The Australian Government is the major funder of aged care in Australia. Total spending on aged care in 2018–19 was $27.0 billion. Of that figure, the Australian Government contributed $19.9 billion. In 2019–20, the figure was $21.2 billion, and rising. Older people contributed $5.6 billion to the cost of their care and accommodation in 2018–19 on a means tested basis.
An increasing focus on in-home care has seen the proportion of Commonwealth expenditure dedicated to residential care drop slightly in recent years—from over 65 per cent, to 63.3 per cent in 2019‒20—though it still forms the majority of expenditure.
This chapter looks at:
the structure of the aged care sector;
the size and composition of the workforce, including;
characteristics of aged care workers; and
earnings and wages of aged care workers.
The chapters that follow consider evidence on the nature and impacts of common employment arrangements, the relationship between job security and COVID‑19 in aged care settings, and proposals for reforms that could deliver greater job security for aged care workers.
The aged care services industry is growing rapidly. In 2011 the Productivity Commission predicted that by 2050, 3.5 million Australians will need aged care services each year; requiring a workforce of 'almost one million direct care workers'. Still, a full ten years later the workforce continues to face the same significant 'cultur[al] and operational barriers to change', including:
high employee turnover, including significant movement between organisations
poor employee engagement and enablement
difficulty in attracting talent
ineffective and inefficient design of work organisation and jobs
undervalued jobs with poor market positioning
suboptimal workforce planning
casualisation of the workforce, particularly in home-based care
leadership effectiveness gaps
key capability gaps and skills and competencies misalignment
career progression bottlenecks
ineffective recruitment, induction and on-boarding processes.
This chapter concludes by examining how job security is linked to the future capacity of the workforce.
The aged care sector
According to the Aged Care Financing Authority (ACFA), in 2018–19 there were more than 3000 providers of aged care services across Australia, including:
873 residential aged care providers;
928 home care providers; and
1458 Commonwealth Home Support Programme providers.
The majority of aged care providers are owned by community, charity or religious organisations and are not-for-profit—though they may still be 'run like a commercial business'. Most of the others are privately owned and run; though there are also a small number of facilities owned and run by state, territory or local governments. Even in Victoria, which has 'one of the largest numbers of state-run aged-care facilities … over 40 per cent of [beds] are held by for-profit organisations … 10 per cent are held by state governments, and the rest are held by not-for-profit organisations'.
The Aged Care Royal Commission identified 'a shift towards consolidation' of the aged care sector into 'the hands of fewer large-scale operators':
In 2009–10, there were just two very large providers or groups in residential care, operating 16% of all places, whereas by 2018–19 this had grown to 10, operating 39% of all places.
Residential aged care is under strain
Aged care providers that participated in the inquiry argued that the residential aged care sector is under significant financial strain. Ms Patricia Sparrow from Aged & Community Services Australia (ACSA) said that 64 per cent of aged care facilities are running at a loss—78 per cent in rural areas.
The 2019‒20 annual report from ACFA provides slightly different figures, but still demonstrates a sector under severe resourcing stress. According to ACFA, in 2019‒20, the residential care sector did substantially worse than the previous year: 46 per cent of providers achieved a net profit—down from 58 per cent in 2018‒19. The ACFA report states:
Residential care providers generated total revenue of $20.5 billion in 2019‒20 … equating to revenue of $296.64 per resident per day;
Total expenses in 2019‒20 were $21.3 billion … equating to $307.27 per resident per day; and
Residential care providers as a whole reported an overall loss of $736 million in 2019‒20, compared with a total profit of $264 million in 2018‒19.
Home and community care providers fared better: 72 per cent of home care providers achieved a net profit in 2019‒20—up from 69 per cent in 2018‒19.
Size and composition of the workforce
Inquiry participants, along with the Aged Care Royal Commission, were forced to rely largely on data from the 2016 National Aged Care Workforce Census and Survey (2016 Census) to understand the nature of the aged care workforce. Professor Sara Charlesworth from RMIT University noted that the 2016 Census data is 'not terrific'. The 2016 Census team only surveyed 'directly employed workers'; that is, 'pay as you go' (PAYG) employees. While they did not survey agency, labour hire and self-employed workers, the 2016 Census team did include questions about the use of these workers in the provider Census.
On 2 September 2021, the Australian Government released the results of the 2020 Aged Care Workforce Census (2020 Census). This report provides data from the 2020 Census, and compares it with the 2016 data, noting there are differences in survey methodology and reporting between the two census years.
Unlike in previous years, in 2020 the Department of Health (department) 'did not collect data from any individual aged care workers' for the Census, due to the 'impacts of COVID-19'. The department only conducted the provider Census.
There was a significant reduction in the provider response rate between 2016 and 2020, with 76 per cent of residential care providers responding to the 2016 Census, and only 49 per cent responding in 2020. Response rates for community and home care were even lower. As such, responses in 2020 were 'weighted to estimate results for all [residential aged care] facilities'.
Finally, where the 2016 Census presented data in two categories—Residential Care, and Home and Community Care—the 2020 Census presents data in three categories—Residential Care, Home Care Packages, and the Commonwealth Home Support Programme. To facilitate meaningful comparisons between 2016 and 2020 data in this chapter, the second two categories have been added together for some of the comparisons.
