At this Hearing, the Commissioners:
Counsel noted that the home care workforce raises a number of unique challenges that will be addressed separately at a later stage.
Counsel believed that the evidence gathered over the workforce hearings highlighted that the aged care workforce is at risk of collapse. It was noted that these problems have been identified before and have only become further embedded as a consequence of inaction and growing care needs.
By way of context, Counsel also noted that the overwhelming weight of evidence received by the Royal Commission suggests that the care needs of people in residential aged care have increased significantly in recent years.
Counsel outlined that the workforce recommendations are based on the following principles:
Counsel acknowledged that the recommendations will require significant reform of the aged care sector, including in relation to regulation, governance and funding.
In particular, Counsel noted that, in conjunction with recommendations about system design, funding and financing, regulation, provider governance, the role of the Australian Government and other areas which Counsel will be proposing in the coming months, the implementation of the recommendations proposed at the workforce Hearing should result in improved quality and safety of aged care.
Counsel acknowledged the staffing challenges this would pose in rural and remote region and advised that these would be addressed at a later date.
Medical Deans of Australia, in conjunction with the Australian Medical Association, Australian Medical Council and the RACGP, should collaborate to:
Each Medical School to review its undergraduate medical curriculum with a view to making:
Professor Charlene Harrington (US) – Professor Emeritus of Sociology and Nursing, University of California, San Francisco
Prof Harrington provided an overview of aged care in the United States and explained that the US Centres for Medicare and Medicaid Service (CMS) website (Nursing Home Compare) is the ‘gold standard‘ for aged care information and rating nursing homes. She outlined a study that demonstrated that inadequate staffing levels, particularly of registered nurses, was directly connected to harm suffered by residents. The study demonstrated an individual resident required 4.1 hours contact with staff per day, including 45 minutes with a registered nurse.
Prof Harrington noted numerous challenges in monitoring and ensuring the provision of adequate staffing standards.
Dr Ravenswood gave evidence regarding employment and workplace conditions in New Zealand, and outlined that the standard of aged care relates to the level of government funding provided. She outlined that standards of care are negatively impacted by low wages and gender-related discrimination in the workforce.
She also highlighted the 2017 Kristine Bartlett equal pay case in NZ that involved a claim that was settled out of court as a consequence of government intervention. Settlement prescribed four mandatory categories of wages for carers based upon the level of individual qualification, which was subsequently legislated.
Dr Ravenswood noted that while the settlement successfully implemented mandatory minimum standards, delivery of the scheme has seen providers employ staff with lower categories of qualification and shorter shift lengths to reduce costs. She explained the scheme has created a perception that workers are now paid more and therefore should take on a higher workload.
Dr Ravenswood advocated for attaching labour standards to the minimum criteria for accreditation for providers with a view towards providing adequate staff numbers and fair remuneration. Additionally, she advocated for changing social values through social campaigns to improve the public perception of aged care workers.
A Selection of Quotable Quotes by Counsel
Catholic Health Australia