This is the second story in this series. Read the first here.
If problems in the aged care workforce have been a staple of policy discussion for years, so has governments claiming to be addressing the issue and failing.
The following list of reviews, inquiries, studies and responses is exhausting — but nowhere near exhaustive. They do, however, illustrate a pattern of policymakers knowing full well what the solutions are but failing to implement them.
Where to start? Perhaps with Christopher Pyne. After several inquiries and reviews by committees and independent panels, the Senate’s community affairs committee reported in 2005 on aged care standards and workforce shortages. Pyne, John Howard’s then-aged care minister, responded by boasting of how much the Coalition was spending on aged care and rejecting any recommendations relating to better remuneration on the basis that “wages and other employment conditions are matters between employees and employers”. In doing so, he cited WorkChoices approvingly.
In 2008 the Productivity Commission — citing many earlier studies and inquiries — warned of staff shortages and noted that the disparity between wages for nurses in acute care and aged care was a major problem. There had been a number of government initiatives to address this but “wage differences between the aged care and acute care sectors have not narrowed” — because providers weren’t passing through funding increases to staff, and hospitals kept getting extra funding for staff as well (illustrating the problem that attracting more nurses to aged care isn’t a simple matter).
The Productivity Commission’s major inquiry into aged care in 2011 again identified low remuneration as a major problem: “The disparity in wages between the public health system and the aged care system can create issues.” It recommended more funding with aged care pricing independently assessed to include higher wages.
The following year the Gillard government announced a major reform plan for the sector and finally committed $1.2 billion to address workforce issues, including wage increases via conditional higher payments to providers. In 2013 it implemented an aged care workforce supplement to specifically direct funding into higher wages.
So what happened after that? We never found out, because in 2014 the Abbott government abolished the supplement, despite warnings from the Aged Care Financing Authority. Instead it argued it was “well aware of the workforce challenge” and told aged care providers to bring more temporary migrant workers in under labour agreements.
Another community affairs committee report on the aged care workforce in 2017 expressed concern “that pay and conditions for workers in the aged care sector are becoming more uncompetitive with other sectors. The committee considers that the move to ‘zero hour’ contracts, which are intended to provide flexibility for aged care service providers but which have the impact of further marginalising aged care sector workers, is making the industry a less attractive alternative for workers.”
By that time an Aged Care Workforce Strategy Taskforce had been established by the government, and in 2018 it produced a strategy that noted there was still a substantial difference between aged and acute care nursing salaries and that low pay was a problem for recruitment and retention. But it limply recommended that “industry develop a strategy to support the transition [of personal care workers] and nurses to pay rates that better reflect their value and contribution to delivering care outcomes”.
That almost brings us to the present and the aged care royal commission recommending unions, providers and the government collaborate to lift award wage rates, and the pricing authority covering the sector to take into account the need to attract high quality staff. It also noted that 20 years on from efforts to close the acute/aged care disparity: “We heard that in the context of the COVID-19 pandemic, the strategy employed by one provider to attract more staff to assist during the pandemic was to increase pay rates and align them with acute sector pay rates. We heard that this strategy worked.”
In its response to the royal commission report, the government declined to provide any part of the additional $18 billion it committed to actually lifting pay rates — even when the Liberals’ preferred policy option of importing more temporary workers was closed off due to the pandemic.
Moreover, it reversed its mid-pandemic decision to prohibit aged care workers in Victoria working across multiple sites, thereby enabling a return to the kind of precarious working conditions that not merely had been a key cause of the spread of COVID in that state but which it was told in 2017 made the industry less attractive.
That is, it refused to address two issues that we know from OECD research and domestic Australian reviews make a difference in recruitment and retention: better pay (especially the disparity between acute and aged care) and precarious employment (platform/gig economy-style employment also means more fragmented care and less investment in training).
Why have governments — the Gillard government being the honourable exception — persistently refused to invest in higher pay and encouraged precarious work in aged care? One factor is the broader problem that has created the tragedy of an unfit aged care system: a lack of political interest in a sector that is not seen as a priority. Voters only care about aged care temporarily, when their own seniors move into it. Otherwise, in the absence of kero bath-type stories, it can be kept below political boiling point — unlike the broader healthcare system where political jobs are on the line when major stuff-ups occur.
The Productivity Commission put its finger on the other issue when it noted the “poor bargaining positions of a highly feminised, part-time workforce which has had limited success in raising wages”. Abouy 90% of aged care workers are female, and on average a little older than the broader workforce. It’s also heavily part-time or casual, and has less public sector involvement as employers than most healthcare industries. This undermines that workforce’s capacity to bargain and lobby effectively despite its numerical strength (compared, for example, with heavily male manufacturing unions and their political influence).
The growing role of gig economy employment in it undermines the bargaining and lobbying power still further. And in Australians’ traditional dismissal of service work as some kind of second-tier employment compared with “real jobs” involving making things, aged care comes out the worst of all.
How likely that between now and 2030 there’ll be still more reviews, inquiries and studies all examining the same problem, suggesting the same solutions, to no effect?