Chapter 3

Impacts of employment arrangements in aged care

Employment arrangements common across the aged care sector are negatively impacting individual workers, their families and communities, and older people receiving care. While the arrangements appear to provide some benefits for aged care providers, evidence suggests the positive aspects are largely outweighed by impacts on workforce retention and morale, and quality of care.
Ms Melissa Leahy from major aged care provider, Bolton Clarke, explained the paradoxical situation:
[W]hile aged care work is secure insofar as it is dependable, it doesn't provide for the level of financial security necessary to meet the needs of frontline workers and their families, which consequentially impacts on employee engagement and stability. Resulting high turnover within the industry directly contributes to higher employment costs with a subsequent potential risk to resident and client care.1
This chapter describes the most common employment arrangements in aged care and details evidence on their positive and negative impacts, for:
not-for-profit, public, and private aged care providers;
care workers and their families; and
older people receiving care.

Common employment arrangements

Evidence from workers and their representatives, and aged care providers, supported the assertion that the predominant form of employment in the aged care sector is low-hours permanent part-time contracts, followed by casual and agency work, with permanent full-time positions rare in the sector.
The Australian Nursing and Midwifery Federation (ANMF) described the sector as dominated by 'insecure work', saying 'what is referred to as parttime employment' is in fact characterised by 'zero- or low-hour contracts' in which workers are guaranteed a small number of hours, then 'flexed-up' or down at the employers' convenience.2
Unions including the ANMF said their members reported needing to work multiple jobs 'because they cannot get the hours of work at one facility or even two facilities'. Some ANMF members reported working 'four jobs to try and get enough income to survive'.3
Recent bargaining conducted by the UWU in Western Australia (WA) with WA's largest aged care provider confirmed this assertion:
They have about 2,500 staff, and we asked them as part of bargaining how many workers were full-time workers. I can't remember the exact number, but it was fewer than 10. That is across enrolled nurses, care workers and support staff. I think that shows that this isn't just a few workers; this is the predominant employment model.4
Inquiry participants also suggested that the use of casual and agency workers is increasing. Data submitted by both private and not-for-profit aged care providers during the inquiry supports the argument that part-time workers are being used as a 'quasicasual' workforce. This evidence is presented below.

Box 3.1:   A look at two providers—Bolton Clarke and TriCare

Bolton Clarke
Bolton Clarke is a large not-for-profit provider of aged care services that employs 5700 people across Queensland, NSW and Victoria.
Contracted hours and actual hours worked Employment type and length of service of non-managerial staff (as at 30 July 2021)
In Queensland (where its residential services are located):
70 per cent of part-time employees in residential aged care; and
90 per cent of part-time employees in community and home care are on 20-hour per fortnight minimum hours contracts.
In NSW, 67 per cent of community and home care workers are on 20hour minimum hours contracts.
In Victoria, only 3 per cent of home care workers are on low-hours contracts.
Importantly, despite the majority of the workforce being on low-hours contracts:
90 per cent of non-managerial staff work 'in excess of their contracted hours';
the average number of 'above contract' hours worked per fortnight is 26 hours; and
the average number of actual hours worked for part-time employees on minimum hour contracts is 23 hours per week.
Employment type and length of service of non-managerial staff (as at 30 July 2021)
521 are full-time (approx. 12 per cent);
3344 are part-time (approx. 79 per cent);
375 are casual (approx. 9 per cent);
62 agency workers were utilised by Bolton Clarke on 30 July 2021.
The average length of service by employment type is:
full-time employees = 6.37 years;
part-time employees = 6.38 years;
casual employees = 4.57 years.
Retention rates are:
75 per cent for full-time employees;
71 per cent for part-time employees;
41 per cent for casual employees.5
TriCare is a private owner and manager of aged care residences and retirement villages employing 1700 staff, with 90 per cent working in residential care.6
Contracted hours and actual hours worked Employment type and length of service of non-managerial staff (as at 30 July 2021)
Of TriCare's 1026 part-time workers:
56 (approx. 5 per cent) are contracted for between less than 15 to 25 hours per fortnight (f/n);
270 (approx. 23 per cent) are contracted for 25.5 to 45 hours f/n;
448 (approx. 44 per cent) are contracted for 45.5 to 65 hours f/n;
252 (approx. 25 per cent) are contracted for 65+ hours f/n;
Personal Care Workers make up 56 per cent of all part-time workers and their average contracted hours is 27 hours per week;
TriCare does not 'track or report hours worked above contracted hours'. However:
the average number of hours worked per week by part-time employees (excluding managerial staff) is 26.5 hours per week; and
the average number of hours worked by casual staff per week is 19.58 hours.
Employment type and length of service of non-managerial staff (as at 30 July 2021)
32 are full-time (approx. 2 per cent);
1001 are part-time (approx. 66 per cent);
492 are casual (approx. 32 per cent);
TriCare reports that agency workers make up 'less than 2% of all worked hours in any fortnight period'.
The average length of service by employment type is:
full-time employees = 5 years;
part-time employees = 5.2 years;
casual employees = 1.6 years.
Retention rates are:
82 per cent for full-time employees;
70 per cent for part-time employees;
63 per cent for casual employees.7

