Health Services Union SUBMISSION

Senate Community Affairs References Committee

Future of Australia’s aged care sector workforce

1O March 2O16

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

About us The Health Services Union (HSU) is one of Australia’s fastest growing unions with over 70,000 members working in health and community services across the country. Our members work across the health and community services sectors in aged care, disability services, community health, mental health, alcohol and other drugs, private practices and hospitals. Members are health professionals, paramedics, scientists, disability support workers, aged care workers, nurses, technicians, personal care and support workers, clerical and administrative staff, managers, doctors, medical librarians and support staff. Since 1911 we have been committed to advancing and protecting the wages, conditions, rights and entitlements of our members through campaigning and workplace activism. The HSU also provides a range of services and support to assist members with many aspects of working and family life. We are a driving force to make Australia a better place.

For questions regarding this submission, please contact: Chris Brown National Secretary

Mark Farthing Senior National Project Officer

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Introduction The HSU represents thousands of workers in the aged care sector across the country. Our members include allied health professionals, nurses, personal care workers and support staff. Each of these workers makes an important contribution to the delivery of timely and quality care for older Australians. The HSU is also a founding member of the National Aged Care Alliance (NACA), which, for sixteen years, has represented the interests of the whole sector: providers, workers and consumers. In preparing this submission, we surveyed a small sample of our aged care members. Their stories, as told by them, can be found throughout this submission and they highlight the systemic workforce challenges facing the sector. Their voices are doubly important as they show the human cost of a chronically underfunded system, which is poorly recongised by governments and society more broadly. Partly this reflects social attitudes which see care work as something that should be done within the home and behind closed doors, with the expectation that the labour involved should be gifted freely and without fanfare by people, the vast majority of whom, are women.1

“We are secretaries, financial guides, family support point, roster data managers, and a thousand other duties in a day people.” Anonymous, Personal Care Worker, NSW The comment above—taken from our recent survey of members working in the aged care sector—is emblematic of the emotional labour and dedication aged care workers bring to their jobs. This member, with over twenty years of experience in the sector, is just one of over 200,000 hardworking carers, health professionals, cleaners, cooks, clerks and managers who form the backbone of the sector. Without them, older Australians would not be able to age well and with dignity. Yet, despite this, aged care workers are some of the lowest paid workers in the country. We welcome the Community Affairs References Committee’s interest in the future of the aged care sector workforce and offer a set of recommendations, which we firmly believe will ensure a sustainable, quality workforce both for now and the future. The HSU would also welcome the opportunity to discuss this submission and our recommendations before the committee. We can also facilitate the appearance of our members so that Senators can hear directly from those who care for and support older Australians. We thank the Committee for the opportunity to make this submission.

1 Meagher, G., Szebehely, M., Mears, J. (2016), ‘How institutions matter for job characteristics, quality and experiences: a comparison of home care work for older people in Australia and Sweden’, Work, Employment and Society, p. 2.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Summary of Recommendations Each of the following recommendations aligns to various arguments we make later in this submission. We believe that it is essential to implement each and every one of them to ensure a quality and sustainable workforce for the aged care sector.

Recommendation 1 Increase base-funding for aged care subsidies, such as homecare packages, with a mechanism to ensure that the increased funding goes to boosting worker wages and addressing workload issues.

Recommendation 2 That the Commonwealth facilitate and fund a workforce development strategy in a co-design approach including unions, aged care providers and consumers. This strategy needs to look at remuneration, precarious employment, skills development, attraction and retention issues (including ways to address workplace bullying, harassment and discrimination) and opportunities for job redesign for older aged care workers.

Recommendation 3 Amend the Sex Discrimination Act to prevent employers discriminating against workers on the basis of their lesbian, gay, bisexual, transgender or intersex status.

Recommendation 4 Investigate the feasibility of, and options for, an accreditation and licensing system for direct care workers, including mandatory minimum qualifications and ongoing continuing professional development.

Recommendation 5 Compel aged care providers to publish minimum and maximum staff/client ratios in the service finder on the My Aged Care website. In an open marketplace, this information is essential for consumers making an informed choice about who will provide their care and support.

Recommendation 6 Task the Australian Industry and Skill Committee and/or the Skills Service Organisation for the community services and health industries, Skills iQ, to commence work on identifying the feasibility of, and options for, innovative job redesign in the sector so that mature-age workers can continue working and caring as they themselves age.

Recommendation 7 Return at least $3 billion2 of funding to the sector and direct it to workforce programs focusing on boosting wages and improving training. This is the amount of funding cut through various budgetary measures since the election of the Abbott/Turnbull Government in September 2013.