The 2020 Census estimated the current aged care workforce to be around 434 107 individuals:
277 671 people work in residential aged care facilities, representing 129 151 full time equivalent (FTE) positions—up 32 per cent since 2016;
80 340 people work as part of the Home Care Packages Program; and
76 096 employees work as part of the Commonwealth Home Support Programme—a total home care workforce of around 156 436 individuals.
For comparison, in 2016 there were estimated to be around 366 000 paid workers, of which 240 000 (or 66 per cent) were engaged in 'direct care roles'.
Role and occupation
According to the 2020 Census report:
208 903 residential aged care employees are 'direct care' workers—up from 153 854 in 2016;
the vast majority (70 per cent) are personal care workers (PCWs, referred to as PCAs in 2016)—this is consistent with 2016, but up from 58 per cent in 2003;
almost 16 per cent are registered nurses (RNs)—largely consistent with 2016 when it was 15 per cent, but down from 21 per cent in 2003; and
almost 8 per cent are enrolled nurses (ENs)—down from 10 per cent in 2016, and 13 per cent in 2003. See Table 2.1 and Figure 2.1 below.
Table 2.1: Nurses in residential aged care, 2020
(<1% of total workforce)
(15.7% of total workforce)
(7.7% of total workforce)
33 445 (68%)
(23.4% of total workforce)
Source: Adapted from Department of Health, 2020 Aged Care Workforce Census Report, September 2021, p. 14. Percentage of total workforce is approximate.
Figure 2.1: Direct care employees in the residential aged care workforce, by occupation: 2003, 2007, 2012 and 2016 (estimated headcount and per cent)
Source: Department of Health, 2016 National Aged Care Workforce Census and Survey, Canberra, 2017, p. 13. Note: Census of residential aged care facilities (weighted estimates).* In 2003 and 2007 both of these categories were combined under ‘Allied Health’.
The residential direct care workforce has grown by over a third since 2016. While there was a substantial decrease in the proportion of the workforce that were RNs between 2003 and 2012, the proportion has remained relatively stable between 2016 and 2020. There has been a slight fall in the proportion of ENs in 2020, continuing the trend apparent in Figure 2.1.
Professor Kathy Eagar, Director of the Australian Health Services Research Institute, commented on the changing make-up of the direct care workforce in residential aged care since 2003, saying:
We don't have enough RNs and ENs and other allied health groups. We have seen a significant reduction year on year of that workforce and a substantial increase in a low-paid, low-skilled workforce of personal care workers.
In 2016, the total home care and home support workforce was estimated to be around 130 263—down 13 per cent since 2012. This compares to the current home care workforce of around 156 436—up around 20 per cent since 2016. In 2016, 86 463 workers were engaged in 'direct care roles' with the vast majority (84 per cent) being community care workers (CCWs). Eight per cent were RNs, and five per cent were allied health (AH) professionals.
In 2020, of the 80 340 employees in the Home Care Packages Program:
64 019 are in direct care roles;
88 per cent are personal care workers (PCWs);
6 per cent are nurses; and
6 per cent are allied health professionals and assistants.
Of the 76 096 employees in the Commonwealth Home Support Programme:
59 029 are in direct care roles;
12 per cent are nurses; and
8 per cent are allied health professionals.
The occupational breakdown in the home care sector has remained fairly consistent since 2016.
The 2020 Census reported in relation to current direct care workforce in residential care:
6 per cent are employed in permanent full-time positions;
71 per cent are permanent part‑time—down from 78 per cent in 2016, and closer to the 2012 level of 72 per cent, and 2007 level of 69 per cent;
19 per cent are casuals or fixed-term contractors (mostly casuals)—almost double the 2016 figure of 10 per cent—and equal to the 2012 figure; and
an estimated 4 per cent are 'employed as agency staff or sub-contractors'.
Figure 2.2 below shows the proportion of direct care staff in residential care by job role.
Figure 2.2: Proportion of direct care staff in residential care by job role
Source: Department of Health, 2020 Aged Care Workforce Census Report, September 2021, p. 15.
Despite hardly any direct care workers holding full-time positions, the 2016 Census reported that 44 per cent of the residential aged care workforce were working for 35 hours or more per week, which meets the Australian Bureau of Statistics (ABS) definition for full-time work.
The 2020 Census noted a slight decrease in the already very low proportion of permanent direct care workers who work full time in residential aged care—with 93 per cent being part-time, which 'is higher than in 2016, when this figure was 87 per cent'.
The 2020 Census reported that, in relation to the current direct care workforce in the Home Care Packages Program and the Commonwealth Home Support Programme:
5 per cent and 4 per cent respectively are employed in permanent full-time positions;
50 per cent and 68 per cent respectively are permanent part-time—compared with 75 per cent across the home care sector in 2016;
41 per cent and 23 per cent respectively are casuals or fixed-term contractors (mostly casuals)—an averaged figure of 32 per cent—almost double the 2016 figure of 14 per cent, and an increase on the 2012 figure of 27 per cent; and
an estimated 5 per cent and 2 per cent respectively are 'employed as agency staff or sub-contractors'.