Permanent part-time

The Health Services Union (HSU) submitted that there is 'an increasing trend by employers to misappropriate part-time arrangements'. The union reported 'a marked increase' in the use of low and zero-hour part-time contracts, which allow employers to roster part-time staff on 'additional hours'—paid at their ordinary part-time rates.8 This allows aged care providers to essentially use permanent part-time employees as a casual workforce without paying casual rates, and is not in keeping with the intention of part-time work which should be predictable.9
Mr Lloyd Williams, National Secretary of the HSU, said employers 'expect workers to be on demand for additional hours', meaning the relationship is not genuinely 'voluntary'.10
Assistant Federal Secretary of the ANMF, Ms Lori-Anne Sharp said the model is ubiquitous, having 'become an employment model for many providers because it makes it easy for them to flex up and down'. ANMF members are commonly contracted to work 16 hours per fortnight 'but routinely work above 32 hours and will do so for years'.11
Professor Sara Charlesworth of RMIT University said standard industry practice is to require employees on engagement to permanent part-time contracts to 'state that [they will] be available for more hours':
So, if you're going to get 16 hours, you have to be available for 20 to 24 hours. Technically, you're supposed to be asked if you're prepared to work those hours, but I've sat with rostering clerks in large aged-care facilities when somebody calls in sick. If they know someone's available for that hour, they ring up: 'Mary, you're on. We need you at so-and-so's home in half an hour's time.' It's used as though these workers are available.12
The United Workers Union (UWU) recently surveyed 5000 aged care workers and found 60 per cent 'wanted more hours—they wanted more hours and couldn't get them'.13
The ANMF submitted that its members report rostering is sometimes used as 'a disciplinary measure', with shifts 'offered' or 'pulled back' depending on relationships, disputes or disagreements.14
The HSU said there is no minimum-hours requirement for part-time contracts in the federal awards, and 'employees are effectively casualised but called parttime',15 and the ANMF concluded that low-hour part-time contracts represent 'another form of casualisation'—one that is not reflected in employment data collected by the ABS: 'because the ABS data, as you're aware, only reflects those with any absence of any leave entitlements'.16
Mr Williams noted that these arrangements keep workers in a state of continual desperation, saying: 'I don't think the relationship becomes one of a voluntary nature, because of the financial circumstances that that worker is placed in'.17

Casual and agency work

Casual employment has grown across the sector, and COVID-19 may have exacerbated this trend.
In 2016, 14 per cent of community and home care workers were casuals who reported 'an irregular work schedule', and less than half (46 per cent) of the workforce 'were happy with their hours of work'—40 per cent of community care workers wanted to increase their hours.18
Considering that almost double (around 32 per cent) of home care workers are now casuals, along with 19 per cent of residential aged care staff, and around another 4–5 per cent are agency or labour hire,19 it is reasonable to assume that the number of aged care workers wanting more hours is likely to have increased.
Ms Butler said casual workers in community and home care are highly concerned with irregular and unpredictable hours, and with 'not being paid properly for their time in terms of travel to see a client or travel between clients'.20
Professor Charlesworth argued that current awards allow 'fractured scheduling' through 'broken shifts', which include gaps of 'unpaid working time and dead time'. Casual and agency workers have no predictability:
What on demand work does is really create working time insecurity through dislocation of your daily life, underemployment and an increase in unpaid work and unproductive working time. I've interviewed many home-care workers who sit in their cars waiting for the next appointment because they don't have time to drive home—that's dead time. They are not available to get on with the rest of their lives. Yet that's the way that their work is organised.21
Professor Charlesworth said it is 'hard to think of' another occupation in Australia where travel between jobs is 'not legally recognised as paid time'. The professor noted that this issue is the subject of a 'long-running' review in the Fair Work Commission, which has yet to be determined.22
Aged and Community Services Australia (ACSA) submitted that the additional 'choice and control' provided by the increase in community and home care options has seen benefits for older people, but has led to detriments for workers—especially underemployment and underutilisation: 'So we're going to have to work as providers, as unions and as workers to make sure that we can address those challenges…'23
Asked if ACSA believes the rates of casualisation are too high in the aged care workforce, Ms Sparrow said: 'Certainly that's a concern'. The situation in Victoria during the second wave of COVID-19 revealed 'there were large numbers of people who were working casually across sites'. Imposing singlesite mandates would have led to many workers losing crucial income, so the Commonwealth Government provided funding to specifically subsidise those workers. Ms Sparrow concluded that this proves 'there is a lot of casualisation, and ultimately that's not really desirable'.24

