Australia is in the midst of crippling workforce shortages, creating the perfect storm for the aged care sector as it also grapples with new staffing mandates.
Cathy O’Leary reports
In the lead-up to the last Federal election, the head of WA’s aged care providers’ industry association was asked to list the three key issues for the sector.
For Liz Behjat – a former Member of the Legislative Council during the Barnett Liberal Government – the answer needed little thought – the main concerns were workforce, workforce and workforce.
As WA State manager of the Aged and Community Care Providers Association, Ms Behjat is trying to help the industry negotiate its way through the challenges of acute workforce shortages amid new staffing requirements.
Aged care providers are having to take a deep breath as new minimum standards for staffing and care start to kick in – including having a registered nurse onsite 24 hours a day – after the Royal Commission found that more than half of residents in aged care lived in homes that were significantly understaffed.
Currently the sector has an average 11% job vacancy rate – with staff shortages preventing 341 elderly West Australian people from accessing residential aged care last year.
A national study by the University of Notre Dame Australia and Catholic Health Australia earlier this year estimated there were about 82,000 vacant jobs in the hospital and aged care sectors – 70% of them in aged care. And it is not just a lack of registered nurses, with many aged care facilities scrambling to find cleaners and cooks, as they compete with the hospitality and mining sectors.
Ms Behjat said retaining staff was difficult, with facilities getting staff in and training them, only to see them go elsewhere where they were offered more money. Some organisations had even resorted to offering incentives such as tickets in staff lotteries for their loyal years of service.
Governments were also trying to make it easier for people in Australia on certain categories of visa to be able to work while they waited for permanent residency.
Innovative pilots
Ms Behjat said the State Government was working hard in this space, including ‘job ready’ pilot programs to give people a taste of what it is like working in the aged care and disability sectors.
“Newly built aged care facilities are not your C-class hospital type anymore – and while there are obviously other issues, the biggest challenge is workforce,” she told Medical Forum. “We have to start looking ahead at different models of care, and where the workforce is to come from.
“In WA, we have the added complexity of distance – what do you do in rural and remote areas, where people want to stay and don’t want to move to the city to receive care. How do you get staff and nurses there – and where do the staff live?”
She welcomed moves to have high school students spend time in aged care homes on excursions or as part of community service programs.
“They learn that there’s more to it than wiping old people’s bottoms and it challenges the preconception that it’s all about old people sitting around in God’s waiting room,” she said. “Many of these kids are surprised to see there are so many activities and therapies like physio and OT, and alternate therapies like art and music therapy.”
Her sentiments are echoed by Clare Grieveson, chief executive officer of Southern Cross Care, one of seven WA aged care providers, representing about 60% of the beds in the State, who are working together in a group known as G7.
Its function is to collaborate with government and industry stakeholders to address issues in the aged care sector, and to ensure the legislative changes for aged care can be practically implemented at the provider level.
“It’s always been a very difficult area, and it’s multi-factorial,” Ms Grieveson said. “The pay for nurses in aged care is lower than in the acute sector, and that’s been the case for some time, so that makes it difficult to attract nurses into the sector.
“The funding from government hasn’t been indexed for many years, so the funding gap has become wider and wider. Now the sector is at the edge of a financial cliff and for some of the really small providers the gap is at the point where it’s getting too large.”
Ms Grieveson welcomed the introduction of the new Australian National Aged Care Classification funding model and recent moves by the Commonwealth, which has pledged to inject more than $17 billion into aged care.
Wages support
She is fully supportive of the case in the Fair Work Commission looking at a 25% wage increase for nurses in aged care – provided it was fully-funded by government.
The recent data showing 60,000 job vacancies in aged care nation-wide was “hugely concerning.”
“It means we can’t fully staff our beds, and existing staff have to work extra shifts, or we need to fill our vacancies with agency staff, which isn’t good for residents because they get to know the existing staff.
“It’s so important to get a workforce to support our residents and provide the staffing levels that are needed in our homes, and while allied health are a core part of the workforce, they’re not recognised in the new funding model, which is disappointing.”
Ms Grieveson said it was time to be more creative about how staff were employed, such as looking at the use of migrant workers, and converting overseas qualifications more quickly.
“Expanding skilled migration arrangements for all workers in aged care, not just RNs, but also our kitchen staff, our carers, is crucial, particularly in WA, where we’re competing with the mining sector where pay is so high.
“When we talk about a perfect storm in the sector from COVID, we need to add the mining industry and workforce shortages into that storm in WA.”