Figure 2.3 below shows the proportion of direct care staff in the Home Care Packages Program by job role; and Figure 2.4 shows proportion of direct care staff in the Commonwealth Home Support Programme by job role.
Figure 2.3: Proportion of direct care staff in the Home Care Packages Program by job role, 2020
Source: Department of Health, 2020 Aged Care Workforce Census Report, September 2021, p. 29.
Figure 2.4: Proportion of direct care staff in the Commonwealth Home Support Programme by job role, 2020
Source: Department of Health, 2020 Aged Care Workforce Census Report, September 2021, p. 40.
Low-hours part-time work—dominant, but not increasing
Inquiry participants maintained that the aged care workforce is dominated by the use of minimum-hours contracts for permanent part-time workers. Professor Charlesworth said the sector has seen a steady 'erosion of the conditions of part-time work' since 2009, which had led to part-time work becoming 'effectively casualised':
There has been change after change in the relevant award. If we go back to the start of the modern award system and take the Social, Community, Home Care and Disability Services Industry Award, there were 132 state and federal awards smooshed into one award. In the course of that, the lowest common denominator prevailed. Where we had state and territory awards, we had, for example, provision for travel time for home-care workers. That was removed. Where there had been a casual conversion clause, that was removed. The lowest pay rates were chosen and the most compressed skill classifications were chosen. That was a major step back. Since the modern award system started back in 2009, we've seen a slow but absolutely progressive further erosion of the security of working time for permanent part-time workers.
For the 2020 Census, the department did not survey workers at all, and the report does not include information about average hours worked by employees. In contrast, the 2016 Census did report on average hours worked. However, the reported ranges are so wide (1–15 hours; 16–34 hours;
35–40 hours; and >40 hours) that the data fails to provide a meaningful picture of 'low-hours' part-time work.
The Department of Jobs and Small Business's Survey of personal care workers in aged and disability care (2018), (PCW Survey) provides more granulated data—though it is limited to personal care workers (PCW). The Survey found that PCW in the aged care sector worked an average of 21.9 hours, with permanent/ongoing PCW working an average of 27 hours per week, casuals working 17.9 hours per week, and contract staff working 15.2 hours per week. (See Figure 2.5.)
Figure 2.5: Average weekly hours worked by part-time personal care workers, 2018
Source: Department of Jobs and Small Business, 'Appendix B: Aged care sector', Survey of personal care workers in aged and disability care (2018), p. 6.
Figure 2.5 shows that most (85 per cent) part-time care workers were working between 16 and 25 hours per week.
It is clear that part-time contracts are the dominant form of employment in aged care, especially for personal care workers, who make up an increasing majority of the workforce. It is also clear that most of these workers work less than 25 hours a week, with a significant proportion working for between 16 and 20 hours per week, and at least 30 per cent wanting more hours.
The 2016 Census noted a steady trend of increasing use of permanent part-time contracts over the last three collection periods. However, data from the 2020 Census indicates that this growth has stopped, with the trend swinging away from increasing part-time employment, towards an increase in the use of casual workers.
Casual work has increased
The 2016 Census recorded a substantial decrease in casual employment in the aged care sector since 2012; with the proportion of casual employment having 'halved between 2012 and 2016 for all occupations, with the exception of [allied health professionals] where it was reduced to a third (from 15 per cent to 5 per cent)'. The report stated that these roles 'appear to have shifted to permanent part‑time employment'.
However, the 2020 Census data confirmed what a number of inquiry participants asserted—that there has been an increase in the use of casual workers across the aged care sector since 2016—especially in the for-profit residential sector, and by home care providers. This data is in line with ABS data from August 2019, which indicated that 17.2 per cent of workers in residential care services were casuals (much higher than the 2016 Census figure of 10 per cent).
Similarly, the Department of Jobs and Small Business's PCW Survey found, among care workers, 'the proportion of [personal care workers] on casual contracts in the aged care sector was 38 per cent'. The Australian Nursing and Midwifery Federation (ANMF) provided similar figures for casual work across relevant nursing and care professions.
The Queensland Nurses and Midwives' Union (QNMU) submitted that, in May 2020, when there were 80 200 Aged and Disabled Carers without paid leave (casuals), there were 122 700 Aged and Disabled Carers with paid leave (mostly permanent part-time staff). In other words, around 40 per cent were casual, and 60 per cent were permanent. The QNMU observed: 'Alarmingly, the aged care and disability care workforce without paid leave entitlements has increased by 10,100 between 2019 and 2020'.
Professor Eagar maintained casualisation rates in aged care have 'waxed and waned' over the years, and ACSA, which represents not‑for‑profit aged care providers, stated that casualisation is increasing.
The ANMF said two reasons for increasing casualisation are the growth of the National Disability Insurance Scheme (NDIS), and impacts of COVID-19. Federal Secretary, Ms Annie Butler, explained:
Unfortunately, across the country, we did see quite a lot of dismissal of staff in the aged-care sector during the pandemic. The height of the COVID in aged-care was in New South Wales primarily and then of course in Victoria. But, because most of the states used a process of locking down their facilities, it was very difficult for our members at the time. They actually got rid of staff. Then staff had to try to come back into the sector, particularly personal care workforce staff … and seek casual employment.
