Diversity in aged care
The Australian population is becoming more diverse and this is reflected
in the increasing proportion of aged care service users with special needs and
preferences. The Aged Care Act 1997 defines 10 groups of people as
'people with special needs' for whom there is additional consideration in the
planning and delivery of appropriate aged care services.
'People with special needs' include people from Aboriginal and Torres
Strait Islander communities, people from culturally and linguistically diverse
(CALD) backgrounds, people who live in rural or remote areas, and lesbian, gay,
bisexual, transgender and intersex (LGBTI) people.
Chapter 1 outlined the diversity of the population accessing aged care
services and listed some of the challenges facing the mainstream aged care
sector. This chapter will highlight the particular challenges in relation to creating
a culturally competent and inclusive aged care workforce to cater for the
different care needs of Aboriginal and Torres Strait Islander peoples,
culturally and linguistically diverse groups, people living in rural or remote
areas, and lesbian, gay, bisexual, transgender and intersex people.
Aboriginal and Torres Strait Islander aged care
We need to investigate how we provide appropriate aged care
for Indigenous older people and in doing so we need to be encouraging
Indigenous people to be participating in the aged care workforce. There must be
provision for the education, support and a career structure so Indigenous aged
care workers can guide and teach non-Indigenous peoples how to be culturally
competent in working with Indigenous older people.
The government funds a number of programs which assist in providing aged
care services to Aboriginal and Torres Strait Islander peoples. These programs
include the National Aboriginal and Torres Strait Islander Flexible Aged Care
Program, which funds organisations to provide flexible, culturally appropriate
aged care to older Aboriginal and Torres Strait Islander peoples close to their
home and/or community, primarily in rural and remote areas.
The National Aboriginal and Torres Strait Islander Flexible Aged Care
Program includes a quality framework, which is based on two principles:
cultural safety and continuous quality improvement. The quality framework sets
out the requirements to achieve effective staff recruitment and retention to
ensure that service user needs are met, including ensuring that services are
provided by appropriately skilled staff who have an understanding of the
cultural needs of the key stakeholders, including service users.
Changing service delivery
It has been very difficult for us, in a sense, and I
understand why the government has done what they have done and removed it as bucket
funding and now it is individual. But for us as a family unit, as a community,
if one is sick at the minute then we all chip in to raise them up to get them
better, whereas now we are having to say, 'I am sorry, Auntie, but your budget
does not allow it.'
Submitters and witnesses to this inquiry have expressed concern that the
national move to consumer directed care (CDC), and the introduction of a
centralised access point to aged care services, will adversely impact on the
delivery of services to regional and remote predominantly Aboriginal and Torres
Strait Islander communities.
In Townsville, the Northern Regional Aboriginal and Torres Strait
Islander Corporation, which delivers aged care and disability services to
Aboriginal and Torres Strait Islander peoples in the area, indicated that the
move to a centralised portal and phone line for individuals to be assessed for
access to aged care services had created a barrier for the service and for
their clients. Prior to the introduction of My Aged Care, the Corporation, and
clients, could access the one Townsville-based Aboriginal and Torres Strait
Islander Aged Care Assessment Team (ACAT) member directly to address issues; now,
however, all transactions with the department must go through the centralised
Now, again, everything has to go through My Aged Care. We
have lost that connection between the multidisciplinary team and the consumer.
This is all consumer directed, but for us it is actually not working. It is
removing that connection that we have all had, and we have built that over a
number of years. So it is quite difficult.
This view has been echoed by service providers in their input to the
2017 performance audit of the Department of Health (department) and the
Australian Aged Care Quality Agency by the Australian National Audit Office
(ANAO), which found that the centralised My Aged Care web portal and call
centre can be a barrier to accessing aged care services for Aboriginal and
Torres Strait Islander peoples, both in terms of cultural appropriateness and, for
those living in remote and very remote locations, where access to communication
technologies and the internet is limited or unavailable.
Similarly, a Northern Territory service provider stated that the
introduction of My Aged Care and CDC had led to a decline in service levels to
aged care clients, as the administrative burden created diverted resources away
from direct care:
To give you an example, previously our programs had one
person in Alice Springs overseeing them. We now have four people, which is
because of the complexities of budgeting, costings, interacting with My Aged
Care—all those sorts of things. That is all money that does not go towards
The Chief Executive Officer of the Western Desert Nganampa Walytja
Palyantjaku Tjutaku Aboriginal Corporation raised concerns that the CDC model
is not compatible with providing services to a small number of people, and
particularly when that small group may, for example, need to relocate
temporarily to another community, taking the funding with them:
For example, in Mount Liebig, where there are currently about
10 old people, the staffing for that service is a full-time coordinator who is
responsible for everything about that service and a few part-time community
employees working a few hours a day...If a few of those old people decide that
they need to go to Kintore for sorry business for a month, they take their
packages with them. We are concerned that there may be a position where you
actually have not got the money to pay the staff on the ground.
The Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal
Corporation and the MacDonnell and Central Desert regional councils all indicated
that block funding, such as that available, for example, under the Aboriginal
and Torres Strait Islander Flexible Aged Care Program, is a more appropriate
funding model for remote and geographically-dispersed service delivery, where
the costs of service provision, and attracting and providing professional
development for staff, are higher than in less remote locations.
The MacDonnell Regional Council, which has attempted to apply for
funding under the National Aboriginal and Torres Strait Islander Flexible Aged
Care Program, recommended that
the funding model for remote Indigenous services needs to
reflect the operating environment. Allocations to the NATSI Flexi program need
to be sufficient to allow many providers that are currently operating within
this context, and under CDC, to transition over to the NATSI Flexi program, to
ensure these providers do not exit the sector, which is a real risk at the
The ANAO performance audit of Indigenous aged care examined the National
Aboriginal and Torres Strait Islander Flexible Aged Care Program in the broader
context of aged care service delivery to Aboriginal and Torres Strait Islander
peoples, finding that the program is a more cost effective and viable model for
residential aged care service delivery in remote and very remote locations,
however, 'the majority of Flexible Program recurrent funding for residential
aged care is allocated to services in major cities and inner regional areas'.
The ANAO recommended that the Department of Health:
- provide an opportunity for eligible existing
Indigenous-focused aged care service providers, which are not currently funded
under the National Aboriginal and Torres Strait Islander Flexible Aged Care
Program, to access the available funding under this scheme; and
- apply a consistent assessment process to ensure that
places allocated through the National Aboriginal and Torres Strait Islander
Flexible Aged Care Program align with service provider capacity and are
targeted to those service providers who will generate the greatest community
The National Foundation for Australian Women (NFAW) and Catholic
Healthcare Wollongong also expressed concern that additional costs associated
with service provision in a regional or remote area, for example, the cost of
transport and travel, are not accounted for in the CDC model.
The department indicated that some remote and/or Aboriginal and Torres
Strait Islander service providers have successfully implemented CDC. The
department stated that it has established the Service Development Assistance
Panel (SDAP) to assist service providers who may be experiencing difficulties,
in relation to:
governance models; and
business systems or business planning.
The ANAO performance audit found that aged care service providers were
not necessarily aware of the SDAP service and further commented that:
there would be benefit in Health better ensuring funding was
targeted towards building financial management and governance capacity within
organisations, rather than supplementing financial losses that are likely to
persist unless changes in organisational culture and skills are made. Raising
awareness of the availability of SDAP funding, and ensuring that funding was
conditional on entities building financial management and governance capacity,
could result in a more equitable and targeted allocation of SDAP funding.
The committee considers that the Government should review the
implementation of CDC and consider alternative models where it is clear that
CDC is not working, particularly in remote and very remote locations. The
committee further notes the challenges to access presented by the
implementation of a centralised access point to aged care services, which
equally need to be addressed. Alternative models of funding and other support
to services operating in remote and very remote locations also need to
encompass attracting, maintaining and supporting aged care workers.
The committee notes the ANAO performance audit findings that the
Aboriginal and Torres Strait Islander Flexible Aged Care Program has been
effective in delivering culturally appropriate access to aged care services for
Aboriginal and Torres Strait Islander peoples. The committee considers that
this program should be expanded, and greater opportunities made available for
eligible Indigenous-focused services to access the program.
The committee considers it essential to ensure that services delivered
to Aboriginal and Torres Strait Islander peoples are accessible, do not present
barriers to access, and are culturally appropriate and appropriately resourced,
and take into account the specific challenges for service providers and aged
care workers operating in remote and very remote locations.
Aboriginal and Torres Strait
The 2016 Aged Care Workforce Survey found that about one per cent of
workers in residential direct care are Aboriginal and Torres Strait Islander
people, a proportion which has not changed since the previous survey in 2012.
The survey found that of these, 81 per cent were personal care
attendants (PCAs), about 10 per cent were registered nurses, 7 per cent were
enrolled nurses and 2 per cent were allied health workers. The survey noted
that Aboriginal and Torres Strait Islander workers are more likely than the
overall residential direct care workforce to be PCAs, rather than enrolled or
registered nurses, or allied health professionals.
The survey did not cover the reasons for this difference; however, it
did note that the proportion of Aboriginal and Torres Strait Islander nurses
had increased from 12 per cent in 2012 to 17 per cent in 2016, and the
proportion of Aboriginal and Torres Strait Islander PCAs had fallen from 85 per
cent to 81 per cent.
There are challenges in finding and retaining Aboriginal and Torres
Strait Islander workers in the aged care industry. The 2015 Stocktake and
Analysis of Commonwealth-funded Aged Care Workforce Activities report
indicated that consultations undertaken as part of the stocktake revealed that
a lack of culturally appropriate training specifically targeted to Aboriginal
and Torres Strait Islander peoples wishing to enter or remain in the aged care
sector was reported to be a 'significant impediment to the attraction,
recruitment and retention of this workforce group'.