Other avenues to grow the workforce included finding ways to fast-track enrolled nurses converting to registered nurses, which currently took 24 months. Reducing that to 12 months and increasing the availability of nursing qualification exams in WA would help, she said.
Another signal of the changing environment goes a step back – to fewer people signing up to nursing places at university. For the first time, Notre Dame University initially struggled to fill its nursing intake quotas this year.
Tom Ristoski, senior director of Industry Partnerships and Pathways at Notre Dame, said that historically its nursing courses had always been significantly overprescribed, but in its mid-year intake this year it struggled.
When the university checked with other higher education institutions, they were seeing the same downward trend in nursing enrolments.
“We ended up filling the places but the fact that it’s gone from consistently high to struggling to fill, something’s happened, and my best guess is that’s to do with borders being shut, and a big blockage in the visa-processing area of the government,” he said.
“Also playing a role is ‘the great resignation’, as has the significant negative news around health care and how hard it’s been in primary care, but specifically in aged care.
“The headline figure is that the trend is worrying if it continues that way, and it’s absolutely the perfect storm, particularly with the laws passed where from July next year an RN must be present 24 hours at all facilities.”
Action needed
Mr Ristoski said that as a university with strong medical schools and health schools, Notre Dame had been working with industry to look at what could be done, such as accelerating recognition for lapsed and international training and developing career maps.
Another initiative was to accelerate the process of getting nurses into aged care and clinical areas by trialling second-year student nurses doing their practicals and getting paid for it.
“In the past, they wouldn’t have been paid, but now employers are seeing that with such shortages we have to start paying these kids even if they’re not fully qualified. They’ve got some of the minimum qualifications to do very simple work.
“A lot of things being done are bandaid and short-term to deal with the current shortages, but at the end of the day the aged care segment is growing and there is a huge upward trend of baby boomers retiring. Meanwhile the birth rate is declining and so is the immigration rate.
“It’s terrific to raise the wages in aged care, and that will attract more people, but there’s only so many people in the working population, and we really have to look at how we bring in skilled and unskilled workers, because I don’t think we’ve ever been in a situation that’s so dire.
“When kids look around, they can earn good money driving trucks so there are lots of options out there, and the nursing and aged care workforces are up against that.”
Ms Grieveson reiterated the need for providers to work together to advocate for sector-wide issues – a call to action to get compassionate people who are willing to learn new skills to care for residents and clients.
There was common humanity across the generations – people wanted connection, communication and relationships, and that became more important as people aged.
“We’ve got an ageing population and more people will need aged care. The trend of aged care being provided at home through community care is great, as people can stay at home for longer, but it means that when people do move into aged care they have more comorbidities and have more complex care requirements.”
Ms Behjat agreed that more people would be staying in their homes for longer, and when they did go into aged care, they would invariably be older and sicker.
The industry was making sure that the changes could be accommodated by the delivery of services into their homes, or into retirement villages.
Aged care would be very different in the future, and it would not be a one-size-fits-all, she said. Providers would need to be more culturally appropriate, and respect choice and gender diversity.
The industry would also need to be smarter with the resources it had through technology such as telehealth services, particularly to support people in regional areas.
And she added that the elephant in the room was the cost of aged care and the reticence of people to contribute to that.
“During our life we pay our rent or mortgage, but for some reason we all think that at a certain point of life the Government has to look after us. But why do we feel that – that’s a hard conversation to have with people,” she said.
However she said there was still a lot of goodwill and determination in the aged care sector.
And while COVID had been very testing on the industry, with lockdowns and people not being able to visit elderly relatives, some positives could be taken from the experience of WA.
“You know we actually did very well during the height of COVID in WA – we had very few deaths in aged care,” she said. “People can now look back and say ‘we still have mum or dad, we didn’t lose them.’
“That’s a great credit to the aged care industry.”
Aged care staffing reforms
As a result of the Royal Commission’s recommendations and the Federal Government’s new funding model, new minimum staffing and care requirements for residential aged care are being phased in.
By October 1, 2023:
- providers must ensure residents receive at least 200 minutes of total care a day from registered nurses, enrolled nurses and personal care workers
- at least 40 minutes of that care must be provided by an RN
- an RN must be onsite for morning and afternoon shifts each day (16 hours a day).
By October 1, 2024:
- providers have to ensure residents receive a minimum of 215 minutes of total care a day
- at least 44 minutes of that time must be provided by an RN
- an RN must be onsite 24 hours a day.
The requirements are industry averages, with each home’s requirements adjusted based on the relative complexity of their residents’ care needs. This means providers with a higher than average proportion of high needs residents would need to have additional staff working.