Recommendation 8 Delay the implementation of changes to Fringe Benefits Tax exemptions for employees of public benevolent institutions, health promotion charities, public and not-for-profit hospitals and public ambulance services until a transitional funding package is in place to support wages for workers in the not-for-profit sector.

2 This figure is comprised of the $1.5 billion “repurposed” from Aged Care Workforce Supplement; $595 million worth of cuts to various aged care workforce programs in the 2015 MYEFO, $295 million worth of “savings” from changes to fringe benefit tax concessions in the 2015-16 Federal Budget; $652 million from discontinuing the Payroll Tax Supplement in the 2014-15 Federal Budget.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Recommendation 9 Include the employment characteristics of support staff in the next Aged Care Workforce Census conducted by the National Institute of Labour Studies.

Recommendation 10 Adopt those recommendations that have not yet been actioned in the Australian Skills Quality Authority (ASQA) report Training for aged and community care in Australia. Additionally, increase ASQA’s base funding to enable it to fulfil its mandate as the guardian of quality in the vocational education and training system.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

The current aged care workforce: underpaid, understaffed, underappreciated Workforce profile In 2012, the third Aged Care Workforce Census (the Census) was released by the Commonwealth Department of Health and Ageing. The Census—undertaken by the National Institute of Labour Studies (NILS)—provides the most accurate and up-to-date composition of the aged care sector workforce. The defining characteristics of the workforce are that it is overwhelmingly female, older and works part-time (defined as less than 38 hours per week). According to the 2012 Census, while males have increased as a proportion of the aged care workforce, 90 per cent of the direct care workforce is still female.3 Our survey results showed a slightly lower proportion of women (87 per cent), however our sample was smaller and included workers in support services, which are traditionally male-dominated, such as transport and maintenance.

Figure 1. Aged care workforce age profile (HSU survey compared with 2012 National Aged Care Workforce Census – residential direct care workforce dataset)

45.0 42.2

40.0

35.0 32.7 31.0 30.0 24.5 25.0 20.7 % 20.0 18.3

15.0 12.3

10.0 7.1 4.9 2.7 5.0 1.6 2.0

0.0 16 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74

HSU Survey 2012 Aged Care Census

In terms of the age profile of the workforce, 1 in 4 workers (27.2 per cent) in the aged care sector are over the age of 55. Our survey results revealed an even older age profile, with 44.2 per cent of workers over the age of 55 (see Figure 1). Overall, however, the results were broadly consistent and they should raise immediate concerns for policymakers given the fact that not only will these workers soon be exiting the sector, but will also require aged care services themselves in the near future.

3 King, D., Mavromaras, K., Wei, Z., et. al. (2012), The Aged Care Workforce, 2012 (Canberra: Australian Government Department of Health and Ageing), p. xv.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Figure 2. Average number of hours worked per week in main job (n=273) (%)

38+ hours 19.4

31-37 hours 28.6

22-30 hours 34.1

16-21 hours 10.3

11-15 hours 4.8

Less than 10 hours 2.9

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0

The workforce is also overwhelmingly part-time. As Figure 2 shows, only 1 in 5 respondents worked full-time hours (defined as 38 or more hours per week). This is similar to the findings from the 2012 Census, which set a lower threshold for full-time hours (35 hours per week) and found that 28 per cent of workers in residential facilities worked full-time hours and 38 per cent in community outlets.4

Underpaid According to the Census, Personal Care Workers comprised 68.2 per cent of the residential aged care workforce in 2012, with Homecare Workers comprising 81.4 per cent of the community aged care workforce. Given the number of workers in these occupational groupings (176,358) and their size relative to the rest of the aged care workforce, their wages can be viewed as a proxy for the overall level of remuneration in the sector. Table 1 shows the hourly award rates of pay for these two occupations and provides a comparison with the General Retail Award rate of pay. Without impugning the value of the work carried out by retail workers, it can be strongly argued that the level of responsibility, skill and emotional labour inherent in care work is much greater than retail, however, this is not reflected in remuneration levels. While some would argue that the award rates of pay are an inaccurate indicator of the sector’s wages given the significant number of Enterprise Bargaining Agreements (EBAs) in effect in the sector, we would disagree. In Australia, remuneration in the sector is governed largely by the quantum of public funding allocated by state and federal governments. Since government funding is based on the award rates of pay, bargained rates of pay in agreements never stray far from the award rates. As we noted in our submission to the Productivity Commission’s 2015 Review of the Workplace Relation Framework – Issues Papers, bargaining takes on a different complexity when the employer is government funded, but not to a level that would enable them to legitimately bargain with their employees.5 The default rate of pay therefore becomes the minimum

4 King, D., Mavromaras, K., Wei, Z., et. al. (2012), The Aged Care Workforce, 2012 (Canberra: Australian Government Department of Health and Ageing), p. xvi. 5 HSU National (2015), Submission to Productivity Commission Workplace Relations Framework Issues Papers, p. 10.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

applicable award rate of pay and there is limited or no capacity to increase the rate, either for employers or employees. Therefore, despite being employed under an EBA, these workers are ultimately award-reliant.

