July 3, 2022

royal commission into aged care

A road map forward 

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The Royal Commission into Aged Care final report is not perfect but there are strong recommendations in key areas such as workforce and governance that can drive the sector to a much better place.

There is much to digest in the commission’s final report which runs to eight hard-copy volumes and has an executive summary of over 120 pages.

There are some in the sector who are disappointed by the report but a close analysis reveals a vision for the aged care workforce that is underpinned by values and policy recommendations that the ANMF and the NSWNMA have been advocating for more than a decade.

The commissioners, Tony Pagone and Lynelle Briggs, recognise that the 1997 Aged Care Act introduced by the Howard government, which is the foundation stone that has shaped the profit-driven sector we now have, has failed.

That legislation allowed providers to decide for themselves what staffing numbers were adequate and how taxpayers’ funding was used. It was from this moment that the replacement of nursing staff with unregulated care workers began.

The consequences of this have been dire and the commissioners have identified key issues that need to be addressed if the sector is to be salvaged.

They point out that there are not enough workers to provide high quality and safe, person-centred care and that the proportion of qualified staff, such as registered nurses and allied health workers is too low.

This is in circumstances where the acuity of people receiving care has increased.

The commissioners agree that the aged care workforce is poorly paid for difficult and important work. They also observe that some staff are untrained or insufficiently trained for the work they do.

Current staffing levels are unacceptable

They accept the evidence that there is a link between staffing levels and care outcomes and observe that currently, staffing levels within large parts of residential aged care, fall well short of acceptable practice standards.

To remedy these deficiencies in the workforce the report recommends that the sector needs:

  • the right number of staff with the right mix of staff and skills
  • a greater proportion of registered nurses, nurse practitioners, and allied health professionals
  • better education and training to achieve a more highly professional workforce
  • registered personal care workers/AiNs
  • minimum qualifications for personal care workers/AiNs
  • improved pay and conditions.

These recommendations match the key objectives of our long, hard-fought campaign for a better and viable aged care sector.

The commissioners recognise that the aged care workforce needs to be professionalised which will require improvements to education, wages and conditions.

They agree that there is a wages gap between aged care workers and workers performing equivalent functions in the public health sector. They are in no doubt that a registration scheme is needed for personal care workers/AiNs.

The commissioners see a clear link between more staff, safety of care, a safe work environment and attraction and retention of staff.

The federal government’s integrity is on the line

The responsibility for implementing the commission’s recommendations now falls to the federal government.

The ball is now in Scott Morrison’s court and it is not an understatement to say the integrity of his government is on the line.

The testimonies and revelations in the lead up and during the course of the commission’s inquiry about the way many aged care residents have been neglected in a sector whose reason-for-being is care of our elders have been heart-rending.

The commission’s report clearly shows that the problems of the sector are deeply structural. The commissioners leave no space for excuses by the federal government to abdicate its responsibility for the governance of the system.

There have been many commissions, inquiries, analyses and reports about aged care in the past that have resulted in absolutely zero change.

We cannot allow that to happen with this pivotal report. Despite its flaws it is a significant step in the right direction.

The NSWNMA and the ANMF will campaign hard to have the commission’s recommendations implemented including through a paid advertising campaign.

New modelling finds investing in childcare and aged care almost pays for itself

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In the absence of an official analysis of the impact of the budget by gender the National Foundation for Australian Women has this morning published its own gender analysis of the budget, across multiple dimensions.

It finds the government has invested heavily in things that will mainly benefit men, including apprenticeships and traineeships (two-thirds of which are taken by males), the construction of physical infrastructure, and tax breaks for the purchase of assets that will primarily assist the male-dominated industries of mining and manufacturing.

The female-dominated care sector was largely overlooked, despite the Royal Commission into Aged Care and the Disability Royal Commission highlighting shortcomings in the current system.

Childcare workers were among the first to lose JobKeeper.

The extra funding injected into the aged care following tragic impacts of COVID was insufficient to bring the sector to a four star quality rating.

The experts believe the budget is a lost opportunity to maximise employment growth, to invest in the (social) infrastructure that will most boost the economy and to address the problems with female-dominated paid and unpaid work exposed by COVID-19.

Care boosts employment

Published with the National Foundation for Australian Women’s analysis is new modelling by the Victoria University Centre of Policy Studies on government investment in the care sector.

It examines what would happen if the government increased funding enough to boost the wages of personal and child care workers and to lift capacity to the point where it met unmet demand.

More than 900,000 Australians who provide unpaid care to the elderly, disabled, and children aged under five say they would like more hours in paid employment.

The modelling finds that the investment in the care economy needed to enable each of these unpaid carers to work an extra 10 hours a week in paid employment has a significant economic payoff, increasing labour supply by 2%.

By 2030 the extra labour supply would be fully absorbed into employment. Annual GDP per person would be $1,270 higher, or more than $30 billion in aggregate.

Women’s paid employment would be 3.75% greater than it would have been if no action had been taken. Men’s employment would be more than 0.75% above the no-action base case.

Employment and labour supply impacts of modelled extra spending on care

Percentage deviation from base.
Centre of Policy Studies, Victoria University

The average incomes of both women and men would be higher, although women’s incomes would be higher by a greater margin.

A boost would almost pay for itself

The budgetary cost of the policy would be largely offset by increased economic growth which would underpin greater revenue collection from income taxes and the goods and services tax.

When fully running, the net cost to the budget would be less than one fifth of the direct cost.

Government investment in physical infrastructure helps in two ways – it provides construction jobs and a useful piece of infrastructure to support future economic activity.

Investment in care helps in three ways:

It stimulates jobs and better conditions in the care sector, a worthy outcome in itself.

It provides economic stimulus to all sectors by freeing people up to participate in the labour market, an impact that cannot be achieved by providing stimulus to other sectors, such as manufacturing, for example.

And it addresses female economic disadvantage by reducing the wage gap and changing the circumstances that often set limits on what women can achieve in their careers.

There’s a new budget around the corner

While the analysis shows the population on average would be better off with an expanded care sector, it says nothing about how to reform access to subsidised or government-funded care.

The system is complicated, as are the (dis)incentives to work resulting from the present tax and charging arrangements.

However charged for, extra spending on childcare, aged care and disability care would produce an bigger bang for the buck than most of the extra spending announced in the budget, as well as producing better outcomes for women.

There’s a budget update around the corner, in December, and a new budget due in May. If extra spending is needed, there’s an opportunity to do it in a way that would really help and almost pay for itself.The Conversation

Janine Dixon, Economist at Centre of Policy Studies, Victoria University and Helen Hodgson, Professor, Curtin Law School and Curtin Business School, Curtin University

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