Labour hire/agency work decreasing?
The 2020 Census report provides limited data on agency and sub-contractor staff in its report, and the data relies solely on aged care provider responses. This is particularly problematic when less than 50 per cent of providers responded to the survey.
Noting these limitations, the 2020 Census reported a total of 11 761 agency or sub-contract staff used by providers in the survey period:
7360 in residential aged care—4 per cent of workers;
2787 in the Home Care Packages Program—5 per cent; and
1614 in the Commonwealth Home Support Programme—2 per cent.
While the 2016 Census did not collect survey data on non-PAYG staff (which includes agency, labour hire and self‑employed workers), it did survey providers on their use of these workers, and estimated these workers to number around 28 000 at that time. The Census noted that about 27 per cent of home care and home support outlets, and 50 per cent of residential care providers, had engaged non-PAYG workers in the fortnight of the survey.
If we add the department's estimated 28 000 labour hire and agency care workers to the 240 000 'direct care' PAYG workers reported in the 2016 Census, it suggests that around 10 per cent of the direct care workforce in 2016 was made up of labour hire or agency staff.
It seems doubtful that the actual number, and relative proportion, of aged care workers employed through agencies, labour hire or sub-contractors would have more than halved in four years. Particularly as, during 2020, COVID-19 reportedly led to an increase in the need for agency and labour hire staff to replace furloughed workers.
Indeed, some participants suggested that non-PAYG roles in the aged care sector have been increasing. The HSU submitted that the use of in-direct employment is 'increasingly common', particularly in home and community care.
According to the Recruitment, Consulting and Staffing Association (RCSA) there are around 360 000 labour hire workers in Australia, with around 10 per cent employed in healthcare roles. RCSA maintained that, in aged care and other care sectors:
Australian Job Agencies provide qualified and credentialed staff at short notice to ensure that our community's care needs can continue to be met when the permanent workforce is unable to perform a function due to surge demand, illness, annual leave or for other reasons.
RCSA submitted that labour hire employment has been critical in helping Australia meet 'the surge workforce needs in aged care, health and in vaccine delivery over the last 12 months', including through replacing staff stood down during aged care outbreaks.
The Department of Health's weekly COVID-19 aged care report published 27 August 2021 provides data on the 'significant surge workforce assistance' provided across Australia during the pandemic. It notes that the surge workforce response includes State and National Aged Care Emergency Response (NACER) teams, and that many workers have been 'deployed from interstate'. (See Figure 2.6.)
Figure 2.6: Workforce resources supplied to residential aged care facilities
Issues associated with COVID-19 and the aged care workforce are detailed in Chapter 4.
Some participants expressed concern that 'a growing number' of workers in aged care are now sourcing work as independent contractors through online platforms.
Professor Charlesworth said workers may work in a residential aged care facility and subsidise their income by working for Mable, as a 'so-called self‑employed contractor', or for Hireup, 'as an employee'. While this may provide additional income, and may seem like a quick fix to workforce shortages, the professor was concerned that gig work is ultimately detrimental to continuity of relationships and quality of care: 'I don't think it's a solution myself. I think that you would find that most aged-care providers will go to those care platforms when they're actually stuck for workers, but they often won't go back again'.
The HSU was concerned about quality of care, and also that workers engaged via labour hire agencies or online platforms, as independent contractors or sole traders may lack access to:
… collegiate and managerial support and supportive environments; safe work practices and safety training; access to ongoing and paid professional development opportunities; and access to fair and adequate industrial and legal representation.
While ACSA said it does not 'have a firm position' on platforms like Mable, it believes it is important to have 'different ways' to attract workers into the sector and can see a benefit for some workers in Mable-style platforms.
Mr Luke Westenberg from the Aged Care Industry Association (ACIA) indicated that online platforms are not a major focus for the ACIA or its members. However, if members expressed interest in using these platforms to engage workers, he would 'highlight the importance' of complying with regulation and quality standards, and ensuing 'obligations are being met and understood by the staff and the provider'.
Asked about the potential role of on-demand platforms to encourage more entrants into the aged care sector, Ms Butler commented that the ANMF believed there are 'preferable models':
We would not want to see a platform like Mable used to get our young nurses, the future of our healthcare system, into the sectors. What would be much more preferable would be secure employment through reliable employers that can offer them the support they need to get through their first year and then to be full practising nurse professionals.
Ms Butler added that platforms like Mable don't offer 'a genuine employee relationship', which, in the ANMF's view, is critical to ensuring quality of care, suitability of staff for roles allocated, and adequate support and supervision.
A further concern raised by the ANMF in relation to on-demand platforms was their potential to play a role in 'driving down wages and conditions for nurses and personal care workers who might choose to seek some work through on‑demand services'—ultimately leading to a decrease in the quality of care.