Some issues relate to circumstances which disproportionately affect
Aboriginal and Torres Strait Islander peoples' capacity to engage in the
workforce. For example, a representative of the aged care service provider,
Australian Unity, stated that many aged care workers are required to have a
driving licence, as a car and licence are requirements of the roles.
Leading Age Services Australia stated that key challenges for engaging Aboriginal
and Torres Strait Islander workers are at the commencement of employment in the
It is at the entry point, supporting the completion of
initial training and shifts that presents a barrier. The age services industry
are looking to other industries to learn from their successes.
One aged care facility in a remote location initially had an Aboriginal
workforce who were replaced by a non-Aboriginal and non-English speaking
background workforce upon a change of ownership, which presented significant
difficulties for the residents:
Using this kind of workforce has really skewed being able to
care adequately for the clients. The Indigenous workers who were there did not
feel safe working there any longer—but now you have the residents, who cannot
leave. We need to be asking those workers why they left and what it would take
for them to come back. What does this organisation need to have to be safe?
Situations like these suggest that a cornerstone to ensure continuity in
culturally appropriate care for Aboriginal and Torres Strait Islander peoples
accessing aged care as users, is to better source, train and support Aboriginal
and Torres Strait Islander peoples to enter the aged care workforce:
If we look at the patterns of ageing and the demographics of
our Aboriginal and Torres Strait Islander populations, our workforce needs into
the future, to 2030, are really critical now around planning and how we
support, resource and invest in models that work for Aboriginal and Torres
Strait Islander people as we live longer.
Australian Unity's Aboriginal Home Care service has developed an
Aboriginal workforce strategy. The key objectives of this strategy include:
...attracting and retaining our Aboriginal workforce, building
capabilities and career pathways for our Aboriginal workforce and improving
Aboriginal cultural competency across the company. The themes include: working
collaboratively with internal and external business partners to create a
supportive cultural environment and promoting staff engagement.
CRANAplus, a peak organisation for professional remote health workers
that provides education, support and professional services to workers in health
and related sectors, discussed how it addresses the education needs of remote
health care workers, particularly those working in Aboriginal and Torres Strait
One of our things is that we take education out to the remote
area workforce. That has been one of our greatest successes—that we acknowledge
the context of your practice is different. You cannot try and make a
metropolitan model fit out there, so you have to be adaptable and take the
education out to the workforce out there. That has been very successful from
our organisation's perspective.
Services specifically available to
support the aged care workforce in delivering services to Aboriginal and Torres
Strait Islander peoples include:
Indigenous Remote Service Delivery (IRSD) traineeships—National
Partnership on Indigenous Economic Participation.
Culturally appropriate and targeted training for the Aboriginal
and Torres Strait Islander aged care workers employed in eligible aged care
Remote and Aboriginal and Torres Strait Islander Aged Care
Service Development Assistance Panel.
Activities under the Dementia and Aged Care Services Fund,
including training and individual support for Aboriginal and Torres Strait
Islander service providers in rural and remote Australia.
While there are a number of options available via the department for
service providers to develop the skills and knowledge of aged care workers
delivering services to Aboriginal and Torres Strait Islander peoples, the ANAO
performance audit of Indigenous aged care found that providers are not
necessarily aware that such programs and supports exist.
The committee notes that there are specific challenges in providing
appropriate training, professional development and secure employment opportunities
in the aged care sector in regional and remote locations, including in
Aboriginal and Torres Strait Islander communities.
There is a need to ensure that ongoing challenges in providing
appropriate professional development and employment opportunities to Aboriginal
and Torres Strait Islander aged care workers, and to those workers providing
services to Aboriginal and Torres Strait Islander communities, are addressed.
The committee considers that these issues cannot be addressed in
isolation, and cannot be addressed by the aged care industry alone, but as part
of a broader re-examination of aged care service delivery in remote and very
remote locations and to Aboriginal and Torres Strait Islander peoples.
CALD aged care sector
As discussed in chapter 1, the population of Australia is becoming more
diverse in cultural and linguistic background, and as the CALD community age,
are taking up aged care services in greater numbers, and their differing needs
are placing new challenges on the workforce.
National Ageing and Aged Care
Strategy for People CALD Backgrounds
The 2012 National Ageing and Aged Care Strategy for People from
Culturally and Linguistically Diverse (CALD) Backgrounds supports the aged
care sector to deliver care that is appropriate and sensitive to the needs of
older Australians from CALD backgrounds.
The Strategy is based on five principles and sets out six broad goals
and associated actions to be achieved by the Department of Health and Ageing
(now the Department of Health) in the period 2012–2017, including:
CALD input positively affects the development of ageing and aged
care policies and programs that are appropriate and responsive (Goal 1);
monitor and evaluate the delivery of ageing and aged care
services to ensure that they meet the care needs of older people from CALD
backgrounds, their families and carers (Goal 4); and
enhance the CALD sector's capacity to provide ageing and aged
care services (Goal 5).