Impacts on aged care providers

Aged care providers were ambivalent about the benefits of workforce models that are currently dominant across the sector. The use of part-time and casual workers provides flexibility in rostering, and the ability to 'flex' the workforce up or down to meet tight budgetary constraints. However, providers were also concerned about negative impacts on their workers and care recipients, as well as the difficulty in attracting and retaining staff.
Provider associations cited a number of reasons why aged care facilities need a flexible workforce. Mr Luke Westenberg from the Aged Care Industry Association (ACIA) explained the need for operational flexibility in aged care:
The care needs of residents can vary quite dramatically from one person to another. No real surprise here—older people are people, people are very different and care needs are very different. But the concomitant of that is that the staffing requirements for a particular facility will change if the resident cohort changes. … It's very difficult to have [a] staffing mix that will meet any given resident cohort's needs.25
Workforce flexibility is also needed to cover planned and unplanned absences. Mr Westenberg said higher than usual levels of unplanned absence generally results in an increase in the use of labour hire or agency staff. He added that some providers 'have a preference to minimise the use of agency staff', but must 'face the reality' that agency staff are often required to meet basic care requirements.26
Aged & Community Services Australia (ACSA) said flexible employment arrangements are often used to help providers balance staff requests for more hours, with the care needs of residents and clients.27
However, the ANMF suggested the primary reason for the dominance of parttime and casual roles in aged care work is that this model helps providers keep staffing costs as low as possible. Assistant Federal Secretary, Ms Lori-Anne Sharp argued the model creates a 'power imbalance … at the expense of the employee', who is unable to plan their life, and 'cannot rely on a stable income'.28
There was some evidence that the use of casual and agency staff may have direct negative impacts on providers as employers. The Queensland Nursing and Midwives' Union (QNMU) said the use of casuals damages working relationships, decreases staff loyalty, harms employee morale, and creates retention issues: 'Casual nurses can often experience marginalisation through practices that affect team membership and clinical performance ... an "us and them" mentality between casual and full-time workers [can] engender a culture of ineffective communication'.29
The role of providers is explored in more depth in Chapter 6, which presents proposals for reform.

Impacts on care workers and their families

Evidence presented during the inquiry demonstrated that workforce management practices common in aged care are impacting on workers, their families, and their communities. Impacts range from economic and social, to physical, mental and even philosophical.
Along with the financial and health-related impacts of insecure work, the committee heard that many aged care workers are deeply passionate about providing care to vulnerable older people. Ms Melinda Vaz, an enrolled nurse from WA said:
Every Australian should recognise the need to look after these elderly people. We're all going to be there one day. We want the best that we can provide. That's why I've stayed there. Yes, I had contemplated leaving at certain times, but I always came back to the fact that these people need people that love to be there, that want to be there and that want to provide the best care for these residents. 30
Employment practices that reduce the ability of these workers to provide care that is adequate—let alone quality care—has detrimental impacts on workers' mental and physical health, as well as job satisfaction.
Evidence from unions, workers, aged care providers, academics and others is discussed in this section.

Economic and social impacts

Many aged care workers are affected by income stress, housing stress and/or an inability to plan their lives because of insecure and unpredictable working hours.
According to the HSU, because of the 'historical model' in place across the sector, most permanent part-time workers in aged care are effectively casual without the benefits of a 'casual loading'. HSU Aged Care Division Secretary, Ms Lauren Hutchins said:
You have people on four-hours-a-fortnight contracts who work well in excess of that, as Gerard said, who are deeply fearful that, with seven days notice, their rosters will change and they will go from 40 hours a fortnight back to four. We have seen that.31
Mr Kevin Crank from the QNMU said that union's aged care members are 'typically' engaged on contracts for 16 to 20 hours per fortnight, but often work 'close to full-time hours'. However, their hours may 'drop occasionally without warning', leaving members unexpectedly short on income and unable to pay their bills.32
National Secretary, Mr Lloyd Williams said this employment model has 'devastating' impacts, making it difficult for the predominantly female workforce 'to build financial security or plan life outside of work'.33 Issues include: not getting 'enough work', being 'unable to get a home loan', or being unable to 'properly plan their lives' or manage caring responsibilities—such as 'picking up and dropping off their children at school'.34
Aged care workers who gave evidence attested to these impacts firsthand. Enrolled nurse, Ms Vaz—who has worked in residential aged care for 14 years—said:
I have seen firsthand colleagues working two to three jobs to pay rent and their bills at home as well as their difficulties getting loans. This affects facilities as often there is not a consistent workforce or continuity of care for the customer. Colleagues have stated to me that they want more hours at one facility, not to have to work at multiple sites. This is inadequate staffing and lack of hours.35
Professor Charlesworth said the discussion about job security in aged care needs to be focussed less on 'casual versus permanent status' (as a large percentage of the workforce hold permanent positions), and more on the issue of 'working time insecurity'. Working time security:
… goes to insufficient hours; underemployment; fractured scheduling of hours; lack of predictability; on-demand work, which is having to be available for work which you may or may not be allocated; income insecurity; and career insecurity, which I think we often forget, which is about limited options for progression or long-term job security.36
A lack of investment in individual worker training and development, along with unclear paths for career progression, further disadvantage workers in the sector. The QNMU said 'lack of career progression' is a 'critical issue' for agency nurses in particular, as 'their work is focused on completing tasks rather than improving knowledge and skills'.37
Aged care workers were asked why they stayed in the sector, despite the low wages and challenging conditions. The responses of Ms Clarke and Ms Mashford—below—are both typical responses, but present an interesting contrast.
Ms Clarke replied that she feels it is an 'absolute honour and privilege' to care for elderly Australians, including giving them 'dignity in death':
I have had the honour and privilege of looking after our World War II veterans, World War I veterans, the ones who built this country. They've been just as much victims of this system as anyone else, and I believe that they deserve better quality care and they need people passionate in the industry standing up and advocating for them.38
Aged care worker, Ms Virginia Mashford said she shares Ms Clarke's motivations, and 'really' loves her job and enjoys doing what she does. However, Ms Mashford added another reason she stays in the industry is because it:
… is all I know. I don't have skills and abilities in other areas. In today's world, one needs to be fairly computer literate and agile, and I'm reaching the end of my working career, and I don't have that agility or that kind of literacy to move into different employment.39