The HSU added that platforms such as Mable are 'a combination of Tinder and Uber':
You put your profile out there and people with disabilities or their carers then make a decision based on the information that is provided. What you don't see is that those workers themselves often don't have access to workers compensation. They certainly don't have access to any form of leave. The arrangements in terms of their pay are often pretty dodgy.
Multiple job holding is probably increasing
Sometimes workers hold positions with more than one employer and/or at more than one facility. This is commonly referred to as 'multiple job holding'.
The 2016 Census reported that:
56 per cent of the residential care workforce were 'happy with their current hours of work', but:
14 per cent wanted to reduce their hours; and
30 per cent wanted to increase their hours of work;
around 10 per cent of the directly-employed residential care workforce reported working more than one job; and
16 per cent of the home care and home support workforce reported having 'more than one current job'.
The 2020 Census report acknowledges multiple job holding and its potential impacts on the accuracy of data, but does not provide any statistics or significant on commentary on the practice. This is probably attributable to the fact that the department did not conduct the usual survey of individual workers that it conducted in previous census years, and most providers do not routinely collect this information about their workers.
It is unfortunate not to have comparative workforce census data for 2020. However, inquiry participants provided evidence to indicate an increase in the instance of multiple job holding among aged care workers. In 2019, the HWU surveyed 1645 current and former aged care workers from across the sector (the 2019 HWU Survey). Approximately 21 per cent of respondents reported working multiple jobs (compared with 10 per cent of residential care workers, and 16 per cent of home care workers in the 2016 Census).
This trend appears to be in line with increases across the broader economy—and in health care and social assistance particularly. Mr Ryan Batchelor from the McKell Institute Victoria said:
The rate of multiple job holdings has been increasing in the economy. Over a five-year period, it's increased across the board from about 14½ per cent to about 15½ per cent, but you see that, in certain industries, there has been rapid growth… [For] women in health care and social assistance, the rate of multiple job holding … has increased by about 17 per cent in the last five years.
ACSA said the reason for workers holding multiple jobs across multiple sites 'is multifactorial'; 'a mix of business requirements plus personal preference'. Ms Sparrow said some people do it because 'they can't get enough hours in one site', some people 'quite like doing it'; and for those who work across multiple not-for-profit providers, there may be a tax advantage. The tax advantage provided by working across multiple not-for-profit providers comes from salary packaging. ASCA submitted:
Public Benevolent Institutions (PBIs) are exempt from Fringe Benefits Tax, subject to a cap. Many Not For Profit Aged Care homes are PBIs. This exemption allows the PBI to provide salary packaging arrangements to attract employees. Employees of PBIs can salary package up to $30,000 grossed up for expenses such as home mortgages or rent, household expenses, and petrol. Such arrangements apply to permanent, casual, full time and part time employees. Employees with multiple PBI employers can utilise these arrangements.
Large not-for-profit provider, Bolton Clarke conducted a consultation with its residential aged care workforce in 2020 to determine the extent of working across multiple sites, which found 10 per cent of its staff were doing so. Some chose to do this because they enjoyed 'a variety of work', but many did it to 'supplement income':
That might be to do with the different shifts and the different shift penalties that were available. Many people were looking for that weekend work because of the penalty rates. If they work across multiple not‑for‑profits, they can access the salary sacrifice caps across multiple employers, which means there is a better take home dollar benefit for them.
Director of Aged Care for the United Workers Union (UWU) Western Australia (WA), Ms Carolyn Smith said workers are telling the UWU they would prefer to work for one employer if they could afford to: 'They don't want to have to run around and do, as you say, four or five different shifts across two, three or four facilities'.
Testimony from workers on this issue is provided in Chapter 3, and the impacts of the practice on public safety are discussed in Chapter 4.
Characteristics of aged care workers
This section looks at demographic characteristics of the aged care workforce, including: gender and age composition; migration status; socio-economic status; and typical education and skill levels.
Gender and age
In 2016 the aged care direct care workforce was 'older than the national average, generally in good health and ha[d] high levels of post-school education and training'. The 2016 Census reported that the workforce was 'relatively stable, with only a small minority indicating an intention to leave the sector within 12 months', and that the 'residential workforce [was] getting younger and the home care and home support workforce [was] getting older'.
Today's residential direct care workforce is slightly younger again than it was in 2016, but still as dominated by women. The figures below provide a comparative analysis—noting that labour hire and agency staff were not included in the 2016 data.
According to the 2020 Census:
86 per cent of the workforce are female—compared with 87 per cent in 2016;
the workforce is still slightly older than the average, but it is getting younger: half of all workers are under 40—up from one third in 2016.
In relation to the home care sector:
33 per cent of direct care workers in the Home Care Packages Program, and 28 per cent in the Commonwealth Home Support Programme, are under 40; and
50 per cent of PCWs and ENs are aged 40–49 years or younger.
While direct comparisons between the 2016 and 2020 data are difficult, the 2020 Census report stated, 'the median age for PCWs and ENs in both HCPP and CHSP is younger than in 2016 and lies between 40–49 years'. Further, the estimated 'median ages for Registered Nurses in HCPP and CHSP appear to be in line with 2016 figures'. This would suggest that workers in the home care sector are not getting older, and may in fact be getting slightly younger; though the sector remains significantly older than most sectors, and older than residential aged care.