The Department of Health has submitted that the strategy includes
coverage for workforce issues, including 'resources to support consumers and
Partners in Culturally Appropriate
An organisation in each state and territory is funded to assist aged
care providers to deliver culturally appropriate care to older people from CALD
backgrounds (Partners in Culturally Appropriate Care (PICAC) organisations).
The PICAC organisations conduct a range of activities—such as training,
information sessions, workshops and resource development—to achieve three
more aged care services delivering culturally appropriate care to
older persons from CALD communities;
older people from CALD communities having increased access to
culturally appropriate residential and community based aged care services; and
older people from CALD communities having greater capacity to
make informed decisions about residential and community based aged care.
The Department of Health has submitted that PICAC organisations:
provide culturally appropriate training to staff of aged care
services, disseminate information on high quality aged care practices and
support the aged care service providers to develop new culturally appropriate
services including clusters, ethno-specific and multicultural aged care
Building capacity for the aged care
needs of CALD communities
The Department of Social Services has developed a number of resources to
support CALD communities with emerging aged care needs to establish aged care
In the 2014 Budget, the Government announced $20 million funding to
support the provision of culturally appropriate aged care services in Western
Sydney: $10 million over three years to the Lebanese Muslim Association; and
$10 million over two years to the Maronite and other Arabic speaking Christian
Mr Christopher Lacey, General Manager, Multicultural Communities Council
of Illawarra (MCCI), emphasised the diversity of people accessing aged care:
In our region at the time of the 2011 census there were about
8,039 people who were aged 70-plus and were born overseas. Of these, around
2,400 people needed assistance with core activities, 1,800 of those people were
living alone and about 2,300 of those people spoke English 'not well or not at
To address the needs of these people, of the 52 staff (approximately 30 FTE
positions) employed by MCCI, around 70 per cent are bilingual:
For us, this is a very significant capability requirement. To
be able to deliver culturally-appropriate care to CALD communities, we need
workers who can speak a range of different languages. It is a key component of
who we are as a business.
The Ethnic Communities' Council of Victoria (ECCV) stated that the
feedback they had received from members indicated that:
Bilingual aged-care workers trained in ethno-specific and
multicultural agencies have invaluable expertise in facilitating the access of
seniors from non-English-speaking backgrounds to the service systems.
The ECCV expressed particular concern about the lack of availability of culturally
appropriate services and resources in rural and regional towns and areas.
Another concern raised, in relation to aged care workers from CALD
backgrounds, was the assumption that these workers do not need training in
culturally appropriate aged care services:
For instance, here in Melbourne we know that all aged-care
facilities in the western and southern regions have residents who prefer to
speak a language other than English. We also know that staff are not provided
with initial training or professional development, as was outlined, in how to
carry out the work that provides the services in a culturally inclusive way.
Further, the Centre for Cultural Diversity and Ageing referred to the
lack of bilingualism in Australia as an additional factor impacting on the
ability to provide culturally appropriate aged care services:
That is something that I think needs to be explored in the
future, because we need more bilingual people who will meet the diversity of
language needs in the aged-care sector.
To this end, the Federation of Ethnic Communities' Councils of Australia
(FECCA) has recommended, given the evidence available on the increasing
cultural diversity of the aged population requiring care, the development of an
Aged Care Workforce Cultural Diversity Management Strategy.
FECCA submitted that this strategy should address the following areas:
ways to attract CALD workers to
employment in aged care services; methods for improving the retention of
culturally competent aged care workers, including but not limited to workers
from CALD backgrounds;
attracting aged care workers to
rural and regional areas;
implications for interface between
the National Disability Insurance Scheme (NDIS) and aged care system; and
strategies to enhance cultural
competency of the aged care workforce, as part of increasing the capability of
the sector to meet the needs of older people from CALD backgrounds.
The call for a specific strategy was echoed by a number of submitters and
CALD people in the aged care
The 2016 Aged Care Workforce Survey found that 32 per cent of the total
residential care workforce were born overseas, and 40 per cent of recent hires in
residential care were migrant workers; and 23 per cent of the PAYG home care
and home support direct care workforce were born overseas.
The 2016 survey asked residential aged care facilities to identify the
benefits of engaging people from CALD backgrounds. Responses indicated that 84
per cent found a benefit in the opportunity to enhance cross-cultural
understandings and activities; and 37 per cent indicated that employing people
from CALD backgrounds was important for developing networks into particular
The ageing population is clearly culturally diverse, and so too is the
workforce providing care to those in need of either in home or residential aged
The committee acknowledges the challenges and opportunities in
delivering culturally aware aged care and the need for the aged care workforce
to be prepared effectively to deliver culturally appropriate care.