Box 3.2:   Economic and social impacts—testimony from workers

The committee heard evidence directly from a number of care workers as part of the inquiry. A few of those workers were concerned about their employment—or future employment prospects—and gave their evidence in private session.
The following quotes are from worker sessions during the inquiry.
Referenced quotes are from witnesses who appeared in public session. Quotes from in camera sessions have been reproduced with the agreement of the participants, have been de-identified to protect the identities of these workers, and are not referenced.
Low wages and unpredictable earnings
'We only get $22 an hour, so I have to work weekends, for low money. I do 11-hour days on a weekend, away from my family, to be able to support them. I've had a lot of friends that have left the sector because they just can't afford to make a living, and some of them had two or three jobs.' ―Ms Tracey Colbert, aged care worker40
'For me, personally, that insecure work has led to insecure housing. Because I've only got a 16-hour contract, I can't sign a lease. My anxiety levels wouldn't allow me to go to a higher rent, so I found myself living in a caravan park. That's insecure and temporary as well. In my park, I have met up to seven or eight other aged-care workers who can't get secure accommodation with a 16-hour contract, especially if they're single.'
—Ms Sherree Clarke, aged care worker41
'There is no family time and no social life. After doing all this, we just get our daily expenses, with not even a single penny to save—no savings at all.' ― Ms Anu Singh, former aged care worker42
Variable hours
'A lot of the causals at work are lucky to get 12 hours a week in work. I don't know how you'd pay your bills on that.' ―care supervisor
'You can't plan anything because you don't know what your roster is going to be from one fortnight to the next. When my mother went through cancer, I couldn't tell her that I would support her to her cancer appointments, because, if you're not available to pick up a shift, they don't offer you that shift the next time. So it's as if you're a casual worker. You're relying on that phone call to pick it up, especially if they've only given you four shifts on the roster. You have to pick up the shifts that they offer, or else you're not called in next time.' —Ms Clarke, aged care worker43
'They can cut our hours any time. So we always depended on casual shifts. To get those casual shifts and look for a second job, sometimes I woke up at 2am or 5am. There were tiring days plus sleepless nights. How do we cope with that?' ―Ms Anu Singh, former aged care worker44
Working across multiple sites
'Currently I am working in two different aged-care facilities. In my contracts, I have 16 hours per fortnight in one workplace and 20 hours per fortnight in the other one. If my employer gives me enough contracted hours, I don't need to find a second job. If I have to find a second job, I need to manage the time; sometimes the shifts overlap. So it is very hard to have a family life and a personal life.' ―aged care catering staff
'Sometimes someone rings in sick and we are called by one workplace. Then someone also rings in sick in the other workplace and there are calls from the other workplace. It's very hard to manage.' ―aged care catering staff
'I've been in aged care for almost 12 years, and I've seen the workforce become progressively more casualised. They're not offering permanent part-time or permanent shifts anymore. I'm not sure what their reasoning for that is, but that seems to be how they are going in my facility. … We [recently] lost three absolutely brilliant registered nurses who knew the residents. Now we are working with agency registered nurses. They don't know the background. They don't know anything about the residents when the doctor comes…' ―care supervisor
'When you come into work and you've got a casual girl on and she doesn't look to have the experience of your normal partner, you've got to train her for every single resident. … You have to go into detail: whether she's one assist and what she likes et cetera. It's a full explanation of every resident before that girl can go into the room. I don't know why they're doing that casualisation thing and not offering more hours. I really don't.' ―care supervisor