Aged care 'is predominantly a female service', and many participants suggested the low rates of pay in the sector reflect a historical undervaluing of the work as 'women's work'. Professor Charlesworth said caring for the old is traditionally seen as 'something women do for free', as 'unskilled', and 'not quite work'. This historical legacy is responsible for both 'disgracefully low wages' and 'insufficient hours of work', creating 'income insecurity' for many.
Ms Emma Dawson from Per Capita said aged care workers are 'predominantly older women' and 'at least one in five of them desperately need more hours than they're getting'.
With 66 per cent of 'residents and clients' being women, and almost 90 per cent of the staff, the aged care sector generally doesn't 'attract men', because the jobs fail to offer 'the status, the pay, the job security and all the other things that men are looking for'.
Mr Williams argued the 'emotional labour' aged care workers provide as part of their work 'is not valued', and Dr Katherine Ravenswood, from the Auckland University of Technology, said aged care work is not seen 'as integral to a public health system, which then leads to it being outsourced in order to achieve labour cost efficiencies'.
Cultural diversity and migration status
The following data compares the cultural diversity of the current aged care workforce (based on 2020 data) with 2016—noting that labour hire and agency staff were not included in the 2016 Census. According to the 2020 Census:
In residential aged care:
1.9 per cent of direct care workers identify as Aboriginal or Torres Strait Islander—up from one per cent in 2016;
Indigenous staff levels were higher in facilities with higher Indigenous client populations;
35 per cent identify as being from a culturally or linguistically diverse (CALD) background—up from 26 per cent in 2016; and
CALD staff are significantly more likely to work in facilities that service CALD clients.
2 per cent of direct care workers in the Home Care Packages Program, and 1.8 per cent in the Commonwealth Home Support Programs, identify as Aboriginal or Torres Strait Islander—consistent with 2016 figures;
Indigenous staff levels were higher for providers that service higher Indigenous client populations;
21 per cent of direct care workers in the Home Care Packages Program, and 16 per cent in the Commonwealth Home Support Programs, are from CALD backgrounds (provider reported)—in 2016, providers reported 18 per cent of their workers were from CALD backgrounds;
CALD staff are significantly more likely to work in facilities that service CALD clients.
The proportion of migrant and CALD workers has gone up slightly in residential aged care between 2016 and 2020, and gone down slightly in the home care sector. However, these figures would have been impacted by COVID-19 and associated travel restrictions and falling migration levels. It is possible that the proportion of workers who were migrants and temporary residents would have been higher if the Census was conducted in, for instance, 2019.
Mr Ray Collins from the HWU Victoria said many workers in the aged care sector today are from migrant backgrounds, and many are on working visas:
… these people are at the bottom end of the income stream, and they will take the work when they can. In the aged-care sector, the majority of the workers in our membership base are Indian, Filipino, Nepalese and Sri Lankan. They are here often on student visas, as well as other visas, doing the minimum hours, and they are, as a result of that, able to be exploited.
Professor Charlesworth said she had conducted a detailed analysis of the data from the 2016 Census, looking at the 'high rates of underemployment', and found migrant workers were more heavily-impacted:
What we know is that, if you're a migrant worker from a non-English speaking background, you're much more likely to be underemployed than if you're either from a country with an English-speaking background or from Australia.
Migrant workers also make up a significant proportion of the care workforce in New Zealand. According to Dr Ravenswood, the work is seen as hard, workloads are high, and migrant workers have traditionally been 'willing to do work for less money'. Recently, due to COVID-19, New Zealand has struggled to secure migrant workers 'to fill current low-wage jobs', which has led to a public discussion around lifting the 'quality' of these jobs so more locals will want to apply.
The UWU reported similar problems in Australia, including increasing pressure on the current workforce during COVID due to travel restrictions preventing migrants and international students from taking up jobs in aged care.
Levels of education and skills
In 2020, facilities who responded to the Census reported that:
66 per cent of their PCWs held a Certificate III or higher in a relevant direct care field, and another two per cent were studying for a Certificate III or higher.
PCWs without a response are assumed not to hold or not currently be studying for a Certificate III in a relevant direct care field and account for 26 per cent of all PCWs.
The qualifications of the remaining seven per cent were reported as unknown by their employer.
While any direct comparison should be made with caution (as the 2016 Census excludes agency staff), in 2016, 67 per cent of PCWs held a Certificate III in Aged Care.
the proportion of PCAs with a Certificate IV in Aged Care had 'steadily increased from 8 per cent in 2003 to 20 per cent in 2012 and 23 per cent in 2016'; and
a high proportion of aged care nurses held qualifications in health-related areas, 'with RNs having mostly degree-level qualifications', and ENs holding mostly a Certificate IV or diploma.
Fifty-three per cent of residential aged care facilities reported 'skill shortages, most commonly for Registered Nurses (RN)'. However, this was down from 76 per cent in 2012.