National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing
and Aged Care Strategy
The 2012 National Lesbian, Gay, Bisexual, Transgender and Intersex
(LGBTI) Ageing and Aged Care Strategy is designed to enable better
education, care and support for older LGBTI Australians in aged care. The
strategy is intended also to help workers to understand any differences between
their personal values or beliefs and appropriate and inclusive workplace
behaviour and practice.
The strategy has six strategic goals and associated actions that are the
outcomes to be achieved by the Department of Health and Ageing (now the
Department of Health) from 2012 to 2017, including:
LGBTI people will experience equitable access to appropriate
ageing and aged care services (Goal 1);
the aged care and LGBTI sectors will be supported and resourced
to proactively address the needs of older LGBTI people (Goal 2);
ageing and aged care services will be supported to deliver LGBTI‑inclusive
services (Goal 3);
LGBTI‑inclusive ageing and aged care services will be
delivered by a skilled and competent paid and volunteer workforce (Goal 4);
LGBTI communities, including older LGBTI people, will be actively
engaged in the planning, delivery and evaluation of ageing and aged care
policies, programs and services (Goal 5); and
LGBTI people, their families and carers will be a priority for
ageing and aged care research (Goal 6).
The Department of Health submitted that the strategy includes coverage
of workforce issues, including 'resources to support consumers and providers'.
Review of strategy implementation
In 2013, the National LGBTI Health Alliance convened the Second National
LGBTI Ageing and Aged Care Roundtable, to review implementation of the
strategy. Four recommendations were made:
update VET qualifications with LGBTI competencies;
include LGBTI with special needs/diversity outcomes in all aged
care standards and linked to accreditation;
include LGBTI within the Survey of Ageing, Disability and Carers
and in all government research; and
ensure workplace inclusion strategies for aged care
LGBTI workers in the aged care
There is no data available on the number or proportion of people working
in the aged care sector who identify as LGBTI, which makes it challenging to
obtain information about LGBTI people working, or seeking employment in, the
aged care workforce.
The National LGBTI Health Alliance has submitted that a significant
issue affecting LGBTI people who wish to work in the aged care sector is the
ability of faith-based organisations providing aged care services to
discriminate in the hiring of workers under Section 37 of the Sex
Discrimination Act 1984:
The exemption to the SDA undermines the ability of
faith-based organisations to create an LGBTI-inclusive service and decreases
the confidence that LGBTI consumers have in these organisations to deliver
inclusive care. Furthermore, the blanket nature of the exemption disadvantages
faith-based providers that do not want to be exempted from anti-discrimination
The National LGBTI Health Alliance argues that this is a significant
issue, given that '[in] 2015-16 faith-based organisations provided 24.4% of
residential care places and 31.9 % of operational home care places in
A member of the Legislative Council of New South Wales, Ms Jan Barham
MLC, also indicated in her submission the inconsistency introduced through
amendments to the Sex Discrimination Act in 2013 that prohibit discrimination
against LGBTI people seeking aged care services, but which allows
discrimination against LGBTI aged care workers.
The Alliance has argued that this matter should be addressed either
through repeal of the relevant section enabling the discrimination to occur, or
to narrow the definition of what kinds of occupation and work the exemption can
Under this option, a faith-based provider would be able to
lawfully discriminate when hiring a chaplain but it would not allow
discrimination against other staff (e.g. cleaners).
The committee has heard evidence that indicates that aged care providers
and other stakeholders including the government have worked to help accommodate
and cater for LGBTI people accessing aged care services. This includes more
services specifically catering for LGBTI people.
The committee is concerned, however, that more could be done to address
discrimination faced by LGBTI workers in the aged care industry and seeking to
enter the industry. While aged care facilities are no longer able to exclude
potential residents and clients because of their LGBTI status, the same does
not apply to LGBTI workers.
Regional and remote aged care sector
Earlier in this report, it was noted that about a third of the
population of Australia aged 65 and over live in regional and remote locations,
and that there is considerable diversity amongst this population.
The aged care workforce in regional
and remote Australia
Recent data shows that just over one third of the residential aged care
workforce, and 40 per cent of the community care aged care workforce, is
employed in regional and remote areas. For both groups of aged care workers,
the majority of those working outside major cities are located in regional
areas, with fewer than two per cent of residential care workers, and just over
four per cent of community care workers, located in remote or very remote
Table 4.1: Distribution of residential direct care
workforce and home support direct care workforce (per cent) by location, 2016.
National Institute of Labour Studies, Flinders University, 2016 National
Aged Care Workforce Census and Survey – The Aged Care Workforce, 2016,
Department of Health, 2017, p.50; 2. National Institute of Labour Studies,
Flinders University, 2016 National Aged Care Workforce Census and Survey –
The Aged Care Workforce, 2016, Department of Health, 2017, p. 112.
*Australian Bureau of Statistics remoteness area
The data from the recently released 2016 National Aged Care Workforce
Census and Survey indicates that there has been little change in the
geographical distribution of workers in residential aged care over the past 5
years. Due to changes in the method of defining categories, data on community
care workers cannot be compared with previous surveys.
