poor and the workforce is relatively untrained. There are no minimum standards or registration requirements for many front-line aged care staff.
An understaffed and under-trained aged care workforce reduces access to services and the quality of care and support.
Aged care providers routinely report it is difficult to attract staff and they can’t meet the growing demand for services from older people.
Staff shortages are already having an impact on residential care occupancy rates falling, with some regional areas now down to only 50% occupancy.
That means older people either don’t get care or they are at increased risk of neglect, malnutrition, avoidable hospital admissions and a poorer quality of life.
Inevitably, lack of aged care workers puts pressure on hospital services when older people have nowhere else to go.
Addressing these challenges requires a multifaceted approach. Australia will need a massive increase in the number of aged care workers and the quality of the care they provide. Wages have to be competitive to attract and retain staff.
But better pay and conditions is only part of the story. Unless aged care becomes a career the community recognises, values and supports, it will continue to be difficult to train, attract and retain staff.
The recent Royal Commission on Aged Care Quality and Safety highlighted the need for a more skilled workforce, emphasising the importance of ongoing professional development for all staff.
To date the federal government’s aged care workforce initiatives have been underwhelming. They are a limited and piecemeal rather than a coherent workforce strategy.
In the short term, skilled migration may be part of the solution. But progress to bring in skilled aged care workers has been glacial. Currently only about 1% of providers have agreements to bring in staff from overseas. At best, overseas migration will meet only 10% of the workforce shortfall.
Registration, qualifications and training for direct care work have to become mandatory to make sure care standards are met.
Much more significant and systematic incentives and support for training will be needed. Supervision, career progression and staff development will also have to be dramatically improved if we are to attract and retain the workforce that is needed.
“Learn and earn” incentives, including scholarships and traineeships for aged care, are needed to attract the future workforce.
At the same time, a much broader investment in upskilling the entire workforce through continuing professional development and good quality supervision is necessary.
Like manufacturing a generation ago, aged care needs to become valued, skilled, secure and well-paid employment if it is going to attract the staff that are needed to avoid a looming crisis.
Aged care work is far from insecure – there’s bucketloads of hours and plenty of almost FT hours. It’s difficult to put people on in a full time capacity due to the fluctuations in resident mix (in nursing home setting) and care minutes don’t ever align nicely with a full-time roster. People also like the 25% casual loading. I’d argue ageing, dying and death are still seem as taboo in Australia. That, coupled with bad press dealing with a handful of shoddy providers and the demonisation of aged care by everyone who has something to say (qualified or not) deters people from pursuing an opportunity in an industry which isn’t going anywhere. Yes, it takes a special kind of person to care but they’re out there. Let’s focus on some good news stories and promote the worth of the elderly and those who care for them. Let’s also call out the dump and run families and those people who financially and psychologically abuse their elderly relatives.
Most of the staff from overseas are very young and seem to have absolutely no training. They are often family members. Husbands and wives sisters and brothers working there. The facilities actually encourage staff to seek out friends and family. The males seem to pick up the majority of full-time work or extra shifts. The workload is becoming very hard. We have big men who are 3 x ass8st or more due to their aggressiveness towards staff. Hot soup and drink’s thrown at staff. Punching the staff. Verbal abuse. Alot of falls as most residents have dementia and / or cannot see the risks of standing up without waiting for assistance. One male resident tries to strangle his wife and threaten to throw her and staff off of a balcony. They are separated now however the male resident is physically and verbally lashing out at staff on a daily basis. Refuses to take his medication. Residents who are are 3 or more assist but staff are not to use restraint. Go figure! Residents like this are physically abusive and staff often leave them incontinent for often days as we are not allowed to hold them while another person cleans them. Sometimes staff have to do exactly that otherwise family complain! Rules of aged care. For good reason ofcourse. But I ask why are abusive Residents allowed to go to aged care facilities where there is no protection for staff? Most are women and mostly 5foot nothing! The men are mostly lazy and I question so many of the “new” staff and their good “compassionate care” . Residency is their main goal. So if you worked in a mental health facility run by the government would the staff be better trained and therefore paid significantly more? With security to call up when a resident is being a danger to all others? You would only attract better staff if the pay reflected the type of dangers, both physical and mental workload that the hands on staff have to endure 24/7 and stop the revolving door of staff coming and going because they cannot work on a roster that is only 2 to 3 shifts a week. This is why they cannot get enough staff. Nobody can survive on short shifts and the pathetic rates of pay.
