July 6, 2022

Aged Care

‘Fixing the aged care crisis’ won’t be easy, with just 5% of nursing homes above next year’s mandatory staffing targets

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In his election victory speech, Prime Minister Anthony Albanese pledged to “fix the crisis in aged care”.

One of the biggest challenges facing incoming aged care ministers Mark Butler and Anika Wells is addressing widespread staffing shortages.

But our latest research shows a mammoth effort will be needed to increase staffing across the sector. Only a fraction of aged care homes currently have staffing levels above new minimum ratios that will be mandatory from October next year.

What has Labor promised?

Following the revelations during the aged care royal commission and thousands of COVID deaths in aged care, much of the public’s attention has focused on the lack of adequate staffing.

Last year the Coalition committed to mandatory ratios in residential aged care homes, so that by 2023:

  1. residents will receive, on average, at least 200 minutes of total care per day
  2. at least 40 minutes of that care will be provided by an registered nurse
  3. a registered will be on-site for morning and afternoon shifts each day.

Labor has since promised to lift staffing levels by implementing more ambitious minimum staffing ratios, so that by 2024:

  1. residents will receive, on average, at least 215 minutes of total care per day
  2. at least 44 minutes of total care will be provided by registered nurses
  3. a registered nurse will be on-site 24 hours a day, seven days a week.

What we found

Our recent report, based on a survey of 1,192 residential aged care homes and 55,821 home care packages, shows providers are struggling to improve staffing levels.

In the past year, total care time grew by only 1.9% across surveyed residential aged care homes.

The average care time (178 minutes per resident per day) is well short of the mandatory thresholds of both the previous and incoming governments.

To reach the 2023 target (set by the previous government) of 200 minutes, providers will have to increase total care staffing by roughly 12.4% by October next year.

When we considered the staffing requirements in combination, we found only 5% of surveyed homes had staffing levels that exceeded all three of the incoming 2023 ratios, and only 3% were above the 2024 thresholds proposed by Labor.

Concerningly, little has changed since our analysis of 2019 staffing levels.

In home care, care staffing time has continued to fall. On average, home care package clients received about 33 minutes of care per day, which is 32% lower than five years ago.

A perfect storm

Staffing shortages have been an issue in aged care for years. Providers have struggled to attract and retain workers, having to compete with other health and disability sectors that offer higher comparative award rates.

Workers are also put off by poor working conditions, limited career pathways and negative perceptions of the industry.

These long-term issues have have been compounded by COVID which severely disrupted the supply of aged care workers. Border lockdowns closed migration pathways, outbreaks forced staff into self-isolation, and health-care workers were diverted towards the pandemic response.

Working during the pandemic also placed substantial pressure on existing staff. A recent survey by the Australian Nursing and Midwifery Federation found 21% of aged care staff reported planning to leave their position within the next 12 months. A further 37% said they planned to quit the sector within the next one to five years.

The final pressure point is the rapid expansion of home care services. Compared to June 2017, there are 126,000 more people receiving support through home care packages.

Increasing the availability of home care is critical to clearing the current waiting list and enabling more senior Australians to receive support in their own homes.

However, the release of more packages has intensified competition for workers, with reports that providers are unable fill shifts to meet demand.

This perfect storm is unlikely to ease soon. In the next year, a further 57,876 new home care packages will be assigned to senior Australians, at the same time as residential care providers try to lift their staffing to meet the minimum requirements.

So what needs to change?

While setting minimum staffing requirements is a crucial first step, it will not improve staffing unless the more fundamental issues in attracting and retaining aged care workers are addressed.

One such issue is workers’ pay. It’s no surprise that on her first day as minister, Wells began work on the government’s submission to the Fair Work Commission in support of workers claim for a 25% increase in the award.

Another issue is the need for more training opportunities for aged care nurses in Australia.

Although border openings may allow for skilled migration to resume, COVID has increased demand for workers in all countries resulting in a global shortage of nurses.

Finally, working conditions need to improve to stop the high levels of staff turnover across the sector. Figures from the 2020 Aged Care Workforce Census reveal an annual attrition rate of 29%, meaning around one in three aged care workers leave their job each year.