Geographical location was nominated by aged care service providers who
completed the survey as the second highest factor causing skills shortages,
with lack of available suitable applicants being the leading cause of skills
The 2016 National Aged Care Workforce Census and Survey also found that
vacancies, especially for registered nurses in residential care facilities,
take longer to fill in remote and very remote areas.
Aged care workforce challenges in
regional and remote communities
Being in a semi-regional area we have the issue of trained
staff – that is probably our biggest problem – and the cost of training, and
also the availability of young people coming through
Delivering aged care services is particularly challenging in regional
and remote communities.The
2016 National Aged Care Workforce Census and Survey shows that there are
difficulties in both attracting and retaining aged care workers in the sector,
and that there are also skills shortages which aged care providers struggle to
address. The survey also shows that these difficulties are more pronounced in
regional and remote areas.
A lack of community level coordination of services across related
health, disability and aged care services and agencies also impacts on peoples'
access to services in remote locations. Dr Kate Smith, a Research Fellow at the
University of Western Australia who has been conducting research into ageing in
the Kimberley region for around 15 years, suggested that greater collaboration
across sectors at a local level may be of use in addressing access to services,
including allied health care workers.
There is concern that where there currently is coordination of services,
the introduction of CDC and the move to introduce greater competition between service
providers may result in a 'weakening of that kind of collaborative, coordinated
delivery of services'.
This is particularly critical when, due to limited service availability in
remote and very remote locations, aged care service providers often deliver
services for young people who have a disability. This places an additional
requirement on those services, and their staff, to possess an appropriate level
of training and skills to meet the differing needs of a broad client base.
Finding and retaining staff to meet this additional need adds to the challenges
facing service providers in regional and remote locations. 
The Aged Care Funding Agency (ACFA) has found that aged care providers
in regional and remote areas generally have higher cost pressures and lower
financial results and 'face a high level of workforce 'churn' and challenges in
recruiting and retaining staff'.
In discussing these issues, Aged and Community Services Australia noted that
there are additional challenges for the aged care workforce in rural and remote
Aged care services in rural and remote Australia are
experiencing particular challenges in accessing the necessary workforce to
provide services to older Australians living in these areas.
Further, aged care service providers can also struggle to maintain
consistent funding in order to engage staff. This is particularly an issue for
remote and very remote services with a small client base. One example raised
during this inquiry is that of the limitation on 'social leave' of up to 52 nights
per year for aged care residents, after which government funding for the aged
care place ceases. This can impact on aged care service providers in remote
locations where Aboriginal or Torres Strait Islander residents may need to
visit their home communities for cultural purposes, and who may exceed the 52
Health Workforce Australia explained that these extra and
well-documented challenges include:
distance from family and friends;
feelings of professional and/or personal isolation;
lack of employment opportunities for partners;
lack of preferred schooling opportunities for children;
lack of professional development opportunities;
lack of local community amenities (eg. theatre, restaurants,
higher workloads and on-call hours; and
poor workplace infrastructure.
The section below will look at two key challenges particularly relevant
to regional and remote aged care workforce: attracting and retaining workers
and lack of training.
Attracting and retaining workers
There are two distinct forms of challenges facing aged care providers in
attracting and retaining aged care workers in regional and remote areas. The
first are challenges that are specific to rural and regional areas, and the
second are general challenges faced by the industry that are made more acute by
the regional and remote location. For example, workers in regional and remote
areas may face challenges in finding and being able to afford adequate housing
and transport close to work, a challenge raised by Bess Home and Community Care
The issue of attracting particularly professional staff to regional and
remote locations was highlighted by aged care service providers, including
Where we find it difficult currently – and I can only see it
getting worse in the future – is when you are looking at professional staff,
such as registered nurses and in particular allied health: physiotherapists,
OTs and those sorts of people. They are very hard to attract to regional areas.
Some submitters suggest that due to the difficulties in attracting
staff, regional and remote providers rely on agency (temporary) staff to fill
vacancies, which can adversely impact on the costs of running services
(including where temporary staff must be brought in to cover a vacancy), the
quality of care provided and cohesiveness of workplace culture.
Some aged care providers stated the difficulty of attracting or
retaining workers related to the lack of opportunities in regional and remote
It is clear that while there are challenges in attracting suitably
skilled and qualified staff to work in the aged care sector in regional and
remote areas, there are also challenges in making use of the existing potential
workforce in regional areas. Ms Nicky Sloan, Chief Executive Officer, Illawarra
Forum Inc., informed the committee that, '[d]espite unemployment in our region
– we do have significant unemployment across the region – we struggle to
attract the workforce that we need.'
While the aged care sector, along with the health sector in general, is
expanding in the Illawarra region of New South Wales, stakeholders are also
trying to find ways to 'broaden the profile of the aged care sector,' to
attract younger people and also men into the sector.