Table 1. Hourly award wage rate comparison (Aged Care Award, SCSHDS Award and General Retail Award)

Aged Care Award SCSHDS Award General Retail Award (Personal Care Worker) (Homecare Worker) (Retail Clerk/Salesperson)

Hourly Rate Hourly Rate Hourly Rate Grade/Level Grade/Level Grade/Level of Pay of Pay of Pay

$18.36 1 1 $18.60 1 $18.98

$19.72 2 $19.13 2 2 $19.43 $19.85

3 $20.12 3 $19.89 3 $19.74 (Cert III) $20.75

4 $21.96 $20.12 4 4 $20.12 (Cert III) $22.39

5 $23.54 5 $20.80 5 $20.95 (Degree/Diploma) $24.47

$21.92 6 6 $21.26

$22.32 7 7 $22.32

The influence of government funding is further demonstrated by the sector’s unresponsiveness to the usual labour market triggers for increased wages. While there are numerous theories of wage determination, at a general level, it is broadly recognised that insufficient supply, or labour shortages, will generally put upward pressure on wages.6 However, this has not occurred in the aged care sector.

Understaffed When asked to assess the adequacy of staffing levels at their current employer, 61.9 per cent of respondents to our recent member survey stated that they were often or constantly understaffed (see Figure 3). While

6 Kent, C. (16 June 2014) ‘Cyclical and Structural Changes in the Labour Market’ Address on Labour Market Developments, hosted by The Wall Street Journal, available at: http://www.rba.gov.au/speeches/2014/sp-ag-160614.html

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

this is a subjective assessment, it demonstrates that large sections of the aged care workforce are feeling overwhelmed by the amount of work required to deliver quality care with the limited resources at their disposal.

Figure 3. Perception of staffing levels at current employer, HSU member survey (n=265) (%)

9.4 Suitable for the amount of work 29.4 Generally adequate, sometimes fall short 28.7 Often understaffed

Constantly understaffed 32.5

Rebecca, a Personal Care Worker employed at a residential facility in Geilston Bay, Tasmania, has worked in the aged care sector for the last four years and describes how these shortages play out on the ground:

“It’s very hard to find carers. It’s very hard work, and the rate that we are on, for the work that we do, is pitiful. So it’s hard to even entice people to get into that industry. In a lot of nursing homes, if somebody is off sick, well then we end up working short because there isn’t staff.” Rebecca, Personal Care Worker, TAS Similar sentiments were expressed by many other members, who commented on how chronic understaffing made the delivery of quality care impossible:

“You cannot look after and attend to the care needs of between 25 to 30 residents with 3 staff (26 hours) over two units in one shift, you have to work like the wind to get finished by your end of shift time putting yourself at risk of injury. Things don't always run to a time plan they usually never do when you’re working with the frail and aged.” Sonia, Personal Care Worker, TAS

“When a new care directive comes in, which takes more time, we are expected to add it to our list how to dos with no extra time or workers. For example, morning staff are expected now to do the medication rounds instead of a medication nurse – no extra time. A person is needed to assist with the 10pm shift, someone is taken from the 2.30pm shift to work later, leaving the 2.30 shift now short of workers to do the pressure area care in the afternoon that requires two people.” Noelle, Personal Care Worker, NSW

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

“As the number of higher care residents increase, the amount of time given to each resident decreases. Staff feel guilty for not giving more time to residents.” Robyn, Support Services, NSW

“It's becoming like a factory. They come in get fed and dressed and they go. The caring is disappearing.” Anonymous, Personal Care Worker, TAS

Lack of relief for staff who have taken leave was a common complaint from our members, with 1 in 10 workers (10.8 per cent) reporting that this was a chronic issue. However, the most pressing workload issue reported by members was the increasing number of high-needs clients without any additional compensatory resources (see Figure 4).