Without meaningful improvements to working conditions in rostering, shift lengths and travel times, shortages of these vital workers who deliver care and support to senior Australians will persist.The Conversation

Nicole Sutton, Senior Lecturer in Accounting, University of Technology Sydney and Nelson Ma, Senior Lecturer, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hope for aged care

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It has been a tough few years for aged care but Labor’s election win promises a better future for the troubled sector.

“Together we can fix the crisis in aged care.”

This was one of Anthony Albanese’s key points in his election night speech as Labor swept to victory in the 2022 federal poll.

The new prime minister said his philosophy was “no-one left behind” and “no-one held back”, and that he wanted to see an economy that works for the people of Australia and not the other way around.

Consistent with this commitment was his pledge to support the outcome of the Fair Work Commission for a wage rise for aged care workers.

During the campaign, the ALP made it clear that fixing aged care – and especially staffing – would be a high priority for them in government.

Anthony Albanese said that the Royal Commission recommendation to require a nurse to be on duty 24/7 in residential care was “core to improving clinical care for frail Australians”.

“Nothing will change without reform to the workforce,” he said.

The ALP also promised an additional $2.5 billion for the aged care sector, with strong checks to ensure that the funding was spent on care.

A government with a plan

ANMF Secretary Annie Butler welcomed the election of a new government that was committed to tackling the massive challenges facing the aged care sector and the public health system.

“We are delighted that we finally have a federal government that has a real plan to fix the systemic issues in health and aged care,” she said.

“Mr Albanese and his team, including Mark Butler (Shadow Health and Ageing) and Clare O’Neil (Shadow Senior Australians and Aged Care Services), have listened to the ANMF and have committed to working with us to develop a health workforce that is ready and able to respond to Australia’s health needs.

“In aged care, the ALP has committed to funding mandated staffing ratios in private aged care facilities, improving wages for the depleted workforce and making sure taxpayer-funds for providers are tied to direct care for residents.”

NSWNMA Acting General Secretary Shaye Candish said the election of an Albanese government, with a strong commitment to addressing the crisis in aged care, was a landmark moment for the union.

“It is historic from our perspective because it has been a long fight to bring attention to the calamity that is aged care, let alone to fix it.

“Aged care has been on a long trajectory into crisis since the Howard government’s ill-judged reforms in the 1990s.

“COVID exposed the folly of taking the ‘nursing’ out of nursing homes and the negligence of successive governments that allowed providers to put profit before care.

“Our aged care members have toiled tirelessly for more than a decade to right this wrong and have stood up for the safety and wellbeing of their residents.

“The Association has put a lot of resources – paid advertising, lobbying, and countless grassroots actions – into getting a better deal for Australia’s elderly.

“Finally, we have a government that has listened to us and has a credible plan to rescue the sector.”

Residents are excited too

NSW South Coast aged care AiN Susan Walton says she “can’t describe the feeling of now having hopeful change after all these years. It’s unbelievable that we won’t be forgotten anymore”.

“The road is not finished. We’ll be holding the government to account. We can’t wait three years. We don’t want to be put to the bottom of the pile.”

Susan says she is optimistic about a good outcome from the aged care work review case before the Fair Work Commission.

“The support of the federal government must mean something. It must give it weight.”

Susan says residents are just as excited as staff.

“They know something will happen and their lives will change. They won’t be left alone in their rooms. There will be more staff. They will have more dignity.

“There is more hope in aged care when before we had none.”

What the new federal Labor government has committed to for aged care

  • 24-hour registered nurse care in every nursing home
  • A mandated minimum 215 minutes of care per resident per day
  • Funding real wage increases for aged care workers
  • Mandated standards for nutrition in nursing homes
  • Residential care providers must report – in public and in detail – what they are spending government funding on.

Wages push in aged care

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The NSWNMA and other unions are seeking big minimum wage increases for aged care workers.

The Fair Work Commission (FWC) has received evidence from NSWNMA members in a historic case that aims to lift award wages in aged care by 25 per cent.

Our members joined aged care workers from around Australia in providing written statements and giving evidence to the FWC.

The Royal Commission into Aged Care Quality and Safety found that aged care work was undervalued, and recommended unions apply to the FWC to improve award wages.

As a result, the NSWNMA’s federal body, the Australian Nursing and Midwifery Federation, applied to vary the Aged Care Award and the Nurses Award.

The application seeks a 25 per cent increase in award wages of registered nurses, enrolled nurses, assistants in nursing, and personal care workers employed in aged care.

