Senior Counsel says Government “missing in action” on aged care – calls for ‘new thinking’ to tackle staffing issues

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Senior Counsel Assisting Peter Rozen QC (pictured above) has underscored the need for the Government to step up and take responsibility for the aged care workforce – in partnership with the industry – as he called directly for written submissions to solve the major issues around staffing.

Unlike recent closing addresses, the Senior Counsel was not as scathing as he has been – though the Commonwealth came in for considerable criticism – rather the focus was on action.

For just over 20 minutes, the Senior Counsel began by outlining the points for action earmarked by the Counsel Assisting team – and there were many.

Size and skills mix:

Mr Rozen stated the aged care workforce is too small with the bare minimum becoming “the norm”. Workers do not have the right skills, which is exacerbated by time-poor staff, poor rostering and inadequate education and training.

“On current trends, the entire system is under serious threat, and without fundamental change we’re concerned the system will fail,” he said seriously.

The need to provide both clinical care and holistic care:

The Senior Counsel said aged care must deliver both quality of life and quality clinical care.

“Unfortunately, the current system appears to be failing on both fronts,” he noted.

The need for more nurses in aged care:

Mr Rozen argued the decline in nurses must be addressed and reversed and staff given more time to spend with care recipients in both residential and home care, quoting Professor Kathy Eagar’s estimate that a 20% increase in total staffing across Australia is needed to provide acceptable (three-star) care.

A need for a model for determining staffing numbers:

“We submit that there’s a strong argument for introducing a methodology to determine appropriate staffing numbers and mix of skills and for any methodology to be transparent,” Mr Rozen put forward.

A reinforcement of the regulatory requirements around workforce:

The Senior Counsel said from the example of the Menarock case study, it is clear that aged care standards and the current assessment processes may not be adequate.

“It is reasonable to conclude that change is required to ensure compliance with the requirement in section 54 of the Aged Care Act that approved providers maintain an adequate number of appropriately skilled staff to ensure that the care needs of recipients are met,” he stated.

The need to recruit the right type of workers:

Citing the Japara case study, Mr Rozen pointed to funding as critical to this reform.

“The issue of staffing numbers and mix is a complex one that is inextricably linked with the funding of the aged care system. Funding is an issue that we will consider in detail as the work of the Royal Commission continues into 2020,” he flagged.

Aged care to be identified as an area of critical skills shortage:

The Senior Counsel said there needs to be more emphasis on preparing graduates to be work-ready in aged care.

More clinical placements for medical professionals:

Mr Rozen said nursing training needs to embrace aged care as “core business” while the coordination of geriatric training must be considered at a Council of Australian Governments level.

Updating the minimum education and training qualifications to work in aged care:

The Counsel added there is scope to fast-track the work of the Aged Services Industry Reference Committee and consider a requirement for ongoing professional development for current aged care workers.

A registration scheme for aged care workers:

“Such a regime should include requirements around training and continuing professional development of that workforce,” Mr Rozen reiterated.

Addressing remuneration:

The Senior Counsel underscored the need to deal with the difference in pay between aged care and the health care and disability sectors.

“As the primary funder and head of the supply chain, an expression used by Professor Charlesworth, the Commonwealth must have a more active role in addressing the remuneration of aged care workers,” he dwelt on.

“Commissioners, we expect you will need to make recommendations to address low remuneration in the aged care sector,” he went on. “Helpful suggestions have been made during the week: legislative reform in industrial relations is one. Proactive involvement by the Commonwealth in enterprise bargaining is another. These and other mechanisms require further consideration.”

The need for strong leadership in the sector:

“Leadership in the sector is crucial,” Mr Rozen stated.

“Aged care needs business leaders who can plan and develop an aged care workforce. Management boards need to be composed of people of mix of skills including people with clinical expertise.”

Senior Counsel also stressed the need for leaders to be accountable.

“In the Royal Commission’s case studies, both this week and in earlier hearings, we have seen how disastrous poor management and governance can be for the safety of residents. Better governance and leadership within the industry could be supported by a regulatory framework that places appropriate emphasis on leadership and governance capability, but regulation alone will not be effective without cultural change in the industry.”

The need for the Government to take a proactive role in the sector:

Here the Senior Counsel was blunt, labelling the Commonwealth “missing in action”.

“It needs to demonstrate leadership and commit the resources necessary to build industry competence and to ensure delivery of an aged care system that meets community standards and it needs to act quickly,” he said.

“While there is a key role for industry in workforce planning, the Commonwealth also needs to be active. Funding from its aged care workforce programs has been stripped. Important data and information on what the industry needs is not captured. The Commonwealth’s failure to lead in aged care has contributed to the distressing outcomes for care recipients, their families and workers that you continue to hear evidence about.”

The need for workforce data:

Mr Rozen called for the aged care workforce census – conducted every four years – to be overhauled.

“We need better data about the workforce to facilitate workforce planning as well as appropriate benchmarking and other transparency and accountability measures,” he said. “There should be regular publication of this data so that industry can use it for planning purposes, and this more regular data collection should be supplemented with a detailed five-yearly census on a wider range of variables.”

In closing, the Senior Counsel emphasised the need for the Commonwealth to step forward and take “positive responsibility” for the aged care workforce in partnership with the sector.

“The time has come for action,” he said. “There have been many reviews, many papers have been written. What is lacking is sustained and coordinated action. There doesn’t appear to be any sense of urgency. The report of the Aged Care Workforce Taskforce published last year, A Matter of Care, is comprehensive. We consider that the 14 strategic actions that Professor Pollaers and his taskforce announced a year ago are broadly on the right track. The blueprint is available. However, the actions are not being implemented; where they are being implemented, we’re concerned, the structures established to drive reform will be ineffective without assistance.”

Mr Rozen acknowledged that the three-year timeframe set down by Professor Pollaers for the implementation of the actions is in doubt.

“Workforce reform as contemplated by Professor Pollaers requires more than band aid solutions and selective and limited refinements in improvements to the way the current system works,” he said. “The strategic actions are designed to be implemented together to achieve an appropriate and effective aged care workforce in the medium and longer term.”

The need for ‘new thinking’

To make his point, the Senior Counsel called for written submissions focusing on “solutions” for the following areas:

  • methods for determining appropriate staffing levels and the appropriate skills mix for aged care;
  • ideas for transforming aged care training and education;
  • a registration scheme for personal care workers;
  • options to resolve low remuneration and poor working conditions;
  • governance, leadership and workforce culture; and
  • the respective role of the Commonwealth and the aged care industry in relation to the aged care workforce.

Details of how you can make a submission will be published early next week on the Royal Commission’s website.

Fittingly, Mr Rozen closed the hearing with a quote from the late Commissioner Richard Tracey which he made following the evidence of four aged care workers at the second Adelaide hearing earlier this year:

“We’re enormously grateful to you for bringing us stories from the coalface and giving us a better understanding of what it is like, to provide quality care to the aged in this community. And the dedication that you display on a day-to-day basis is something this community must be exceedingly grateful for.”

“We’ve heard in this Commission about the challenges facing the aged care sector, but as a community, we ought to follow Commissioner Tracey’s lead and be exceedingly grateful for the dedication that so many aged care workers display on a day-to-day basis,” the Senior Counsel reflected. “However, we submit that gratitude needs to mean something in real terms. It needs to mean a safe place to work. It needs to mean respect for that work. It needs to mean that the work is properly valued.”

I’d say that’s a call to arms.