Conclusion and recommendations
The aged care sector in Australia is undergoing significant growth and
change. Factors contributing to this include:
the growth in the ageing population, and projections of a
significant rise in the proportion of people aged 65 and over;
increasing diversity in the ageing population;
greater complexity of healthcare needs in those accessing aged
significant changes to aged care service delivery and the impact
of new technologies; and
growth and change in other sectors, in particular, the disability
care sector with the roll out of the National Disability Insurance Scheme
The government has placed considerable focus on establishing the NDIS
and establishing a user determined model for disability service delivery, which
it has also introduced into the aged care sector as the 'consumer directed
care' (CDC) model. It is the view of this committee that, in doing so, there
has not been sufficient focus on the unique challenges associated with aged
care service delivery and with the changing aged care sector. This is
particularly evident in relation to regional and remote services and service
delivery to diverse communities.
The committee is concerned to ensure that service delivery changes, and
other ongoing challenges facing the aged care sector, receive sufficient focus
and support from government.
The committee has heard that the aged care workforce will need to grow
by two per cent per year to accommodate demand for services, yet there is
no clear plan in place as to how this will be achieved. The committee also
heard that ageing Australians living in remote or very remote locations, and
the service providers and workers delivering services to them, cannot rely on
the CDC model of service delivery alone to provide an appropriate level of
The aged care workforce, which is the focus of this inquiry, is being
significantly affected by ongoing issues with pay and conditions. Workers often
struggle to secure competitive pay and conditions, relevant and timely
training, and have fewer career and advancement opportunities than may be
available in other comparable sectors. They also face, in the changing aged
care sector, greater insecurity as the model of service delivery changes. For
regional and remote workers, these challenges are felt more acutely,
particularly in relation to training and professional development, and
insecurity in the face of the introduction of CDC.
There are four key themes that arose during the inquiry:
the need for an integrated sector-wide workforce development
the need for improved training;
the need for further workforce and workplace regulation; and
the particular challenges facing the aged care workforce in
Aged care workforce development strategy
Throughout this inquiry, there has been an almost universal call for a
workforce strategy that should be developed by key stakeholders in the aged
care sector, including service providers, representatives of workers,
consumers, their carers, and government.
The committee welcomes the government's announcement to commit resources
to support the establishment of an industry-led taskforce to develop a national
aged care workforce strategy. The committee also notes the aim of the taskforce
to explore short-, medium-, and long-term options to address supply, demand and
productivity issues for the aged care workforce.
In establishing and setting the direction for the workforce strategy
taskforce, the following issues have been identified during this inquiry that should
interaction with the NDIS Integrated Market, Sector and Workforce
workforce issues including wages and conditions, career
structures, development opportunities and succession planning;
deficiencies in data;
the role of informal carers and volunteers;
the role of medical and allied health professionals;
mandatory minimum nursing requirement; and
the challenges of service delivery to a diverse, and
geographically dispersed, population.
The committee considers that the aged care taskforce must be
representative of all stakeholders in the aged care sector. The composition of
the taskforce should include representation from across the full range of
service providers (public (state, territory and local government), for-profit,
not-for-profit, urban-based, remote and very remote), workforce representatives
from across the spectrum of aged care sector employment categories, including
nurses, care workers/personal care attendants, medical and allied health
professionals, and others, and representatives of consumers and volunteers.
The committee notes that the government regulates, sets the policy
direction for and is the main source of funding and revenue in the aged care
sector. The committee considers that the government has a responsibility to
ensure that the aged care sector responds to workforce challenges in a way that
will make best use of the considerable public funding that supports and
underpins the aged care sector. The government should be more than a mere
'facilitator' for an industry-led response to the aged care workforce
Given that the strategy must be developed within the broader context of
aged, disability and health care delivery, the government must play a key role
in the development of the workforce strategy to ensure the proper alignment of
policy and outcomes across different sectors, where this will achieve better
service delivery, value for public expenditure and address workforce shortage
issues. These are not matters that the aged care industry can or should be
required to achieve on its own, or even with government facilitation. This is
something that requires active participation and leadership from government.
The committee believes it will be important to take an holistic approach
to the National Aged Care Workforce Strategy, to ensure that all levels of
government, consumers and related stakeholders are appropriately consulted in
the development and implementation of the Strategy.