According to the 2016 Census, at that time, 88 per cent of home care and home support workers held post-secondary qualifications. Forty five per cent of outlets 'reported that more than three-quarters of their CCWs held a Certificate III in an aged-care related field'; and 42 per cent reported skill shortages, most commonly for CCWs—down from 49 per cent in 2012.
Professor Charlesworth commented that people often 'refer to [aged care] as a low-skill sector', but that's 'simply not the case':
We know the majority of workers, between 70 and 80 per cent, have at least a certificate III. In order to perform the work of care, you need time to do it. You might have, off your own bat, done a certificate IV in dementia care. I come across numerous aged-care workers who've done this because they want to have the skills to deal with people who have dementia.
It was suggested that aged care work is becoming more complex, with an increasing expectation on personal care workers today to complete 'quasi‑nursing duties'. Professor Charlesworth said people would be surprised to see care workers 'doing PEG feeding', 'changing catheters', 'monitoring … for skin integrity': 'These are skills that have been based on education but also, importantly, by gaining knowledge on the job'.
Earnings and wages
In 2011, an Australian Productivity Commission report identified the need for 'improved wage rates … to improve the attractiveness of the sector to current and future workers'. Despite 'inadequate' wages being recognised as 'a significant problem in 2012', in 2016, the Aged Care Workforce Census noted the issue of low wages remained 'pertinent'.
The Australian Government's Labour Market Information Portal provides an average figure of $1265 a week weekly full-time equivalent wages for Aged and Disabled Carers. However, inquiry participants noted disabled carers tend to be paid more highly than those working in aged care.
The 2020 Census report does not include any information on wages. However, Figure 2.7 below shows median weekly earnings for residential aged care workers in 2016. Inquiry participants indicated that wages have not risen meaningfully since that time.
Figure 2.7: Median weekly** earnings (gross) of the residential direct care workforce, by occupation and working hours: 2016 ($ per week)
Source: Department of Health, 2016 National Aged Care Workforce Census and Survey, Canberra, 2017, p. 28.
Mr Collins said aged care sector workers, 'particularly in the private sector', are 'amongst the lowest paid Australians, averaging around $23 an hour in Victoria'.
Professor Charlesworth described the wages as 'appallingly low':
A grade 1 personal care worker, for example, in the Aged Care Award, is paid just $2 more than the national minimum wage, which is the lowest legal wage allowed to be paid to workers in Australia. When you marry that together with insufficient and unpredictable hours of work that creates income insecurity … and in terms of career insecurity, the skill classifications in the Aged Care Award; which covers residential aged-care workers and the Social, Community, Home Care and Disability Services Industry Award, which covers homecare workers, are rudimentary and compressed. There are few differences between levels in the award. There are 27 cents between some of the levels. So they not only fail to provide meaningful progression in terms of pay rates, but also lack any relevant description and specification of the skills that are actually required in frontline aged-care jobs, including at different skill levels.
Aged care workers—especially those who are casuals—often hold multiple jobs. The McKell Institute reported that 'overall rates of remuneration' for women who work multiple jobs 'are substantially lower than they are for men working similar multiple jobs'—a gap of $10 000 per year—and that the more jobs a person works, the less they earn overall:
That's because it's about people trying to stitch together work rather than knowing and having the security of what's in front of them. So, we do see those trends right across the labour market … there are more female dominated industries across the board, women are more likely to be casuals and more likely to have multiple jobs, and, when they do have multiple jobs, they are more likely to earn less.
Workers report being expected to undertake training in their own time. The 2019 HWU Aged Care Survey found over 23 per cent of respondents attended unpaid training at the workplace in the preceding 12 months, and almost 28 per cent attended unpaid staff meetings.
Aged care worker, Ms Tracey Colbert said, while she is paid to complete mandatory training, 'a lot of it is not mandatory'. Nevertheless, if she does not participate in the unpaid training, employers 'say they'll take our shifts away'.
Respondents to the 2019 HWU Aged Care Survey identified the following rates of unpaid overtime:
Figure 2.8: Amount of unpaid overtime worked by aged care workers
Source: Health Workers' Union (HWU), Aged Care Survey Final Report, July 2019, p. 12.
Workers reported that they performed this unpaid overtime 'to support resident's basic and emotional needs' or to complete administrative tasks, including:
showering, toileting, dressing or feeding residents;
talking to residents, making tea, or keeping residents company; or
completing paperwork and administration, including conducting 'handover'.
Seventy-eight per cent of respondents to the 2019 HWU Aged Care Survey indicated that, considering the hours they work, the pay they receive, and the work they perform, they 'feel exploited working in the aged care industry'.
Concerns about the future of the workforce
Participants in the inquiry agreed there are serious concerns around the future of the aged care workforce. Ms Smith said:
I think we are about to hit a second crisis of care. We're going to be in a royal commission in another five years. I've been around aged-care workers now for a number of years. I have never seen the level of concern and agitation. … The real abuse of elderly Australians is that every day we have to say no to them. Every day we don't give them the quality care they deserve … I'm really concerned about where we're heading…
Professor Eagar said the workforce 'is very low paid', 'highly casualised', and 'has a substantial turnover':
People don't want to work there. So we have to attend to the two basic ideas of attraction and retention. We have to attract a workforce that we want to work in aged care, and then we have to build systems to retain them. Unless we do those, aged care will continue to lurch from crisis to crisis, as it has done for the last 10 years.