Figure 4. Perception of impact of various measures on increasing workloads (HSU member survey)

Extra tasks being added to core duties (n=262) 9.2 18.7 44.3 27.9

Increasing workloads stemming from increasing client care 5.7 15.6 45.4 33.2 needs (n=262)

Vacant positions left unfilled (n=257) 24.5 35.4 32.3 7.8

Lack of relief for staff on leave (annual, parental, LSL) 15.4 31.5 42.3 10.8 (n=260)

0% 20% 40% 60% 80% 100%

Not at all Rarely/Slightly Frequently/Significantly Permanently/Chronically

With the move to a more market-driven aged care system and the reality that quality care cannot be delivered without adequate staffing levels, we believe the government should mandate that aged care providers list their minimum and maximum staff/client ratios on the My Aged Care service finder. We believe that this information is essential for consumers to make an informed decision about which service provider they wish to deliver their care.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Underappreciated In a recent comparison of home care work in Australia and Sweden, Meagher, Szebehely and Mears found that in both countries and more broadly, ‘institutional recognition of the skills of home care workers is weak, reflecting the pervasive, gendered undervaluation of care work.’7 Indeed, across the international literature there is a consistent finding that aged care work is a female-dominated occupation with low status and poor pay. Aged care worker acutely feel this:

“The sector and work done is not recognised in the general community. People have little idea or concept of what aged care workers do e.g. the work associated with dementia patients & general care of the elderly.” Sandre, Personal Care Worker, NSW

“We are underpaid and we are not considered an important job.” Christine, Support Services, NSW

“You do not receive the recognition you deserve for the care given to our most vulnerable people.” Anonymous, Personal Care Worker, NSW

7 Meagher, G., Szebehely, M., Mears, J. (2016), ‘How institutions matter for job characteristics, quality and experiences: a comparison of home care work for older people in Australia and Sweden’, Work, Employment and Society, p. 2.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Key drivers of workforce attraction and retention Pay and Conditions The impact of wages on workforce attraction and retention cannot be overstated. International research suggests that the intrinsic benefits of aged care work—that is, the personal nature of the work and relative autonomy for homecare workers—are not strong enough to overcome negative extrinsic factors. In a 2013 study, researchers investigating the quality of frontline healthcare jobs in the United States—including those in aged care—found that for the majority of workers, low-pay, precarious employment and unreasonable workloads outweighed the satisfaction they gained from the inherent nature of care work itself. The researchers concluded that “these ‘bad job’ characteristics play a stronger role in whether workers will stay with their employers.”8 While this was study focused on workers in the United States, the same dynamics are playing out in the Australian context. Our member survey found that over 1 in 4 respondents (28.5 per cent) were likely to leave the aged care sector altogether in the next 12 months. Since employee intention to leave is the strongest predictor of turnover behaviour,9 these results present great cause for concern for policymakers and aged care providers. That being said, the results should not come as a surprise. Earlier in this submission we showed a comparison of hourly wage rates in the Aged Care and SCSHDS Awards with those in the General Retail Award. Far from being an abstract exercise, aged care workers are highly cognisant of the fact that their wages compare unfavourably with those of workers in other sectors. Below are a small sample of member comments taken from our survey, which highlight this wage dissatisfaction:

“Our payrate is as low as McDonalds, we work very hard especially now our residents are high care.” Anonymous, Personal Care Worker, TAS

“I know tradesmen that earn more than me an hour with less responsibility.” Anonymous, Enrolled Nurse, TAS

“One of my colleagues gets more money at her other job in a fruit shop preparing the vegetables for sale. So in reality vegetables are valued more than people if pay rate represents what we value. As a Team Leader giving out medication with little training and little support and managing a team, and being in sole charge, I receive just over a dollar an hour more than our laundry person.” Josephine, Homecare Worker, NSW

“I could earn more working for Aldi or McDonalds.” Anonymous, Personal Care Worker, NSW

“My colleagues and I don't do our job for monetary reasons, we do it because we care! There are more menial jobs which have a higher pay rate! People who feed animals at a zoo get paid more than we do!” Michael, Personal Care Worker, TAS

8 Morgan, Dill, Kalleberg (2013), ‘The quality of healthcare jobs’, p. 817. 9 Radford, K., Shacklock, K., and Bradley, G. (2015), ‘Personal care workers in Australian aged care: retention and turnover intentions’, Journal of Nursing Management, Vol. 23, p. 559; Howe, A., King, D., Ellis, J., et. al. (2012), ‘Stabilising the aged care workforce: an analysis of worker retention and intention,’ Australian Health Review, Vol. 36, p. 84.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

“All aged care wages are dramatically below what they should be considering the amount of responsibility for vulnerable persons.” Anonymous, Manager, NSW

“Could get paid more to stack shelves at a supermarket.” Quentin, Homecare Worker, TAS