The committee recommends that the aged care workforce strategy taskforce
be composed of representatives of service providers, workforce groups,
including nurses, care workers/personal care attendants, medical and allied
health professionals, and others, and representatives of consumers and
volunteers. Representatives of workers, care providers and consumers from
regional and remote areas should also be included.
The committee recommends that the government, as a key stakeholder in
aged care in terms of regulation, policy, intersections with other sectors and
the coordination of government involvement, and as the key source of funding
and revenue for the aged care sector, must be an active participant of the
taskforce and must take ownership of those aspects of the workforce strategy
that will require government intervention and / or oversight.
Interaction with NDIS Integrated
Market, Sector and Workforce Strategy
The committee has heard the concerns raised by the aged care sector that
providers will progressively lose staff to disability service providers, and
particularly so in regional and remote areas. The committee also notes that the
government has recognised the similarities in the kinds of work undertaken,
skills and knowledge required to provide aged care and disability services.
Evidence presented to the committee indicates that while many
stakeholders welcome moves to better coordinate care across different sectors,
for example, the disability sector, there are concerns that aged care policy,
programs and funding may be at risk as a result of this move, which may see a
shift of focus (and potentially resources) away from aged care service
The committee further notes the 2017-18 Budget announcement of $33 million
over three years to increase the supply of aged care and disability workers in
rural, regional and outer suburban areas, with funding drawn from the
Department of Health and Department of Social Services.
The committee considers that the aged care workforce strategy must be
developed within the broader context of aged, disability and health care
delivery. It should include review and consideration of existing programs and
resources available, and refer to the NDIS Integrated Market, Sector and
Workforce Strategy. The strategy must consider the opportunities that arise
from overlapping workforce issues for the aged care and disability sectors, as
well as the competitive pressures that are now beginning to emerge.
The committee recommends that the aged care workforce strategy include a
review of existing programs and resources available for workforce development
and support and ensure consideration of the NDIS Integrated Market, Sector and
Workforce Strategy to identify overlapping issues and competitive pressures
between the sectors and how they may be addressed.
The committee notes the evidence of poor working conditions in the aged
care sector, including comparatively lower pay than other similar sectors, lack
of sector-wide career structures, difficulties for workers in accessing
development opportunities and concerns over workplace health and safety issues.
The committee considers these matters that affect many individuals in the aged
care sector, and which can also impact on the quality of care delivered,
require urgent attention and should be a primary focus of the workforce
The committee is concerned that pay and conditions for workers in the
aged care sector are now becoming more uncompetitive with other sectors with
the move to 'zero hour' contracts, which are intended to provide flexibility
for aged care service providers, but which have the impact of further
marginalising aged care sector workers and making the industry a less
attractive alternative for workers.
The reputation of the aged care sector as a career choice for workers
has been recognised by the industry as a significant barrier to attracting and
maintaining staff. The committee considers that addressing the key workforce
issues will go some way to rehabilitating the reputation of the industry;
however, industry and other stakeholders also have a role in developing a more
positive image of the industry.
The committee commends the work being undertaken by the sector to
improve the image of the aged care sector, and considers the aged care
workforce strategy as an important means of broadening these efforts across the
The committee recommends that, as part of the aged care workforce
strategy, the aged care workforce strategy taskforce be required to include:
development of an agreed industry-wide career structures across
the full range of aged care occupations;
clear steps to address pay differentials between the aged care
and other comparable sectors including the disability and acute health care
mechanisms to rapidly address staff shortages and other factors
impacting on the workloads and health and safety of aged care sector workers,
with particular reference to the needs of regional and remote workers including
provision of appropriate accommodation; and
development of a coordinated outreach campaign to coincide with
developments introduced through the workforce strategy to promote the benefits
of working in the aged care sector.
Deficiencies in data
The committee acknowledges the work undertaken by the National Institute
for Labour Studies (NILS) at Flinders University in ongoing surveys of aged
care service providers and the aged care workforce, and considers it essential
that this work should continue into the future. The committee notes, however,
the limitations of the data available in relation to aged care and aged care
service delivery. The lack of nationally agreed standards enabling the
collection and analysis of the composition of the workforce across all relevant
occupation groups needs to be addressed.
