The initial report for the Royal Commission into Aged Care Quality Safety was published last week. It confirms what many of us have been dreading, that Aged Care facilities and services are just not meeting the needs of their consumers. The report outlined the extent of the substandard care and the workforce that is responsible for delivering this care. There were many issues identified, and reading the report, it was reiterating what most Aged Care providers already knew - but now have to act upon.
A recent study concluded that Aged Care employees reported high levels of job satisfaction but low satisfaction with the rate of pay. The job satisfaction rate was attributed to employees feeling that they had a significant impact on consumers' they care for and a real sense of team with their coworkers. Whilst this is good news for providers as it demonstrates that the majority of employees are devoted to their work, it puts pressure on the industry which is already reporting underfunding.
Aged Care providers are either covered under the Aged Care Award or an organisational Enterprise Agreement. A Personal Care Assistant employed as permanent employee under the Award is currently entitled to be paid $21.96 an hour, whilst their Enterprise Agreement covered employee counterparts make roughly around $0.20 more an hour. Not-for-profit provider employees have the option to Salary Package their wages, which decreases their taxable income and increases their take home pay each pay cycle. This means that Enterprise Agreement covered employees are paid slightly higher than their Award equivalent, however to put that wage into perspective, a Wardsperson (after 1 year of service) employed under the Health Employees (State) Award, makes $997.72 a week or $26.25 an hour. You can see how this is an issue for the sector and for the employees that occupy these roles.
A wages gap exists between Aged Care workers and workers performing equivalent functions in the acute health sector. Successive governments have made several failed attempts to address that gap by providing additional funds to providers in the hope that they would be passed on to Aged Care workers by way of increased wages. They were not.
The Report highlights as a key strategy, that the Aged Care sector and Unions must work together to professionalise the Personal Care workforce. This will require cultural change and improvements to education and training, wages and labour conditions for these roles.
2. Staffing Levels
The Report outlined that staffing levels of Registered Nurses and Personal Care Assistants were not adequate for the needs of their consumers, stating that according to the University of Wollongong “58% of Aged Care facilities had unacceptable staffing levels”. The report is backed by a recent study of Aged Care employees that flagged understaffing as a significant issue.
The report outlined that the workforce is a provider's highest spend. In a bid to reduce costs, providers have changed staffing ratios. This change has meant there is a reduction in Registered Nurses on duty each shift and an increase in Personal Care Assistants. This funding pressure has meant that care is compromised, with consumers being limited in accessing care from Registered Nurses or similar health professionals.
The understaffing of providers has meant that employees are often overworked and highly stressed. In the study, participants noted that they had to sacrifice quality, as the time stress meant they needed to juggle multiple tasks, meaning that one-on-one time with consumers was often compromised.
The Commission report recommended that Aged Care providers needed to “rethink and consider restructuring” and that staff ratios should be introduced to ensure there are enough staff to meet the demands of consumer care. It also noted that the skills mix of staff needed to be considered, with a focus on education and upskilling. The skills mix is already contained within the new accreditation standards, and providers are actively working on meeting this standard.
Outlined in the Royal Commission report were the shortage of skills, education and training of employees in the sector. This means that providers are failing to cater for the differences in care and personal needs of consumers. A recent study outlined a similar issue, with mandatory training being carried out, but not placing value on extra training on topics such dementia and palliative care; wound management, mental health and first aid. This feedback mirrors the recommendation from the Royal Commission which includes providing and improving education courses and training arrangements on areas such as dementia and palliative care. It also notes that this needs to be changed to meet the needs of consumers, so it is not going to be a one-size fits all educational need.
The report also outlined that Personal Care Assistants should be registered under AHPRA, like other health professionals. This would mean that there is a national standard and that employees would need to undertake ongoing training and qualifications to keep their registration. This recommendation may increase the level of qualified staff, as currently the sector is an easy one to obtain work in.
4. Career Development
Attracting employees, high turnover and retention was a large issue uncovered by the Royal Commission. One of the reasons for this was due to a lack of career progression. The recommendation concluded that the “aged care workforce should develop as a profession, with properly structured career paths and consistent occupational groups, job design, job pathways, training and development programs, and leadership training which support the various occupational groupings”. This statement feeds back into the wage and education issues, where pay would be linked to classes, and training, placements and other needs could be met through an external provider.
In a recent study, 90% of employees currently in Aged Care noted that they did not begin their career in the sector, which means that there is a lack of young people attracted to working in the industry. Through implementing these strategies, Aged Care work will likely become a more favourable profession with those that are career driven, therefore reducing turnover and increasing retention.
As someone who has worked in this Industry for almost a decade, I know and understand that my clients are overwhelmed and are in need of strategies to meet their obligations. Whilst we wait for the Government to outline to the Industry the response to this report, we can begin to address some of the issues in our workplaces by implementing strategies as set out in the Aged Care Quality Standards. We have been working with clients to improve their workforce strategies through:
Supporting Workforce Planning. This can be done through auditing and reviewing the skills and attributes of the current workforce and developing training and recruitment strategies to improve retention and engagement.
Implementing and improving employee feedback channels Improving employee feedback through collaboration to understand the importance of person-centred care over task-focused care, resulting in consumer-focused programs and a more personal approach to care.
Improving communication loops. Improving communication so that the documents underpinning the workforce are meaningful. This is done through collaborating with staff to set up real career goals through upskilling and training.
Culture audits. Conducting impartial staff surveys and reporting on turnover, performance and training to outline strategies for improvement. These results are communicated to the workforce and boards (if applicable) to demonstrate continuous improvement for good governance.
Conducting Independent investigations and performance management processes. For constant and fair treatment of all disciplinary actions. Mitigating potential risk and cost.
Karen Ansen Consulting are Aged Care industry specialists and experts in Standard 7 under the Aged Care Quality Standards. We develop, design and implement HR frameworks for organisation’s who need guidance and support around their obligations. We also provide legal advice regarding workforce and other employment related issues. Please do not hesitate to give us a call on 0407 863 017 or send us an email at firstname.lastname@example.org.