Physical, mental and emotional impacts

Insecure and precarious employment in the aged care sector is impacting workers' physical, mental and emotional wellbeing. The QNMU submitted that academic research from 2016 found nurses who perceived their employment to be under 'threat' also reported:
… higher levels of burnout, less job and career satisfaction, more job stress, lower levels of work engagement, greater intentions to quit, more exhaustion and psychosomatic symptoms, and less life satisfaction (Burke & Singh, 2016).45
Unions reported that many of their members in aged care report high levels of stress in relation to their working hours, workloads and financial pressures, but feel 'powerless' to do anything about it. The QNMU submitted:
Nurses and midwives often hold the genuine fear that if they raise workplace safety issues, safety and quality concerns, workload issues, engage in union activity, or do not attend work when they are called up, their hours will be reduced or they will not be offered any work. This sense of powerlessness can also be reflected in the growing incidence of wage theft in Australian workplaces, where there is little recourse for unscrupulous employers who underpay and exploit workers.46
The QNMU cited 2018 research by the Australian Council of Trade Unions which found people 'trapped in a cycle of insecure work … are more likely to suffer physical and mental health issues'. This places a financial strain on the medical system.47
Aged Care Director of the UWU in WA, Ms Carolyn Smith highlighted the psychological and philosophical stress experienced by aged care workers when they feel they cannot provide the care that residents need, due to inadequate staffing, saying: 'our members take very seriously their role as ambassadors fighting for quality care in aged care'.48
Ms Vaz agreed that current staff-to-patient ratios do not provide 'enough time to care', and the 'stress involved and the physical impact on the body is just overwhelming'.49
There were also concerns raised about potential mental health impacts on agency or platform workers brought in to unfamiliar situations. The QNMU submitted that agency nurses can 'experience feelings of anxiety' if they are 'compelled to work in inappropriate settings', or complete tasks they not trained for, or familiar with.50

Box 3.3:   Physical, mental and emotional impacts—testimony from workers

Emotional impact of providing inadequate care
'The worst thing that I've gone through is that, at the workplace where I used to work, we used to have two carers for 15 to 20 residents, and they just gave us a time frame of 20 minutes. In those 20 minutes, we used to wake up our residents, who were about 90 years old, and do showering, toileting, dressing and undressing; tidy up their rooms; make their beds; and then take them slowly to their dining. Can you imagine doing all this just for yourself in 20 minutes? Well, we did that with our residents. We had to push ourselves. We don't just push ourselves physically. We are mentally stressed and emotionally broken.' ―Ms Anu Singh, former aged care worker51
'I love my job. I absolutely love hearing the stories of those people. It's just such a humbling job, to care for fellow Australians who have done the hard yards for our country. To go in there and say: 'I've only got one staff member on the floor at the moment, sweetie. I know you need your pad changed, but I can't do it until she comes back from her break'―it's heartbreaking, to have to say that to somebody, but it's the truth. It's not just my facility, either; you'll find it throughout the whole aged-care sector.' ―care supervisor
'I'm very passionate about aged care. I work every day with them. I see them crying. I see them missing their families. I see all those things. We're the next step from their families, and we treat them like they're our mothers or grandmothers. When I can't do something that I should be doing, that hurts me too.' ―care supervisor

Impacts on care recipients

Inquiry participants highlighted a number of impacts of insecure and precarious work on the recipients of aged care services. These were primarily related to:
the safety of residents and home care clients, and the quality of care provided in these settings; and
the impacts of job security on continuity of care.