Australia needs to recruit 500 000 workers into aged care over the next 10 years—a task Mr Williams said he believes will be impossible 'if we are seeking to attract those workers to casualised and part-time work'.
Providers agreed that attraction and retention are major challenges. Ms Leahy said, while the challenges have been known for some time, COVID has created a 'rapid onset of that need for workforce':
We have seen a 60 per cent reduction in applicants over the last 12 months. That's 60 per cent fewer people applying for every role that we advertise than we had pre-COVID. We're also seeing our turnover increase. Our voluntary turnover has increased from 16 per cent pre-COVID to 25 per cent. We currently have over 500 vacancies that we are struggling to fill. … One is that we don't have any immigration coming into Australia because our borders are closed. … We're seeing the student and graduate pipelines dry up, for two reasons. Students are unable to get placements. … We're also seeing a surge in other health sectors. For example, the COVID vaccination clinics are pretty much taking up all of the nurses around the country. At the moment, they're getting offered higher wages to do the COVID vaccination clinics. We're also definitely losing workers to the NDIS because of higher wages.
Workers may also leave the sector for jobs in the disability care sector, which pays higher wages. Witnesses suggested higher wages in the disability care sector is related to particular awards and a 'higher funding model than aged care', which providers can 'pass through as wages'.
The ANMF said policy-makers should be 'very concerned' about the entrance of the on-demand platform model into the caring profession, 'particularly in the aged-care sector, at a time when we know that we're going to have to grow the aged-care workforce'. Assistant Federal Secretary, Ms Lori-Anne Sharp argued that attracting and retaining aged care workers into future would require government to put in place 'a sound structure and secure work' that retain people who want to do this 'difficult work'.
Professor Charlesworth said the key to building a more sustainable workforce is genuine professionalisation:
The Royal Commission into Aged Care Quality and Safety made a number of really important recommendations … a wholesale revision of the classifications of the occupations, which I think necessarily then raises issues around work value. If, indeed, the government is proposing to take up the mandated care hours in residential aged care, we're going to need more workers and we're going to need more workers with more recognised skills.
ACSA said the not-for-profit aged care providers are 'supportive' of the recommendations from the Aged Care Royal Commission, and 'really want to focus on addressing the workforce'.
The 2020 Aged Care Workforce Census Report is disappointing. The 62-page report is significantly less detailed and comprehensive than the 2016 report, which included 248 pages of high-quality data and analysis.
The committee understands that COVID-19 put the Department of Health, and the aged care sector under increased pressure during 2020. However, the choice not to conduct the usual worker survey appears to have led to a report that is thin, lacks critical data fields, and provides significantly less value than in previous years.
Noting serious concerns raised by workers and their representatives, the sector, the Aged Care Royal Commission, academics and others, about the future of the aged care workforce, the committee considers it critical that the aged care workforce survey is conducted urgently.
Some of the important categories of information that are entirely absent from the 2020 Census report include:
contracted hours and actual hours of work;
pay rates and average earnings;
over-time and rostering information;
length of time in current position;
intention to remain in the sector.
While some of this information would require an employee survey, a lot of it could have been gathered and reported on using the provider census, which was conducted.
The department could also have included aged care labour hire and agency worker providers in the Census, and reported separately on their workforces, to provide a realistic figure of the number of aged care workers who are engaging in employment through these services.
Nevertheless, a comparison of the data from 2016 and 2020 allows us to see plainly that the workforce is low-paid and under‑recognised for its education and skill-levels, and is characterised by insecure work with unpredictable hours, and unreliable income.
We can also observe that:
casual employment has almost doubled since 2016—in both residential and home care settings—now exceeding the levels recorded in 2012;
around 19 per cent of residential and 32 per cent of home care workers are casuals; and
at least 4-5 per cent are labour hire or agency staff—though there is reason to suggest these figures may be underreported.
Low hours part-time contracts are still the dominant form of work in aged care, but even this may be being slowly eroded by casual work. Secure, full‑time jobs remain virtually unattainable, despite the fact that many staff do work full-time hours, and many others would like to.
Chapter 5 of this report considers why the aged care workforce is structured as it is, and explores proposals for reforms that would address insecurity in aged care work.
The committee recommends that the Australian Government conducts the Aged Care Workforce Census in 2021/2022, to ensure that this critical data is available for policy development. The survey should be distributed to labour hire, agency, on-demand platform and self-employed aged care workers, as well as directly‑employed workers.
Along with the data collected in previous surveys, the survey should include:
questions on contracted hours;
questions on actual hours worked;
questions on salary and/or wages earned;
questions on multiple job holding, and working across multiple sites, and individuals' motivations for these; and
diversity of the aged care workforce, including with respect to gender, cultural diversity, and visa status.
The committee recommends that the Australian Government includes labour hire, on-demand platforms and staffing agencies that provide workers to the aged care sector in future Aged Care Workforce Censuses, and distribute a specific census survey to these companies in 2021/2022 to capture this data.