Quality in aged care is underpinned by a strong workforce

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In her recent Press Club address, the Federal Minister for Health and Minister for Ageing, Sussan Ley, spoke about the Government’s priority of ensuring choice and flexibility of age services for older Australians. Quality was a key theme of her speech, and quality is the topic of the month across aged care.

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In NSW a parliamentary inquiry into nursing levels in aged care released its report at the end of October, and much of its recommendations relate back to quality improvements.
The inquiry was prompted by the removal of the high care/low care distinction in the federal Aged Care Act, which impacted on existing NSW legislation that required an RN be on duty at all times in a high care facility. NSW was the only state in Australia with such a requirement.
While this is currently a state matter, the inquiry called for an overhaul of the national aged care regulatory framework and for the NSW Government to drive national change in relation to staff-to-resident ratios and wage disparity between nurses in aged care and the public health system through COAG.
The implications of this would be far-reaching into health and community and disability services as we all draw from the same finite workforce, making mandated staff ratios in aged care a further workforce recruitment and retention issue for our health services, without the review providing any evidence that ratios will improve quality outcomes or quality of life.
In 2011 the Productivity Commission stated that “…across-the-board staffing ratio is a fairly ‘blunt’ instrument for ensuring quality care because of the heterogeneous and ever changing care needs of aged care recipients - in the Commission’s view it is unlikely to be an efficient way to improve the quality of care.”
LASA supports this view and has serious concerns about any legislation change that does not enable greater flexibility of service delivery as this impacts providers and more importantly, older Australians receiving age services.
The key focus in any legislative or policy change – at state or federal level – has to be on quality outcomes and improving access to services. Age service providers need flexibility to adjust the profile of care as peoples’ needs change.
We cannot ignore the fact that mandating staff ratios will generate significant staffing cost increases, which in turn stands to jeopardise quality and innovation if funds are diverted from these areas.
Eliminating incentives for providers to invest in innovative models of care, or adopt new technologies that could assist care recipients was another concern raised by the Productivity Commission back in 2011.
If we look at the approaches by other countries with ageing populations and similar workforce shortages, in the UK they are focusing more on improving skills and diversifying training for accredited and care staff, which is a far more sustainable approach.
Already this year we have seen a number of landmark decisions which amplify existing workforce issues in age services, and will continue to do so if action isn’t taken.
Workforce issues including staff recruitment, retention and wage costs are one of the biggest ongoing challenges for age service providers. Out-dated industrial relations frameworks, policies and legislation at federal and state levels currently hamstring many providers, irrespective of their business model, impacting the care of older Australians.
While we are still waiting on the government to confirm the work plan on a national aged care workforce strategy, a number of parallels can be drawn from the NDIS workforce strategy, which was published online in July 2015.
The draft workforce relations framework report released by the Productivity Commission shows promise of greater flexibility and legislation to support employers and staff to deliver care services outside of historically standard hours; a growing trend being driven by consumer directed care. However, until this framework is finalised and rolled out, the flexible care options particularly for home care services that require workforce flexibility will remain difficult or in many cases unachievable.
There are other options to boost our aged care workforce such as revised migration policies that would improve opportunities for skilled and semi-skilled care workers from overseas to join our age services workforce on both short and longer term arrangements.
Separate to the Productivity Commission inquiry, LASA is already working with representatives from both government and the opposition on alternate workforce models, which includes different models for migration intake.
In addition to everyday care, changes to migration policies should address changing cultural diversity within our ageing population by matching target countries to CALD demand.
While often considered an interim solution, it must also be realised that revised migration or immigration opportunities is not a silver bullet for our needs and such migration policies will still take at least two years to implement – longer if training programs need to be developed and rolled out in the countries we seek to draw staff from.
Therefore migration policy changes need to be considered in concert with other initiatives identified and developed as part of a single workforce strategy.
Focus in age services must be on continuous improvement rather than regulation or compliance. This will only be achieved through supporting access and availability of age services that reflect population needs via facilities, accommodation and a strong workforce.
The fact remains we need 80,000 more beds in the next eight years to meet demand in residential care alone while investment is needed to meet demand for in-home services that will ramp up as the baby boomers enter their 70s from next year.
It is up to industry and consumers to work together to improve access to information and services, enabling care and accommodation more effectively and efficiently. With aged care now back under the health portfolio and with a seat at the cabinet table there is greater opportunity for new solutions to issues that cannot be developed for our industry in isolation from health such as workforce strategy.

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“Workforce issues including staff recruitment, retention and wage costs are one of the biggest ongoing challenges for age service providers”.

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