Safety and quality of care

The structure of the workforce is one of a number of factors that determines the quality of care in aged care facilities. Professor Kathy Eagar from the Australian Health Services Research Institute summarised international evidence, identifying 'four factors that drive quality and safety' in aged care:
the first is 'total staffing'—in Australia, 'fifty-eight per cent of residents are in homes that have unacceptably low levels of total staffing';
the second is 'staff mix'—Australian aged care does not have 'enough registered nurses or allied health workers [and is] overly reliant on personal care workers';
the third is 'casualisation'—'the higher the rate of casualisation—this is in the international literature—the higher the rate of adverse events and the poorer the quality of care'; and
the fourth is 'clinical governance'—'how well the home is actually run'.52
The American five-star rating system is considered 'the most robust of all the international standards' for rating aged care facilities. Professor Eagar provided the following data in relation to aged care facilities in Australia:
58 per cent of residents are in one or two-star facilities;
27 per cent of residents are in three-star facilities;
14 per cent of residents are in four-star facilities; and
only one per cent of aged care residents in Australia are in five-star facilities.
According to the professor, this means 58 per cent of residents in Australian aged care are currently in homes with 'unacceptably low total staff hours'.53
Short-staffing can make it difficult to provide even adequate care. Ms Annie Butler said that ANMF members report being 'rushed' and unable to meet basic requirements for the residents:
They just know they can't get to their residents—not even for nurses to meet high level needs such as medication or wound care. Wounds don't even get looked at for days. We know that, on some occasions, people don't get fed. The royal commission reports that up to 68 per cent of residents in nursing homes are at risk of malnutrition.54
Aged care worker, Ms Sherree Clarke said, unlike many of her colleagues, she has chosen to limit herself to working at one facility—despite the financial 'struggle' it causes her. She does this to protect the residents, because:
… even before COVID, there was a risk of bringing influenza and gastro viruses. But, the more time I spend with my residents and the more shifts I do with them, the more I know what they like and when they like it, so I can provide the best possible care for them.55
According to Professor Eagar, research demonstrates 'the best quality care is relationship based, not transaction based'—continuity of staffing not only makes residents feel safer, it makes them objectively safer. Professor Eagar explained:
Part time is better than casual in terms of fewer adverse events, fewer falls, less poorly managed continence, fewer pressure injuries, et cetera. But if you want relationship based care, then the more full-timers you've got, the better … It's very difficult to see how you could have a competent workforce in a home that was overly dependent on casuals or part-timers. That's not to say there isn't a place for them, but they shouldn't be the dominant workload model in a home.56

Continuity of care

Casual and insecure work negatively impact continuity of care. The HSU highlighted the importance of 'relationships … to the care outcomes' in the sector. Mr Williams said the Aged Care Royal Commission proved that 'you get better outcomes, get more continuity of care, more continuity of support and more continuity of relationships when you have secure employment across this sector'.57
Inquiry participants pointed out the potential trauma for elderly people in being cared for by a constantly-changing string of workers. Mr Williams said: 'Can you imagine what it would be like to have a different person coming into your home and showering you every day?'58
Similarly, Dr Katherine Ravenswood from Auckland University of Technology, who appeared in a private capacity, emphasised the detrimental effects of casualisation on home care recipients:
[I]magine we are ill, frail and vulnerable in our home. Imagine having a different person you've never met turn up to your door every day. That's what a casual workforce would do, so immediately the quality of care, just in terms of personal security, in a way, would be lower.59
The HSU said, as well as exposing 'terrible things' occurring in aged care, the Royal Commission has 'identified some of the root causes that bring them about'. One of these, Mr Williams argued, is insecure work:
… lack of training, lack of supervision and lack of other risk protections that can occur as a consequence of a churning workforce—a different person every day; someone who has insecure work and may come into the sector for a short period of time and then leave. All of these things are connected.60

Box 3.4:   Impacts on care recipients—testimony from workers

Anxiety for residents
'I spoke with one of the residents this afternoon and asked her what does it mean for her to have new staff coming to her every day. She said it creates anxiety for her. They don't know her routine. It's unsettling. She said she cries. She gets depressed… Residents become frightened. You're 90 years old and a new person comes in every day to do your personal hygiene. It's confronting. They like the same people all the time. But in our facility people are leaving. It's a constant tum over of staff because people can't survive on the hours that they're offering.' ―care supervisor
Job security and quality of care
'Working with an agency, you get thrown into the deep end. You have to look after all these residents that sometimes you haven't seen before and you're expected to take on the role of a nurse and look after these people. That can be quite daunting—the pressures of doing that work with so many residents. I'm finding the ratios are just too high in aged care and … things do get missed—for example, wounds don't get looked at for days. It creates a snowball effect in a way with the care that's being missed with others.' ―Mr Paul Bott, agency nurse61
'I work in the dementia wing, and every day with different staff I have to explain the same care needs to them, which is sometimes overwhelming to them because they've never worked in that wing before.' ―Ms Vaz, enrolled nurse, WA62
The future of the workforce
'The retention rate in aged care is not there. One of my jobs in aged care is to train and mentor new nurses, new carers, coming in. You can see some potentially great carers there that you build and train up, but they don't last. They can't build a family. They can't build a secure life. So they leave for a better-paying job, a more secure job.' —Ms Clarke, aged care worker63
'Full-time hours provide job security in the workplace. Knowing who you're working with provides fulfilment in their jobs. The customers also need continuity, regular staffing who know their exact care needs to provide a supportive environment with staff management to give the best quality of care in a dignified way and professional manner. This is what the elderly deserve. We need to change now urgently. If we don't, the future is very bleak.' ―Ms Vaz, enrolled nurse, WA64
The next chapter looks at COVID-19 and aged care, and Chapter 6 of this report considers how the issues raised in this chapter can be addressed, by looking at proposed reforms to the aged care workforce.