That would lift award wages by $5.16 per hour for an AIN Certificate 3 and $6.19 per hour for an EN – based on a 38-hour week.

RNs would get hourly award increases of $6.29 or $7.56, depending on classification and based on a 38-hour week.

The unions are seeking to vary the two awards for ‘work value’ reasons.

Unions argue that wages no longer reflect the nature of the work being done, the level of skill and responsibility involved, and the value of that work.

75% of workers considering leaving sector

ANMF Federal Secretary, Annie Butler, said witness statements from aged care workers described their work, the challenges it involves, and the many skills they bring each day to provide safe and quality care to residents and people living at home

“Our evidence also includes statements from union officials and academic experts who explain the historical and gender-based reasons aged care work has not been properly valued,” Annie said.

In the run-up to the federal election, NSW aged care nurses and supporters campaigned in several electorates in order to focus public attention on the aged care crisis.

A group of RNs, ENs and AiNs from nursing homes across the state travelled to Canberra to meet with MPs.

Meanwhile, a survey of more than 2000 NSWNMA aged care members revealed that 75 per cent were considering leaving the sector in the next year, unless urgent aged care reforms occurred.

Unsafe workloads and low wages were the main reasons for people wanting to leave the sector.

In a radio interview, NSWNMA Acting General Secretary, Shaye Candish, said the Royal Commission “pointed out strongly that we don’t pay aged care workers highly enough for the work they do. That is why it’s so difficult to attract people to the sector.

“We are really staring down the barrel of a long-term workforce crisis if we don’t do something to improve the pay for these workers,” she said.

“We need to see the government do so much better. They need to invest in aged care, they need to pay workers appropriately, they need to invest in nurses in aged care facilities.

“The government needs to ensure that appropriate people are there to staff facilities, look after these residents and give them the life that they deserve.”

*Note: The Fair Work Commission has now completed its hearings and finished accepting submissions. A decision in the case is expected later in the year. 

‘Our work is undervalued’

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Aged care staff tell the FWC their wage rates do not match the range, quality and importance of their work.

A registered nurse who gives in-home care to elderly patients in northern NSW told the Fair Work Commission (FWC) her work is valued by her patients and their families, “but not by my employer”.

In a written statement to the FWC, RN Pauline Breen, who has worked in aged care for the past 15 years, said she drives her car to the homes of between eight to 11 patients per day. Most have dementia.

“I enjoy working with my patients and speaking with them when I visit,” she said.

“I also enjoy working with my colleagues, even though we do not see each other very often. I like seeing my patients achieve better health outcomes and find that a very satisfying part of my job.”

She said, however, that her workload had increased due to clients’ growing care needs and COVID-19.

She is sometimes allocated only 15 minutes per client and 15 minutes’ travelling time between each client, and only 30 minutes per week for administration.

“This often does not reflect the actual work I need to perform. It is very difficult to fit in our meal breaks and contend with traffic conditions.

“We are all so busy, which makes it very difficult to properly manage the clinical care needs of patients, particularly when we are required to travel such long distances in a rural area.”

As a result, it was getting harder to visit patients during their preferred times.

“Also, relatives of some patients do not understand my workload and the number of patients I need to see in a shift, and express disappointment about the limited time I am able to spend with their loved one,” she added.

“Dealing with suspected cases of elder abuse is a particularly challenging part of my role.

“Caring for palliative patients and going through the end-of-life process with them and their families can also be quite stressful and upsetting.”

Training offered by her employer has become increasingly computer-based and not always in paid time, with only one computer terminal available for nurses to use in an office that is soon to close.

“I do not know what we will do for training when the office is closed,” she said.

She said COVID-19 has made work more hazardous and she now needs to don PPE, for example, to provide wound care and attend to suprapubic catheters.

Another health and safety concern is the failure to properly assess a client’s environment before the nurse’s initial visit.

“There are many issues that need to be assessed, such as access to dangerous driveways, vicious dogs, domestic violence, guns in the house etc.

“In many cases the client will have relatives living with them. Sometimes those relatives have drug or alcohol problems. This can be dangerous and unsafe for our staff.”

Pauline uses her own car, “and when the price of petrol goes up, this is an additional cost that I have to pay for”.

“Many of these additional issues are not factored into our wages or the time that is allocated for us to do our work.”