The committee considers it essential that the aged care taskforce review
the workforce and other industry data available and ensure it meets the
industry's needs for planning (and reporting) purposes. It is also necessary to
ensure that data review and development enables comparisons between sectors,
for example, the disability and acute health sectors.
The committee recommends that the aged care workforce strategy taskforce
include as part of the workforce strategy a review of available workforce and
related data and development of national data standards in a consultative
process with aged care sector, and broader health sector and other relevant,
stakeholders. Any nationally agreed data standards should enable comparison
across and between related sectors where possible.
Informal carers and volunteers
The committee acknowledges the role of informal carers and volunteers in
the provision of aged care services. The committee has heard that there is some
concern that the CDC model introduced to aged care does not sufficiently
account for, or enable planning in relation to, informal carers and volunteers.
The committee considers the convening of the taskforce to develop an
aged care workforce strategy an excellent opportunity to consider the role of
informal carers and volunteers and the issues and challenges for these very
important groups within the context of the changing sector, and changes in the
composition and size of these groups over time.
The committee recommends that the aged care workforce strategy include consideration
of the role of informal carers and volunteers in the aged care sector, with
particular focus on the impacts of both the introduction of consumer directed
care and the projected ageing and reduction in these groups.
Medical and allied health professionals
The committee has heard evidence that allied health and medical
professionals are underutilised in the aged care sector, particularly in rural
and remote areas.
The committee agrees allied health and medical professionals need to be
better integrated into the aged care sector. The committee considers that the
proposed national aged care workforce strategy provides an opportunity to
examine the current state of medical and allied health professional involvement
in the aged care sector and opportunities to address care and skill shortages
through better use of available medical and allied health resources.
The committee recommends that the national aged care workforce strategy
includes consideration of the role of medical and allied health professionals in
aged care and addresses care and skill shortages through better use of
available medical and allied health resources.
Mandatory minimum nursing
The committee is concerned that the ratio of workers to clients in some
residential aged care facilities is too low, leading to the risk of
compromising the quality of care delivered. It can also detract from the appeal
of working in the aged care sector for many potential employees, and can lead
to exit from the sector.
The committee notes the concerns expressed by residential care providers
that mandating staff to patient ratios may not be the best solution to this
challenge, and considers that mandating a minimum number of registered nurses
working at any one time may be a more appropriate regulatory requirement. The
committee also notes advice from the Department of Health that while a mandated
staff to client ratio is not currently government policy, the government has
been asked by the Australian Health Ministers' Advisory Council to consider, as
part of the development of the single aged care quality framework, the
inclusion of a standard that requires that clinical care provided in
residential aged care be best practise and provided by a qualified clinician.
The committee also notes the findings of the Australian Law Reform
Commission (ALRC) report on elder abuse commissioned by the Attorney General,
which recommends that the government commission an independent evaluation of
research on optimal staffing models and levels in aged care, and most
importantly, make use of the evaluation findings to assess the adequacy of
The committee considers that such an evaluation must be undertaken in
close consultation with all industry stakeholders, including aged care workers
and service users and consider the costs and benefits of a range of options for
better ensuring appropriate levels of clinical care in aged care facilities and
services, how best to implement any agreed approach, and monitoring and
evaluation of outcomes.
The committee also considers that a mandated requirement for residential
aged care facilities to publish their staff to client ratios should be
explored, given the shift to consumer directed care. Publication of such
information is appropriate in order to assist consumers to make informed
choices in their aged care planning.
The committee notes that any regulatory requirement imposed on aged care
service providers may require additional funding and support from governments
in order to meet the requirement.
The committee recommends that the government examine the introduction of
a minimum nursing requirement for aged care facilities in recognition that an
increasing majority of people entering residential aged care have complex and
greater needs now than the proportions entering aged care in the past, and that
this trend will continue.
The committee recommends that the aged care workforce strategy include consideration
of and planning for a minimum nursing requirement for aged care services.
The committee recommends that the government consider, as part of the
implementation of consumer directed care, requiring aged care service providers
to publish and update their staff to client ratios in order to facilitate
informed decision making by aged care consumers.