In an Australian study of aged care workers’ perceptions of the quality of their jobs, many stated that they loved the work because they were able to ‘make a difference.’ However, the researchers noted that issue of low-pay permeated the interviews and focus group discussions: ‘participants felt that the hourly rate of pay failed to reflect the importance of their role (to both clients and the community) and the level of responsibility associated with that role. Low wage rates tend to reinforce the notion that care work requires minimal skills, and that low skilled women will work ‘for love, not money.”’10 It is not an accident that care work is poorly remunerated. Rather, it reflects the way these jobs have been designed, such as minimising formal skill requirements and narrowing career pathways, thereby keeping wages low. Furthermore, the high availability of vulnerable populations (specifically, women and migrant labour) who take these jobs act as an additional brake on wage increases. Whether this is sustainable is highly questionable. Morgan, Dill and Kalleberg (2013) have raised concerns that ‘the use of “bad job” characteristics to control costs may ultimately make organisations less competitive and raise labour costs over time as they are faced with high levels of frontline worker turnover and a contingent workforce that is underprepared to meet critical skills gaps.’11 The HSU strongly believes that any policy conversation about attraction and retention is not worth having unless the core issues of wages and conditions are on the table.

Insecure work It is not so much job insecurity, but income insecurity that defines the sector. Indeed, with the continued expansion of aged care places, the sector (at least in the medium-term) will continue to provide certainty of employment for prospective workers, however there will be no guarantee that the hours on offer will provide a consistent standard of living. Out of the 303 respondents who answered our survey question about working in multiple jobs, 15 per cent reported working in more than one job. When asked to explain why this was the case, a few stated that they enjoyed the flexibility and variety that came with their choice. However, the overwhelming majority explained that there was no choice involved in their decision, but, rather, that poor pay and inconsistent hours compelled them to work for multiple employers. This was particularly the case for those working in the community aged care sector:

“The pay is so low I need to work multiple jobs. The industry is a part time one, very few employers will give you full time work.” Josephine, Homecare Worker, NSW

“Homecare work is unreliable and inconsistent and can't pay the bills.” Shelley, Homecare Worker, NSW

10 Clarke, M. (2015) ‘To what extent a “bad” job? Employee perceptions of job quality in community aged care,” Employee Relations, Vol. 37, No. 2, p. 202. 11 Morgan, J., Dill, J., Kalleberg, A. (29 July 2013) ‘The quality of healthcare jobs: can intrinsic rewards compensate for low extrinsic rewards?’ Work, Employment, Society, Vol. 27, pp. 817-18.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

“Would like consistent roster without gaps through the day, steady reliable income is important to most people who have bills and home loans to pay.” Quentin, Homecare Worker, TAS

When asked whether they would like to work more or fewer hours per week, 1 in 4 respondents to our survey stated that would like to increase the number of hours that they work. There is a risk that policy changes will exacerbate the levels of precarious work in the sector. In a recent study examining job quality in the community aged care sector, many community carers expressed a fear that the introduction of consumer-directed care (CDC) would increase the pressure on them to provide quality care without any compensatory rise in additional funding or hours.12 Indeed, employers are already arguing that changes to the way government funding is provided will require increased flexibility in the Modern Award. Employer groups are arguing that “flexibility” will be achieved by reducing minimum engagements, essentially turning permanent part-time employees into casuals, but without 25% casual loadings. While the HSU supports the ability of consumers to have choice and control in how their aged care services are provided, it is in no one’s interest to run a race-to-the bottom campaign on wages and conditions to achieve this aim.

Limited career pathways It is well acknowledged in both the national and international literature that career paths in the sector are limited.13 Two thirds of respondents (66 per cent) to our member survey stated that they saw no career advancement opportunities in the sector:

I was laughed out of the office by the manager when I showed interest in becoming an RN within the company and studying through them. So now I do it alone. I used to believe in this company. Very damaging to my self-esteem and took me years to gain the confidence to believe I was still capable of my dream. Kristen, Specialised Dementia Carer, NSW

Limited opportunities due to long standing employees holding onto positions, even though they are not motivated to progress, change, etc. Difficult working culture. Karen, Clerical/Administrative Worker, NSW There is the need for the sector to develop more clearly articulated career pathways and this needs to be a key objective of a future aged care workforce development strategy.

