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It’s an awful death too many Australians are facing: losing the battle to breathe against a relentless disease, alone but for medical staff, prevented from seeing and touching family and friends, unable to say farewell.

That’s been the fate of 71 people so far in aged care facilities, and likely many more before the Victorian outbreak is finally suppressed. It’s a number that represents over 40% of Australia’s COVID-19 death toll.

The outbreaks in more than half-a-dozen aged care facilities in suburban Melbourne involving nearly 700 patients come months after the deadly Newmarch House outbreak in Sydney that claimed 19 lives despite lockdowns of facilities.

The failure of Newmarch House managers to send ill residents to hospital has been raised as a key reason why the outbreak was so much deadlier there than in other facilities. The families of victims also complained they were banned from removing their ailing relatives from the residence.

Now the focus in Victoria is on aged care staff working at multiple facilities spreading the virus.

Last week, Minister for Aged Care and Senior Australians Richard Colbeck announced a funding package to enable operators to pay staff to work at single sites, and said the Victorian industry had begun “an urgent process to ensure aged care workers work in a single aged care facility where possible”.

“The industry will commence a cooperative process to identify existing workforce sharing and negotiate safer arrangements across the sector to minimise the risk of COVID-19 transmission in aged care.”

But one industry peak body claimed 20-30% of the aged care workforce work in more than one facility. For a sector employing around a quarter of a million people across Australia, that’s at least 50,000 people nation-wide.

Industry sources are telling the media they remain unclear about exactly how the scheme to end multiple work environments will work, while Colbeck is adamant that no worker should be working at more than one site now.

If the 20-30% figure is correct, it represents a large increase on a decade ago, when a Department of Health study of the aged care workforce identified 10% of the workforce as holding more than one job.

Notably, for around half of those who had more than one job, their other job wasn’t in residential care — it was in community care or outside the sector altogether, meaning the challenge for the industry isn’t merely consolidation of existing positions.

This is a heavily part-time workforce — in 2010, more than 90% of aged care workers other than registered nurses were part-time or casual; even 80% of nurses were part-time or casual, reflecting the heavily female composition of the industry.

At least one of the sites of the current outbreaks has serious questions over its compliance with standards, and has been evacuated, as have others, but workers brought in by the federal government were also apparently unqualified.

That is, once again the aged care workforce is at the centre of major concerns about the failings of the aged care system. The workforce is a recurring feature of the many inquiries that have been held into aged care over the last 20 years and more, including the horrific interim report from late last year of the aged care royal commission currently underway.

The issue has not been the lack of funding being pumped into aged care — that has expanded significantly, and gone into both residential care and home care. But private providers have been the main beneficiaries of that increased funding, and have increased their role in the sector at the expense of facilities run by religious groups.

There is now an Aged Care Workforce Industry Council, which has been up and running for over a year, and a two-year-old workforce strategy. The strategy identifies many of the issues also identified in the interim report around the aged care workforce, including high turnover, “poor employee engagement and enablement”, difficulty in attracting talent (a huge problem for regional aged care facilities) and “key capability gaps and skills and competencies misalignment”. It also identifies “casualisation of the workforce” as a problem.

The challenge of improving the aged care workforce and making it a better fit for the kind of care that we want for our seniors has been known about for many years, and government processes have been under way for the last couple. But now seniors in Victoria face having to pay the highest price for our failure to get it right. And minister Richard Colbeck is insisting major reforms happen, literally, yesterday.

This isn’t a problem so much of funding, or even of non-profit versus private providers: it’s a complex policy problem about effective linking of the vocational training system, service provision, consumer empowerment and aged care funding mechanisms so that the sector can attract and retain people with the right competencies.

It’s a national scandal that we have known about the challenge for so long but have failed to respond to it, and it’s one we all share the blame for, not just one government or one provider.

How can we improve the aged care system? Let us know your thoughts by writing to [email protected]. Please include your full name to be considered for publication in Crikey’s Your Say column.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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