Challenges of service delivery to a
diverse, and geographically dispersed, population
The committee considers that the aged care workforce strategy must take
into account the context within which service delivery occurs, and the
location- or culturally-specific skills, knowledge and experience that may be
required of the workforce delivering those services. In particular, the
strategy should recognise and address the particular challenges for attracting,
retaining and training staff in remote communities, including issues in
relation to housing, security, transport and remuneration.
The committee considers that a 'one size fits all' approach, as is being
rolled out through the implementation of the CDC model in aged care, is
problematic. This is particularly evident in the remote and very remote
locations the committee has had the opportunity to visit and see first-hand as
part of this inquiry. The committee has heard compelling evidence from service
providers, aged care workers and other stakeholders of the need for a more
tailored, flexible approach to aged care service delivery.
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, not through an
unwillingness to try, but because this model is not appropriate to remote
circumstances. In this context, a degree of uncertainty and concern over the
ongoing viability of these services is adding to the existing challenges of
attracting and retaining workers in remote locations. It is clear that more
needs to be done to engage with and assist aged care workers and service
providers operating in remote and very remote locations.
The committee notes that the government has supports and programs
available to assist workers and service providers, but the evidence from this
inquiry is clear: there are aged care service providers unable to access these
services, or unaware of their existence. In some cases, the existing supports
and programs intended to assist aged care providers do not meet their needs. The
committee considers that these issues must be reviewed and addressed as a
matter of priority.
The committee recommends that the government take immediate action to review
opportunities for eligible service providers operating in remote and very
remote locations to access block funding, whether through the National
Aboriginal and Torres Strait Islander Flexible Aged Care Program or through
other programs. The committee further recommends that consideration be given to
amending the 52 day limitation on 'social leave' for aged care residents living
in remote and very remote aged care facilities.
The committee recommends that the Department of Health review the
implementation of consumer directed care to identify and address issues as they
emerge. Specific attention should be paid to any impacts on remuneration, job
security and working conditions of the aged care workforce, and impacts on service
delivery in remote and very remote areas, and to service delivery targeting
groups with special needs, as identified in the Section 11-3 of the Aged
Care Act 1997.
The committee considers it essential to ensure that services delivered
to Aboriginal and Torres Strait Islander peoples, people from culturally and
linguistically diverse backgrounds, and lesbian, gay, bisexual, transgender and
intersex peoples, are accessible, do not present barriers to access, and are
culturally appropriate and appropriately resourced.
The committee recommends that the aged care workforce strategy ensure
consideration of the service delivery context in which the workforce is
expected to perform. The strategy should also include medium and long term
planning for location- and culturally-specific skills, knowledge and experience
required of the aged care workforce working with diverse, and dispersed,
communities throughout Australia. This must specifically include addressing
workforce issues specific to service delivery in remote and very remote
The committee is concerned by evidence there is considerable
inconsistency in the quality, scope and suitability of aged care programs offered
to students. Of particular concern is that some RTOs are offering courses that
fall below the Australian Qualifications Framework (AQF) guidelines and
standards. The committee notes that this means that some students are not
attaining the necessary skills and practical training to commence work in the
aged care sector.
The Committee notes the October 2015 Education and Employment References
Committee inquiry into the vocational and education training (VET) sector,
which made 16 key recommendations. Some recommendations were implemented by
government, but not all. Key recommendations yet to be implemented include:
Establishment of a scheme to ensure national consistency in
disability worker training;
Establishment of a disability worker registration scheme,
including requirements for ongoing professional development;
A national approach to State, Territory and Commonwealth service
delivery accreditation programs; and
ASQA maintain a close scrutiny of and give priority to the aged
care training sector.
The same issues raised in the 2015 Education and Employment References
Committee inquiry continued to be raised in this inquiry, specifically in
relation to aged care training.
The committee recommends that all recommendations of the Senate Education
and Employment References Committee inquiry into the operation, regulation and
funding of private vocational education and training (VET) providers in
Australia be implemented.
The committee notes the Australian Skills Quality Authority evidence
that around 25 per cent of courses offered are still too short for people to
get properly skilled and that no changes have been made to minimum course
The committee recommends that the aged care workforce strategy taskforce
work with Australian Skills Quality Authority to establish nationally
consistent minimum standards for training and accreditation.