Totally agree
As a training provider currently in the Pacific delivering the Certificate 3, I can hand on heart say that Aussie aged care providers that are NOT currently utilising Pacific islands workers are missing out. What I have witnessed is a potential workforce motivated, with ingrained family values and a solid work ethic, and that speak and understand English perfectly.
If regional (and even urban) need staff, there doesn’t need to be a shortage.
And if anyone is interested in knowing how I can help, reach out on LinkedIn.
Working in aged care can be very demanding. Caring for people with dementia is challenging. Trying to shower, toilet, and maintain/manage incontinence can be difficult with aggressive behaviour and the patient simply not understanding. Residents can be frail and unable to mobilize, this requires skills to assist these people with activities of daily living, and staff need time to give supports correctly with dignity and respect. Many times it is a hurried environment with understaffing to basically to add to the pressure. Assisted feeding needs to be done with patients, this at times is also rushed. Wound care needs to be updated for all staff to achieve. Treatments and procedures are usually done by qualified staff. Then you have palliative care and this should be a specialised area, again much education on dying with dignity. My personal opinion that assisted dying should be an option instead of placement in a nursing home. Many people are terrified of going into a nursing, and who could blame them. You depend on someone to shower you, help you with personal hygiene and movement. Staff regularly deal with faeces and urine incontinence, this is also a sensitive area that many could not achieve.
Thanks for that review Hal. I would like to add to that. Aged care is a community service and communities should be involved in providing and managing care and in deciding who and what sort of care their communities need. Citizens and families should be engaging with staff and admiring their efforts so that staff become admired role models for caring community values and so encourage the young. This would attract staff.
Social systems including markets work well when there is a balance of insights and power so there are checks and balances. Neoliberal free market solutions have centralised management, regulation and control. They have excluded communities who have little involvement and no power so is not balanced.
Market values and competitive pressures put community values under pressure and they can wither, creating a context that does not attract. Royal Commissioner Pagone supported and recommended the regionalised and more independent system you advised from the Grattan Institute. He was very critical of the alternative recommendations of the other Commissioner, which government adopted because they left this neoliberal model and all its flaws intact.
A subsequent 2020 Grattan model for change added the local community advisory committees and a central independent representative community body to work with central management that we at Aged Care Crisis recommended.
The draft of the new aged care act placed all the control and oversight in the hands of the central bodies managed by government appointed individual and has left the structure of the failed market system intact. Stephen Duckett, who also wrote the Grattan reports has likened it to Thatcherism in its denial of community and still riddled with the old ideology. That will probably be taken to parliament.
We at Aged Care Crisis have been pressing politicians to make amendments that insert accountability to the communities served as a principle in the act, require central bodies to consult with the local communities when issues affect them, set up a central body representing local communities to advise on issues and appoint a representative to the board and management of each of the central bodies to ensure transparency. That would create a balanced system that would build community and be far more attractive to potential staff.
Any support from you or your readers would be welcome.
Thank you for giving attention to this matter.
I hope the government will do something to save staffing at aged care.
I’ve been working in aged care for 15years and I can see the staffing crisis this days compared years back. Management just leave the numbers of who turns up for the shift. And even the roster is short before the shift, they just leave it as it is if no one agrees to come and work. Most of the facilities now DO NOT consider calling agencies anymore so team need to do the job with what they got. It is happening almost everyday.
Also, staffs doing double shifts, extending their hours or no days off for the roster week.
It is exhausting and tiring.
The reason many aren’t working in aged care is due to the criteria to enter the workplace.