Workload and job design The combination of an ageing workforce and physically demanding work means that the older aged care workers will not be able to continue performing their roles as they are currently structured. Workers, both young and old, repeatedly highlighted the physically taxing nature of their jobs in our survey:

12 Clarke, M. (2015) ‘To what extent a “bad” job? Employee perceptions of job quality in community aged care,” Employee Relations, Vol. 37, No. 2, p. 202. 13 See, for example: Meagher, G., Szebehely, M., Mears, J. (2016), ‘How institutions matter for job characteristics, quality and experiences: a comparison of home care work for older people in Australia and Sweden’, Work, Employment and Society, p. 12; Morgan, J., Dill, J., Kalleberg, A. (2013) ‘The quality of healthcare jobs: can intrinsic rewards compensate for low extrinsic rewards?’ Work, Employment, Society, Vol. 27, p. 818; Martin. B., (2007), ‘Good Jobs, Bad Jobs?: Understanding the Quality of Aged Care Jobs, and Why it Matters’, Australian Journal of Social Issues, Vol. 42, No. 2, p. 185.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

“I was a tradesman earlier in life. But I am getting to old to go further. But also the pressures of this of this profession are wearing me down both physically and mentally.” Anonymous, Personal Care Worker, NSW

“I find the work exhausting, and heavy manual handling, with many overweight residents needing to be transferred and rolled.” Anonymous, Personal Care Worker, TAS

“I’m finding the work hard on the body and not enough staff to carry out the needs of the residents.” Anonymous, Enrolled Nurse, NSW

“Work is heavy, I am 28 and fit and come home with sore wrists... From contralto pushing and turning a standing hoist, there is no time to recover. We are constantly on the move.” Anonymous, Personal Care Worker, TAS The opportunity is ripe to enable these experienced workers to continue caring for longer if the most physically challenging aspects of their roles can be ameliorated. We believe that the Government should task the newly established Australian Industry and Skill Committee (AISC) and/or the Skills Service Organisation for the community services and health industries, Skills iQ, to commence work on identifying innovative job redesign opportunities for older direct care workers in both residential and community aged care.

Workplace bullying and harassment Workplace bullying and harassment in the sector is far too prevalent. In addition to the devastating consequences it can have on the mental health and wellbeing of workers, from a workforce planning perspective it is a key influence on retention rates. Our survey results revealed that only 21.3 per cent of respondents had never witnessed or experienced bullying or harassment in their current workplace and that over a third (36 per cent) had been witnesses to bullying and harassment as well as experiencing it themselves (see Figure 5).

Figure 5. Responses to the question "have you ever experienced or witnessed bullying or harassment in your current workplace" - HSU member survey (n=258) (%)

21.3 21.3

Yes, experienced

Yes, witnessed

Yes, both 21.3 No 36.0

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Of further concern is the fact that fewer than half (44.9 per cent) of respondents to our survey believed they would receive management support if they reported experiencing or witnessing bullying or harassment in their workplace. Nearly a third (30.9 per cent) indicated that they would not receive management support, with the remaining quarter of respondents (24.2 per cent) unsure. The growing number of workers in the sector who were born overseas (35 per cent for residential aged care and 28 per cent for community aged care)14 is also giving rise to a growing incidence of racial discrimination, with 8.3 per cent of respondents to our survey indicating that they have been the victims of workplace racial discrimination. It is imperative that providers, unions and government work together to develop strategies to end the scourge of workplace bullying, harassment and discrimination. It is the firm belief of the HSU that this should be incorporated into a detailed workforce development strategy for the sector.

14 King, D., Mavromaras, K., Wei, Z., et. al. (2012), The Aged Care Workforce, 2012 (Canberra: Australian Government Department of Health and Ageing), p. xv.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Cross-sector considerations: the NDIS The Department of Employment expects that one in every four new jobs created between 2013 and 2018 will be within the health and community services sectors.15 Longer-term forecasts predict that the aged care sector alone will require an additional 1 million workers by 205016 whilst the disability workforce will need to more than double from approximately 73,600 full-time equivalent (FTE) workers to 162,000 FTE workers to cope with the full implementation of the National Disability Insurance Scheme (NDIS).17 Increasingly, the lines are blurring between disability support workers and aged care workers. We often hear reports from members who will be working with older clients in the morning, before heading to another engagement supporting people with disabilities in the afternoon. We anticipate that this trend will accelerate as the NDIS rollout continues, as does the government agency charged with the rollout of the NDIS, the National Disability Insurance Agency (NDIA). In a 2015 report, the NDIA observed that ‘reforms to the disability and aged care sectors are likely to increase the number of suppliers who operate in both systems, which will generate opportunities for those working in both sectors and increase the risk of competition for the same pool of workers. Coordination of disability and aged care workforce initiatives is important, given the interdependencies between the workforces to ensure successful policy outcomes.’18 As a first step, we recommend that government commence work on harmonising safeguarding and quality standards for direct care workers in both sectors. Initially, this could take the form of a standardised national working with vulnerable people check, possibly modelled on the existing scheme in the ACT.19 We also believe there is a need for a move towards a national, role-based registration and accreditation scheme modelled on the Australian Health Practitioner Regulatory Agency (AHPRA), which, at a minimum, includes mandated minimum qualifications and ongoing continuing professional development (CPD) requirements for certain roles. We believe such a scheme would serve multiple purposes. It would improve inter-sector mobility by ensuring that workers are not hampered by competing regulatory frameworks when moving between the sectors, as well as improving the quality of care delivered to clients and, finally, helping to professionalise both sectors and make them more attractive as career options for prospective workers.