Committee view

The evidence provided to the committee by aged care providers, aged care workers, unions and academics support the findings of the Aged Care Royal Commission that:
Australia's aged care system is understaffed and the workforce underpaid and undertrained … Inadequate staffing levels, skill mix and training are principal causes of substandard care in the current system. The sector has difficulty attracting and retaining well-skilled people due to: low wages and poor employment conditions; lack of investment in staff and, in particular, staff training; limited opportunities to progress or be promoted; and no career pathways.65
Just six per cent of the residential aged care workforce in Australia is employed in permanent full-time positions. By contrast, the proportion of aged care workers employed as casuals has almost doubled in the last five years to 19 per cent.
The predominant form of employment—permanent part-time, is often offered with extremely low minimum hours. The actual hours worked under these arrangements can fluctuate wildly, leaving the actual arrangement more closely resembling casual employment, but without the casual loading, overtime or penalty rates.
The aged care workforce is among the lowest paid in Australia, with Award wages barely above the National Minimum Wage. This reflects an ignorant and grossly unjust perception that caring work is "women's work" and is inherently less valuable.
The consensus evidence of aged care providers, aged care workers, unions and academics is that the vast majority of aged care workers are in insecure and underpaid work arrangements, and that this negatively impacts upon the quality of care for aged care recipients, and quality of life of aged care workers.
The neglect uncovered by the Aged Care Royal Commission is a direct product of an exploited, insecure and underpaid workforce, and will continue until aged care jobs are secure and fairly paid.