When we are told to take a vaccine of a min amount of shots or we can’t work. The constant having to inject our bodies with toxins is killing the industry. Every year we are told to take a flu jab – to protect others – yet we all know the vaccine only protects ourselves not others. And let’s not talk about the Covid jab which didn’t protect anyone and made carers very ill & injured.
I saw carers stood down for not wanting to put toxins in their body – not just carers but other healthcare workers.
The government and workforces themselves have created their own problem & it is effecting the lives of those who need care.
To get honest – carers aren’t wanting big money and majority of us carers are in the industry because we want to help those in need. But there is a limit as to how much harm one has to do to themselves just to be able to look after others. When we have families of our own – children to look after – they don’t need a vaccine injured parent.
Remove all requirements to have to jab oneself & you might see a bigger influx of carers & those returning to work who were stood down.
Out of a class of 17 who I did the aged care course with – only 3 got the shot – the rest of us walked away due to body autonomy.
I watched residents all get jabbed & walk around sick infecting each other. It never came from the carers nor the visitors – but from the shots the doctors give in mass proportions.
In the NT the crisis of staffing is already here.
Those involved in Aged Care have been aware of the problems of low pay and no career progression for decades. Successive governments seriously dropped the ball to the detriment of our ageing Australians.
If We bring in overseas workers where will they live? Some Staff leave because We are often subject to abuse from Residents. We get threatened, spat on, punched and are told to walk away which is not always possible as We have to make sure other Residents are safe from those who are threatening!
If you go to a great restaurant for a meal you will recommend this facility to all of you friends. The same goes for other service you receive. If a Carer works at a great aged care facility, with a good aged care managers supported by a great Provider, they are going to be the loudest voice. This is how you for get and retaining staff. The opposite applies when they are treated badly as is a case I am aware of.
Just read feedback about poor aged care providers, harassing managers and poor unsafe work sites.
Carers have very little say and have do not have voice. This is the case especially when they have experienced personal work replated problems, and when are they are concerned about the people they assist and care for in their dally roles.
Anthony. If you look at my earlier comment above, that is exactly why we want the system, and providers to be accountable to the communities they serve and work closely with them. The new act excludes communities and that sort of thing can continue unchecked. Staff are fired if they speak out. You get toxic cultures.
If community members whether staff or residents are not well treated then they will have something to say about it. We have been watching and listening to staff saying that sort of thing for years and pressing for a balance of power in the community so there is an umpire with the capacity to intervene and act when they see problems. This challenges the ‘free market’ policy of government and its marketplace advisors and has been resisted by those who designed this act.
Aged care is not the only sector where these market policies have seen society’s values breeched and vulnerable people harmed. Many economists around the world, who once supported these free market policies are now the strongest critics pressing for change. We think its time and believers in this policy feel threatened by that.
The ability, and perhaps willingness, of managers in Aged Care to manage staff well is a huge problem.
Bullying, short notice shift changes, poor induction training, very high work loads are all problems.
My observation over a number of years with family in care and employment supporting unpaid family Carers, is that many Managers in Aged Care have very poor personnel management skills.
Perhaps that is because they are also burnt out on the job ?
Perhaps other reasons.
Aged Care Managers need to treat staff as very valuable assets. Employ them as permanent, train them properly, ensure their place of employment is supportive of their needs and get rid of the incompetent and idle in the Roster. Not much is more demoralising than working hard and seeing those who do not work hard get the same pay and keep their jobs.
Let’s face it, often when older Australians enter care, it is because they ned medical care related to existing fragility and/or diseases. They don’t need carers, they need trained and qualified staff who can offer both care and medical intervention. Nurse aides at least with qualifications in understanding the medical needs of the older person. Plus, higher pay. In most cases, in both the nursing and care industry, the pay for mainly women is much lower, yet the majority of women in Australia have higher education qualifications than men, plus more qualifications. So why is there a disparity in wages? Its because the positions that most women hold are considered to be or have les value that, say a motor mechanic.
Until such time as women are treated as equal, with equal rights and pay, the demand will remain high. You can bring in as many migrants as you want, but without equality, it will still not be sufficient.