The available workforce in the Wollongong and Illawarra region of New
South Wales has in recent times been affected by the loss of job opportunities
in other industries, but aged care providers have found that the sector is not
seen, and in many cases is not, an attractive industry for many workers moving
out of other, higher paid, industries, a point raised by Catholic Care:
Especially in Wollongong, we did a lot of work with members
leaving BHP and looking for a new place to work, and there was just not the
competitiveness in wages for that to sustain them to work full time in the
In Port Augusta, South Australia, the Port Augusta City Council is a
provider of two residential aged care facilities and provided evidence to the
inquiry that a key issue in relation to attracting and retaining registered and
enrolled nurses, is the competition with other services, including the local
hospital and the Port Augusta prison. This is because '[p]ublic sector
employees are paid at higher pay rates and also have the benefit of more
attractive salary-sacrificing options here in Port Augusta.'
Competition with other sectors was raised by a number of submitters, as
there are often more attractive conditions available in the acute health
sector, services associated with the National Disability Insurance Scheme, and
other services, including those provided through Multi-Purpose Services (MPS).
The MPS Program, a joint Commonwealth-state/territory initiative, provides
'integrated health and aged care services to small regional, rural and remote
communities,' and was recently provided with additional funding of $8.5
The Multi-Purpose Services Programme (MPS) is a joint initiative of
commonwealth, state and territory governments to provide integrated health and
aged care services for some small rural and remote communities: 'It allows
services to exist in regions that could not viably support stand‑alone
hospitals or aged care homes'.
MPSs receive funding from the Commonwealth for the delivery of aged care
services, with the relevant state or territory government providing funding for
a range of health services.
The National Foundation for Australian Women is supportive of the
collaborative approach underpinning the MPS program:
The development of Multi-Purpose Services in rural and remote
areas has demonstrated a model that has supported multi-disciplinary workforces
in many MPS that would not be viable in separate services in small communities.
These approaches are critical to supporting employment of women in rural and remote
communities and achieving benefits to the wider community by way of the social
stability this can bring.
Another key issue for Port Augusta is the challenge of finding suitably
qualified staff, particularly personal care attendants. The committee heard
that the use of agency staff presented challenges, especially covering
additional costs such as travel and accommodation for staff brought in from
other locations, for which no additional funding is available, as the City is
not eligible for any supplementation. The City of Port Augusta indicated that 'being
a regional centre there is no acknowledgement of those higher costs in relation
To address these issues, the City of Port Augusta established a training
program in partnership with a local training provider (TAFE SA), and accessed
funding through the Regional Development Australia Far North program funding.
The Illawarra Regional Workforce Planning Strategy for the Aged Care
Sector recommended a strategy to 'enhance community awareness about the Aged
Care sector and improve its visibility in the community'. It does this by
producing promotional material, conducting Career Expos, promoting government
programs such as Young at Heart with TAFE and using social media platforms to
advance aged care and the broader community and disability services sectors.
The committee heard that another issue aged care service providers is
the move to CDC, which presents a challenge for regional but particularly
remote and very remote aged care providers and workers alike:
The thing is: a marketised model is probably not going to
work very well in regional and remote areas where you do not have the demand.
It just does not work. Maybe the goal in these regional areas is not to have a
choice of multiple, different providers but to have real and meaningful control
over your care and the way it is delivered.
Lack of training
Further to the training issues considered in chapter three, the
committee notes that there are several training related challenges specific to
regional and remote aged care providers and workers.
The quality of training was raised on a number of occasions throughout
the inquiry, with a number of submitters and witnesses identifying
inconsistencies in the quality of training available as contributing to the
challenges of maintaining an appropriately qualified and skilled aged care
In particular, submitters stated that service providers in regional or
remote locations can find it difficult to source good quality local training
providers to cover the full range of training required by staff working in the
aged care sector. For example, in the Illawarra region, Catholic Care
Wollongong indicated that 'there is a vast difference between different RTOs in
The prohibitive costs of either bringing trainers on-site or sending
staff to a major centre to undertake training is another key issue affecting
the aged care workforce in regional and remote areas. Port Augusta City Council
We also experience difficulties in relation to training of
staff in that it costs more to hold training on site here in Port Augusta due
to travel and accommodation for trainers and the increased cost of sending
staff to Adelaide for training purposes. What we found previously was that not
all certificate III qualified staff were job ready on employment.
Ms Sarah Brown, Chief Executive Officer, Western Desert Nganampa Walytja
Palyantjaku Tjutaku Aboriginal Corporation, submitted that services should have
flexibility to provide their own training:
In my experience, giving aged-care coordinators of staff on
the ground some skills to train the support staff is much more sustainable. It
means that education and training support is happening all the time and it is
not from a for-profit company, where they are coming in for a couple of days
and they have got no real idea of the culture of the place or the cultural
Where training is not available locally, there can be considerable costs
involved in getting staff to the location of training and covering their shifts
while they are away. This was highlighted by Bess Home and Community Care Inc.,
an organisation which operates in regional Western Australia:
The main bulk – I would say 99.9 per cent – of the training
that is offered is always around the Perth area. If you want to put some staff
through, say, medication training, half of your workforce goes up to Perth. So
you have to pay for the course and their accommodation and we do not have the
staff backup to cover them.
