Yahoo Finance Relying on casuals in aged care will weaken royal commission's reforms, experts warn
Unions and aged care experts are outraged that the royal commission into the sector has not recommended a clear path away from the “overcasualisation” of the system’s workforce, warning the extra time residents are set to receive with carers will ultimately feel “transactional” and detrimental to dementia sufferers if providers can still rely on labour hire agencies.
The Australian Council of Trade Unions is mostly optimistic that key recommendations on training, skills and daily minutes of care per resident made on Monday would, if adopted by the Morrison government, boost the number of carers at residential facilities and lift wages across the traditionally underskilled, underpaid and exhausted workforce.
Aged care experts who advised the royal commission believe the requirement for 200 minutes of care per resident a day would mean care staff would have time to talk to and understand often lonely residents, but they share the ACTU’s pessimism about the continued reliance on casual staff, which makes it difficult for residents and carers to develop relationships that in turn deliver the best outcomes.
In the aged care royal commission’s final report, released this week, commissioner Lynelle Briggs noted that “older people get the best care from regular workers they know, who respect them and offer continuity of care as well as insights into their changing care needs and health requirements”, and that casually employed carers can struggle “to provide continuity of care and form ongoing relationships with older people”.
However, Briggs and fellow commissioner Tony Pagone were not unanimous in their 148 recommendations. In recommendation 87, only endorsed by Briggs, the government is urged to require aged care providers to have policies “that preference the direct employment of workers” and “where personal care or nursing work is contracted to another entity, that entity has policies and procedures that preference direct employment”.
The president of the ACTU, Michele O’Neil, does not believe the recommendation provides a mechanism that, if adopted, would address the “insecure work and staff working across multiple employers in order to pay the bills” that has been “at the heart of the crisis in aged care”.
“We are disappointed that the royal commission did not directly address the problem of overcasualisation,” O’Neil told the Guardian.
“We welcome report recommendations for increased training, professional development opportunities and higher wages – however this is not enough. One of the most pressing issues in the sector is overcasualisation, and they have not addressed it at all. No aged care worker should be forced to do multiple jobs just to survive.”
Prof Kathy Eagar, director of the Australian Health Services Research Institute at the University of Wollongong, is keen to see the government adopt the royal commission recommendation that from 1 July 2022, residential aged care recipients should require at least 200 minutes per resident a day of care time for the average resident, 40 minutes of which should be provided by a registered nurse.
Research provided to the royal commission by the institute found the current average of care time older Australians each received in residential facilities was 180 minutes, with about 36 minutes of that provided by a registered nurse.
The recommendation on minutes of care per resident – which increases in July 2024 to 215 minutes’ care, with 44 minutes from a registered nurse – is in lieu of a set staff-to-resident ratio, as the minutes per resident requirement effectively dictates how many staff a facility must employ to meet the new standards.
Eager told the Guardian that if the staffing recommendations were adopted by the government, the sector’s workforce would need to grow by about 20%.
Related: From funding to a right to care: the aged care royal commission's key recommendations
“One of the criticisms of the system is that the staff are so busy that all they get time to do is tasks, like helping with toileting, showering, dressing and feeding residents,” she said, noting that 35% of older Australians in residential aged care could not get out of bed themselves, and that this task alone required a large chunk of carers’ time.
“A lot of residents report they’re relatively lonely, because even if there are staff, they don’t have the time to talk to them.”
Eagar echoes the ACTU’s concern and believes the recommendations don’t adequately address the reliance on casual workers.
“There is significant evidence all over the world that one of the predictors of safe care is staff continuity,” she said. “The staff come in and they know the residents, and the residents know the staff. You also find you have less medication errors.
“For people with dementia it helps to have the same people every day. If I don’t know my name because I’ve forgotten it, but the care worker does know my name, that’s a whole different proposition to if I don’t know and my carer doesn’t know either.
“People in aged care want relationship-based care, not transactional-based care.”
Eagar also noted the importance of staff continuity during Victoria’s second wave of coronavirus, “when they had a lot of agency staff working between facilities”.
Prof Joseph Ibrahim, head of the health law and ageing research unit at Monash University’s forensic medicine department, said he was disappointed the only recommendation to reduce the reliance on casual workers “lacked a specific mechanism or measure to make sure that occurs”.
“What does it mean by ‘preference’ direct employment? Should it be so 75% of workers are permanent? Providers aren’t being told how to do it,” Ibrahim said. He noted that other recommendations, including the minutes of care per resident, had specific measures.
The government has indicated it will respond fully to the recommendations, and outline its plan for the sector, in the 11 May federal budget.