‘We are all so busy, which makes it very difficult to properly manage the clinical care needs of patients.’  —  Pauline Breen

Working weekends to get by

An assistant in nursing (AiN) with 20 years’ experience told the FWC she believes aged care work is undervalued partly because the workforce is mostly female.

Linda Hardman, who is employed permanent part time for 75 hours per fortnight at a South Coast nursing home, said she worked weekends in order to get loadings.

“If I did not, I would not have enough money to get by,” said Linda, who gave written and verbal evidence to the FWC.

“I do not think that the pay is adequate for the work that is done.

“The sense I get is that people who are not actually on the floor, working in aged care, do not know or care how difficult the work actually is.

“I do not do it because it pays well. I do it because I feel like an AiN in my heart. I enjoy caring for people.”

Linda said she does feel valued by residents.

“They know what I do. They are encouraging and I have relationships with them.

“That is another difficult part of working in aged care. I do not think it is well understood that aged care workers have relationships with the residents, sometimes over many years.

“When someone passes away, you do not even have time to grieve. If you are lucky, your RN will tell you to go and have a cup of coffee because they know it has affected you.

“These are people that I look after and care for. That’s the heart of it. It is not just a job.

“I also feel valued by other aged care workers for the same reasons. They know what it is like. There is camaraderie and we uplift each other.”

Linda said COVID-19 had made it harder and sometimes impossible for families to visit aged care facilities.

“For me to provide proper care means that I spend an extra five or ten minutes with residents. Sometimes they cry and need a bit of TLC. That has to be done, but then it is harder to fit in all the other work.”

ANMF congratulates Anthony Albanese on election win

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The country’s largest union, the Australian Nursing and Midwifery Federation (ANMF), congratulates Anthony Albanese and the Australian Labor Party (ALP) on last night’s federal election victory.

The ANMF and its membership of over 310,000 nurses, midwives, care workers and students are confident the new Albanese Government will deliver much-needed reforms for health, aged care, better wages for low-paid workers, gender equality and action on climate change.

“We are delighted that we finally have a Federal Government that has a real plan to fix the systemic issues in health and aged care,” ANMF Federal Secretary, Annie Butler, said today.

“Mr Albanese and his team, including Mark Butler and Clare O’Neil, have already listened to the ANMF and have committed to working with us to develop a health workforce which is ready and able to respond to Australia’s health needs.

“In aged care, the ALP has committed to funding legislating mandated staffing ratios in private aged care facilities, improving wages for the depleted workforce and making sure taxpayer-funds for providers are tied to direct care for residents.

“On behalf of our members across the country, the ANMF congratulates Mr Albanese and his team on winning government and we look forward to working with them in developing and delivering real solutions which can ensure fair and equitable outcomes in health and aged care for all Australians.”

Three Months On, Aged Care Workers Still Waiting for COVID Payments

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More than 70% of aged care workers still haven’t received their $400 bonus, as promised by Prime Minister Scott Morrison back in February, the Australian Nursing and Midwifery Federation (ANMF) revealed today.

Results of a national poll of nurses and aged care workers conducted by the ANMF has found:

  • 71% have not received any of the two promised bonuses;
  • 26% have received one bonus;
  • Only 2.7% have received both.

Federal Secretary Annie Butler said the ANMF and its members were ‘angry and disappointed, but unfortunately, not surprised’.

“When the Morrison Government first announced this bonus payment, meant to recognise the extraordinary efforts of aged care nurses and workers throughout the COVID-19 pandemic, our members were not impressed. Aged care unions and providers called for much more for overwhelmed aged care workers – genuine measures to fix the crisis in aged care,” Ms Butler said.

“But the Government failed to take action – it did not address the staffing crisis and it refused to participate in the Fair Work Commission’s process to increases wages for aged care workers, opting instead for two pro-rata payments of up to $400 aimed at preventing an exodus of staff from the frontline. While acknowledging this small offering, unions warned that the payments remained grossly inadequate. Now we discover that not only has the Morrison Government failed to take real action to fix the crisis in aged care, it hasn’t even delivered on its promised bonus payment for workers.

“Our members have had enough of this complete lack of regard from the Government. It’s simply disgraceful that during these toughest of times, some of our lowest-paid workers have been abandoned. They are sick of being undervalued and ignored by Government, and they’ll be looking for real solutions this election,” Ms Butler said.