Some aged care providers have developed innovative solutions to the
challenge of providing appropriate training to aged care workers, or people
seeking to enter the industry, through partnerships with training providers.
Hall and Prior Health and Aged Care Group implemented a training program in
Albany, Western Australia, in partnership with the Chamber
of Commerce and Industry and what is now called the Great Southern
Institute of Technology. This training program:
garner[ed] attention because we won a national award for it,
but it was a real solution to a real problem of how to manage older people with
high and complex care needs in a regional centre by staff, who, up to then, had
not been adequately trained to meet those care needs.
The impact of changes in policy direction or support by government can
be significant. For example, the funding that had supported this successful partnership
between Hall and Prior Health and Aged Care Group, Great Southern Institute of
Technology and the Chamber of Commerce and Industry in Albany was removed or
Submitters highlighted the need for greater cooperation between
Commonwealth, state, territory and local governments across health, disability
and aged care services in regional and remote areas to take advantage of the
economies of scale and scope.
The Australian College of Rural and Remote Medicine recommends that the
committee explore opportunities for 'cooperative management' of Commonwealth,
state, territory and local government funded aged care resources in regional
and remote communities.
In 2015, the government undertook an examination of Commonwealth-funded aged
care workforce activities. The analysis covered activities implemented over a
three year period from 2011–12 to 2013–14.
A key finding of the government's Stocktake and Analysis of
Commonwealth-Funded Aged Care Workforce Activities report was that:
'Consideration should be given to developing specific strategies in respect of
the workforce in regional and remote areas.'
This finding was based on analysis which showed that only around 3.7 per
cent of Commonwealth funded aged care workforce activities, and 7.9 per cent of
funding, were listed as specifically for regional, rural and remote service
Recognition of the specific characteristics and challenges of remote
service delivery will be needed in developing any strategy to strengthen the
aged care workforce in remote locations. For this reason the NFAW recommends
that the extent to which the impacts of geographic isolation
on the aged care workforce can be moderated by organisational integration and
outreach be taken into account in the development of service delivery models in
rural and remote areas that strengthen and support workers in those areas, and
that this strategy consider ways of bringing all services in these areas into
such support networks.
The Greater Northern Australia Regional Training Network (GNARTN), a
cross-jurisdictional network funded by the government has been developing an
issues paper on the aged care workforce in the Northern Territory. Mr Robert
McPhee of the Kimberley Aboriginal Medical Service, a member of the GNARTN,
told the committee that the issues paper, part of a series, has identified around
12 recommendations relating to aged-care workforce issues in northern
Australia. Mr McPhee informed the committee that the completed issues paper
will be submitted to the government for consideration.
The evidence presented during this inquiry confirms the findings of the
ACFA report and the 2016 National Aged Care Workforce Census and Survey. The
issues of high turnover and recruitment and retention of staff have been
consistent themes for aged care service providers outside of major urban
There are particular needs for training the aged care workforce for
regional and remote areas that will need innovative approaches, most likely
across aged and disability care and the health sector.
The recently announced National Aged Care Workforce Strategy will need
to address the particular needs of regional and remote service delivery,
particularly in the context of CDC, and work in collaboration with stakeholders
to arrive at locally relevant and workable solutions to challenges facing
particular regions or communities.
The taskforce should consider work already undertaken by the Greater
Northern Australia Regional Training Network (GNARTN) in its issues paper on
aged care workforce issues in the Northern Territory.
Concluding committee view
The committee acknowledges the particular challenges facing aged care
workers and service providers in delivering services to a diverse and
geographically dispersed ageing population. As part of this inquiry, the committee
has had the opportunity to visit and see first-hand, and to hear compelling
evidence from, these service providers, aged care workers and other
stakeholders. Their message has been clear: there is a need for a more
tailored, flexible approach to aged care service delivery, particularly in
remote and very remote areas.
Aged care service providers delivering services to Aboriginal and Torres
Strait Islander communities, particularly in more remote locations and often as
the sole provider, are struggling to adapt to the CDC model, indicating a need
for review and change. The committee notes that the government has programs
available to assist workers and service providers. However, the evidence from
this inquiry shows that some aged care service providers are either unable to
access these programs or are unaware of their existence. In some cases, the
available support programs do not address the particular needs of the aged care
service providers and/or their workforce.
Equally, service providers delivering services to CALD and LGBTI people
are facing difficulties delivering training to prepare and develop the skills
of aged care workers in maintaining culturally appropriate care, and in the
case of LGBTI workers, of ensuring equitable access to employment.
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