The committee notes the evidence that nursing courses do not have an
aged care component as core curriculum, and there is a lack of dementia-skills
training and that very few student nurses seek aged care facility placements
The committee recommends that the aged care
workforce strategy taskforce work with the Australian Nursing and Midwifery
Accreditation Council (ANMAC) to establish aged care as a core part of the
nursing curriculum, establish dementia skills training, and develop greater
collaboration between the sector and nursing colleges to increase student
placements in aged care facilities.
The committee is concerned at the particular challenges facing the aged
care workforce in regional and remote areas in accessing appropriate training
and professional development. It is clear that regional and remote aged care
service providers often struggle to find appropriately trained workers, and
that they also face difficulties in accessing affordable and suitable training
opportunities for their staff, given the additional costs involved with travel,
accommodation, temporary replacement staff, or in attracting trainers to more
remote places to deliver training on-site.
The committee recommends that the government and the aged care
workforce strategy taskforce develop a specific strategy and implementation
plan to support regional and remote aged care workers and service providers to
access and deliver aged care training, including addressing issues of:
the quality of training;
access to training;
on-site delivery of training;
upskilling service delivery organisations to deliver in-house
additional associated costs relating to regional and remotely
should take account of consultation and analysis such as that undertaken
through the Greater Northern Australia Regional Training Network (GNARTN).
The committee recommends that the government work with the aged care
industry to develop scholarships and other support mechanisms for health
professionals, including nurses, doctors and allied health professionals, to
undertake specific geriatric and dementia training. To succeed in attracting
health professionals to regional and remote areas, scholarships or other
mechanisms should make provision for flexible distance learning models, be
available to aged care workers currently based in regional and remote areas,
and include a requirement to practice in regional or remote locations on
completion of the training.
Workforce and workplace regulation
The committee notes the concerns raised by aged care service providers
and worker representatives that the absence of some form of registration of
workers can have significant impacts, including on the cost and quality of care
delivered in the aged care sector, and on the well-being of aged care workers.
The committee also notes the support for an examination of what might be
the best approach in relation to workplace and workforce regulation, noting the
concerns raised that any costs of regulation not unfairly burden aged care
In examining aged care worker registration or other means of regulation,
consideration must be given to ensuring that any restrictions on employment in
the aged care sector are relevant and appropriate. In particular, the committee
considers that historical criminal offences should be considered in employment
decisions but should not automatically rule out a person's employment in the
sector. The implementation of recommendations in the ALRC report on elder abuse
in relation to the establishment of national employment screening for aged care
workers and the establishment of a new serious incident response scheme, may
help to ensure that appropriate and relevant factors are considered in the
employment of aged care workers. The ALRC has also recommended that
unregistered aged care workers be subject to the planned National Code of
Conduct for Health Care Workers.
The committee notes the recommendations made during the committee's 2015
inquiry into violence and abuse against people with disability, regarding the
regulation of the disability sector workforce and workplaces.
The committee further notes the work being done under the NDIS on care
worker regulation. The committee believes that to enforce regulation and
oversight in the disability sector but not in aged care, when there is growing workforce
overlap, increases the risk to consumers in an unregulated aged care sector,
where portions of the workforce might migrate to avoid scrutiny. The committee
therefore considers that there is a need for aged care regulation to be at
least consistent with that in the disability and acute health care sectors.
The committee recommends that the government examine the implementation
of consistent workforce and workplace regulation across all carer service
a national employment screening or worker registration scheme,
and the full implementation of the National Code of Conduct for Health Care
nationally consistent accreditation standards;
continuing professional development requirement;
excluded worker scheme; and
workplace regulation of minimum duration for new worker training.
The regulation of
the workforce must address:
historical issues impacting on employment of Aboriginal and
Torres Strait Islander peoples; and
ways to ensure the costs of this regulation are not passed on to
The committee has been continuously impressed by the dedication, passion
and commitment of aged care workers and service providers operating in a very
challenging and changing environment.
The committee particularly commends the individuals and organisations it
has met on its visit to the Kimberley region of Western Australia, upon whom
the delivery of services in remote communities depends.
Senator Rachel Siewert
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