15 Community Services and Health Industry Skills Council (CS&HISC), (2015) Environmental Scan 2015: Building a Healthy Future, p. 3. 16 CEPAR (2014) Aged care in Australia: Part I – Policy, demand and funding: CEPAR research brief 2014/01, Australian Research Council. NB: 1 million growth figure is based off 2012 levels. 17 NDIS Integrated Market, Sector and Workforce Strategy (June 2015), p. 19. 18 NDIS Integrated Market, Sector and Workforce Strategy (June 2015), p. 24. 19 ACT Government, Working with Vulnerable People (Background Checking) Act 2011

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Training, quality and accreditation The 2012 Census found that 88 per cent of the residential direct care workforce and 86 per cent of the community care workforce held post-school qualifications.20 Our own survey of aged care sector members found that 84.4 per cent possessed post-school qualifications. Yet, despite this, aged care workers fail to gain the extrinsic benefits normally associated with post-school qualifications, specifically, increased wages. New research examining the relationship between vocational education and training (VET) qualifications and rates of pay in modern awards finds that a Certificate IV qualification in health and community services is worth considerably less in the labour market than a Certificate IV in other fields, particularly compared to traditional “blue-collar” occupations found predominantly in the private sector.21 Indeed, award rates for VET-qualified workers in the community services and health industries are only slightly higher than the minimum wage and well below average weekly earnings (see Table 2).

Table 2. Award pay rates for selected VET-qualified roles in health and community and services (table adapted from Community Services & Health Industry Skills Council (2015), Environmental Scan: Building a Healthy Future).

Award + Required Weekly Award Rate as % of FT As a % of Classification Qualification Rate (FT) Minimum Wage22 AWOTE23

Aged Care Award Certificate III $746.2 116% 51% (Level 4)

Nurses Award 2010 Diploma $760.1 119% 52% (EN, Level 1)

Again, this links back to the pressing need to better remunerate workers in the sector, an objective which can only be realised by way of greater government funding. It is critical that any funding increase needs to take into account both the growing numbers of older people entering the aged care system as well as recognising that the base level of funding provided to current service users is wholly inadequate to properly compensate those caring for them. A separate, although by no means less important issue is the quality of training. The Australian Skills Quality Authority (ASQA) is the national regulator of Registered Training Organisations (RTOs) in the vocational education and training (VET) sector. In 2013, ASQA conducted a national strategic review of aged and community care training. What the regulator found was of great concern, stating that ‘the quality and quantity of training in the sector varies widely, with insufficient on-the-job, or work-based, training being provided.’24 ASQA also found that many trainers and assessors failed to possess current industry experience

20 King, D., Mavromaras, K., Wei, Z., et. al. (2012), The Aged Care Workforce, 2012 (Canberra: Australian Government Department of Health and Ageing), p. xvi. 21 Oliver, D., & Walpole, K. (2014) Missing links: Connections between VET qualifications and pay in modern awards, paper presented at the 23rd National Vocational Education and Training Research Conference: Melbourne. 22 Full-time national minimum wage as at 13 January 2015 23 Average Weekly Ordinary Time Earnings (AWOTE), trend, May 2014 ($1453.90). See ABS (2014), Average Weekly Earnings, Australia, Cat. No. 6302.0 24 Australian Skills Quality Authority (2013), Training for aged and community care in Australia: a national strategic review of registered training organizations offering aged and community care sector training, p. ix.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

and that after an initial audit, 87.7 per cent of RTOs delivering aged care training were not compliant with at least one of the national training standards.25 These failures are having flow-on effects for the sector, with experienced workers questioning the capacity of new entrants to the sector and new workers acknowledging the limited quality of the training they received:

“These days the aged care course doesn't seem to go long enough…for some new carers coming through seem to struggle.” Anonymous, Personal Care Worker, TAS, 6-10 years experience