  • 1
    Ms Melissa Leahy, Chief People Officer, Bolton Clarke, Proof Committee Hansard, 28 July 2021, p. 21.
  • 2
    Ms Annie Butler, Federal Secretary, Australian Nursing and Midwifery Federation (ANMF), Committee Hansard, 19 April 2021, p. 1.
  • 3
    Ms Butler, ANMF, Committee Hansard, 19 April 2021, p. 1.
  • 4
    Ms Carolyn Smith, Aged Care Director, United Workers Union (UWU), Proof Committee Hansard, 28 July 2021, p. 15.
  • 5
    Bolton Clarke, Answers to written questions on notice, Senator Walsh, 5 August 2021 (received 18 August 2021), pp. 1‒2.
  • 6
    TriCare, Answers to written questions on notice, Senator Sheldon, 9 August 2021(received 23 August 2021), p. 1.
  • 7
    TriCare, Answers to questions on notice, public hearing, Canberra, 28 July 2021 and answers to written questions on notice, Senator Walsh, 5 August 2021(received 18 August 2021), pp. 1‒3.
  • 8
    Health Services Union (HSU), Submission 84, p. 4.
  • 9
    HSU, Submission 84, p. 4.
  • 10
    Mr Lloyd Williams, National Secretary, HSU, Committee Hansard, 13 April 2021, p. 10.
  • 11
    Ms Lori-Anne Sharp, Assistant Federal Secretary, ANMF, Committee Hansard, 19 April 2021, p. 3.
  • 12
    Professor Sara Charlesworth, Work, Gender and Regulation, School of Management, and Director, Centre for People, Organisation and Work, College of Business, RMIT University, Committee Hansard, 19 April 2021, p. 23.
  • 13
    Ms Ffion Evans, Coordinator, Member Power, United Workers Union (UWU), Committee Hansard, 19 April 2021, p. 12.
  • 14
    Ms Butler, ANMF, Committee Hansard, 19 April 2021, pp. 1‒2.
  • 15
    Mr Lloyd Williams, National Secretary, Health Services Union (HSU), Committee Hansard, 13 April 2021, p. 9.
  • 16
    Ms Sharp, ANMF, Committee Hansard, 19 April 2021, p. 4.
  • 17
    Mr Williams, HSU, Committee Hansard, 13 April 2021, p. 10.
  • 18
    Department of Health, 2016 National Aged Care Workforce Census and Survey, Canberra, 2017, pp. 67‒68.
  • 19
    Department of Health, 2020 Aged Care Workforce Census Report, September 2021, pp. 14–15,
    pp. 25–27 and pp. 37–38.
  • 20
    Ms Butler, ANMF, Committee Hansard, 19 April 2021, pp. 1‒2.
  • 21
    Professor Charlesworth, RMIT University, Committee Hansard, 19 April 2021, p. 23.
  • 22
    Professor Charlesworth, RMIT University, Committee Hansard, 19 April 2021, p. 22.
  • 23
    Ms Patricia Sparrow, Chief Executive Officer, Aged and Community Services Australia (ACSA) ACSA, Committee Hansard, 19 April 2021, p. 30.
  • 24
    Ms Sparrow, ACSA, Committee Hansard, 19 April 2021, p. 31.
  • 25
    Mr Luke Westenberg, Chief Executive Officer, Aged Care Industry Association (ACIA), Committee Hansard, 21 April 2021, pp. 10‒11.
  • 26
    Mr Westenberg, ACIA, Committee Hansard, 21 April 2021, p. 11.
  • 27
    Ms Patricia Sparrow, Chief Executive Officer, Aged & Community Services Australia (ACSA), Committee Hansard, 19 April 2021, p. 30.
  • 28
    Ms Lori-Anne Sharp, Assistant Federal Secretary, ANMF, Committee Hansard, 19 April 2021, p. 3.
  • 29
    Queensland Nurses and Midwives' Union (QNMU), Submission 15, [p. 8].
  • 30
    Ms Melinda Vaz, Aged Care Member, United Workers Union (Western Australia) (UWU), Proof Committee Hansard, 28 July 2021, p. 17.
  • 31
    Ms Lauren Hutchins, Aged Care Division Secretary, Health Services Union NSW/ACT/QLD (HSU), Proof Committee Hansard, 14 July 2021, p. 28.
  • 32
    Mr Kevin Crank, Industrial Officer, QNMU, Proof Committee Hansard, 14 July 2021, p. 35.
  • 33
    Mr Williams, HSU, Committee Hansard, 13 April 2021, p. 9.
  • 34
    Mr Williams, HSU, Committee Hansard, 13 April 2021, p. 13.
  • 35
    Ms Vaz, UWU Member, Proof Committee Hansard, 28 July 2021, p. 14.
  • 36
    Professor Charlesworth, RMIT University, Committee Hansard, 19 April 2021, p. 22.
  • 37
    QNMU, Submission 15, [p. 10].
  • 38
    Ms Sherree Clarke, Member, QNMU, Proof Committee Hansard, 14 July 2021, p. 37.
  • 39
    Ms Virginia Mashford, QNMU Member, Proof Committee Hansard, 14 July 2021, p. 37.
  • 40
    Ms Tracey Colbert, Member, United Workers Union (UWU), Committee Hansard, 19 April 2021, p. 11.
  • 41
    Ms Clarke, QNMU Member, Proof Committee Hansard, 14 July 2021, p. 36.
  • 42
    Ms Singh, UWU Member, Committee Hansard, 19 April 2021, p. 12.
  • 43
    Ms Clarke, QNMU Member, Proof Committee Hansard, 14 July 2021, p. 36.
  • 44
    Ms Singh, UWU Member, Committee Hansard, 19 April 2021, p. 11.
  • 45
    QNMU, Submission 15, [p. 6].
  • 46
    QNMU, Submission 15, [p. 7].
  • 47
    QNMU, Submission 15, [p. 7].
  • 48
    Ms Carolyn Smith, Aged Care Director, United Workers Union (Western Australia) (UWU), Proof Committee Hansard, 28 July 2021, p. 14.
  • 49
    Ms Vaz, UWU Member, Proof Committee Hansard, 28 July 2021, p. 14.
  • 50
    QNMU, Submission 15, [p. 10].
  • 51
    Ms Anu Singh, Member, United Workers Union (UWU), Committee Hansard, 19 April 2021, p. 12.
  • 52
    Professor Eagar, AHSRI, Committee Hansard, 19 April 2021, p. 37.
  • 53
    Professor Kathy Eagar, rector, Australian Health Services Research Institute (AHSRI), University of Wollongong, Committee Hansard, 19 April 2021, p. 36.
  • 54
    Ms Butler, ANMF, Committee Hansard, 19 April 2021, p. 2.
  • 55
    Ms Clarke, QNMU Member, Proof Committee Hansard, 14 July 2021, p. 36.
  • 56
    Professor Eagar, AHSRI, Committee Hansard, 19 April 2021, p. 37.
  • 57
    Mr Williams, HSU, Committee Hansard, 13 April 2021, p. 11.
  • 58
    Mr Williams, HSU, Committee Hansard, 13 April 2021, p. 12.
  • 59
    Dr Katherine Ravenswood, Private capacity, Proof Committee Hansard, 28 July 2021, p. 13.
  • 60
    Mr Williams, HSU, Committee Hansard, 13 April 2021, p. 14.
  • 61
    Mr Paul Bott, Member, Australian Nursing and Midwifery Federation (ANMF), Committee Hansard, 19 April 2021, p. 2.
  • 62
    Ms Vaz, UWU Member, Proof Committee Hansard, 28 July 2021, p. 14.
  • 63
    Ms Clarke, QNMU Member, Proof Committee Hansard, 14 July 2021, p. 37.
  • 64
    Ms Vaz, UWU Member, Proof Committee Hansard, 28 July 2021, p. 14.
  • 65
    Royal Commission into Aged Care Quality and Safety, Final Report—Volume 1: Summary and Recommendations, p. 76, (accessed 8 October 2021).

 |  Contents  |