“In todays training to receive Cert 3 today is very different and there is nowhere enough theory or on the floor training.” Anonymous, Personal Care Worker, TAS, 11-15 years experience

“Cert 3 in aged care is not adequate for the responsibilities involved. I am currently studying the degree in Dementia Care, and the knowledge obtained is invaluable in my work.” Lili, Personal Care Worker, TAS, 1-5 years experience These instances of fast-tracked training were highlighted by ASQA, with the regulator finding that that 70 per cent of RTOs delivered the Certificate III in Aged Care in less than the 1200 hours recommended by the Australian Qualifications Framework (AQF) Guidelines—with some RTOs delivering it in fewer than 200 hours.26 Although competency-based training (CBT) does not necessarily require timeframes, ultimately, it is impossible for an RTO to impart the appropriate skills, knowledge and competencies to learners in such an accelerated timeframe. We note that there have been some improvements to the quality of the aged care qualification since ASQA undertook its strategic review. The HSU, along with other unions, employers and professional associations, participated in the most recent review of the Community Services (CHC) Training Package which led to the development of a Certificate III in Individual Support. This new qualification, which streamlined the previous Certificate III in Disability, Certificate III in Aged Care and Certificate III in Home and Community Care, prescribes a minimum of 120 hours of work-placement in the assessment criteria. While this will go some way to addressing quality concerns, it is our strongly held belief that the underpinning issue affecting quality is the proliferation of poorly regulated, rent-seeking, for-profit RTOs delivering sub-standard training, coupled with a failure of the regulatory system. For industry and consumers to have confidence in the quality of aged care training, government must take much stronger action to deregister rouge RTOs and strengthen ASQA’s ability to fulfil its mandate.

25 Australian Skills Quality Authority (2013), Training for aged and community care in Australia: a national strategic review of registered training organizations offering aged and community care sector training, p. ix. 26 Australian Skills Quality Authority (2013), Training for aged and community care in Australia: a national strategic review of registered training organizations offering aged and community care sector training, p. xi.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

The impact of current government policies Cuts to aged care training and workforce development programs On 15 December 2015, the Turnbull Government announced over half a billion dollars’ worth of cuts to health and aged care workforce development programs. In total, $595.1 million was removed from programs that were addressing the looming workforce crisis facing the sector. These cuts came mere days after the long- awaited release of the Government’s stocktake of aged care workforce programs.27 Despite the Government previously stating that the stocktake was meant to help inform the development of an aged care workforce strategy, its actions revealed that it was simply an elaborate exercise to find out how much they could cut. To-date there has been no announcement from Government about developing an aged care workforce strategy.

“Repurposing” of the Aged Care Workforce Supplement The HSU supported the introduction of the Workplace Supplement as a simple, practical and transparent tool to provide additional funding to approved aged care providers to take steps towards improving the employment conditions of their workforce, which would enhance the attraction and retention of employees. The Workforce Supplement aimed to improve the aged care sector’s capacity to attract and retain a skilled and productive workforce by providing funding assistance to deliver fair and competitive wages in the short term. The policy recognised that an appropriately skilled and qualified aged care workforce is fundamental to the delivery of quality and appropriate care across residential and home care. Any application for additional funding under the Workforce Supplement was voluntary and despite the rhetoric of some commentators at the time of its introduction, no approved aged care provider was obliged to participate. However, the Abbott Government, shortly after winning power in September 2013, “repurposed” the $1.5 billion worth of funding linked to the Workforce Supplement, depriving aged care workers of the opportunity to see increased wages.

Changes to fringe benefits tax concessions and ending Payroll Tax Supplement In the 2015-16 Budget, the Government announced changes to fringe benefits tax (FBT) concessions for employees of public benevolent institutions,28 health promotion charities, public and not-for-profit hospitals and public ambulance services. These changes, due to start 1 April 2016, are forecast to produce revenue of $295 million over the four-year forward estimates. For the not-for-profit sector, these concessions were designed to help them attract and retain staff by enabling employees to reduce their tax liability and thereby receive a larger take-home wage.29 The HSU acknowledges that FBT concessions are an inefficient and inequitable way—inequitable insofar that the limits are not indexed and therefore their value in real-terms declines year-on-year—to provide wage assistance to the sector and its workforce. However, we believe that the Government should have adopted the recommendations of the Henry Tax Review to phase out these concessions over a ten-year period and replace the wage gap with direct government funding.30 The

27 Department of Social Services (2015), Stocktake and Analysis of Commonwealth Funded Aged Care Workforce Activities: Final Report (prepared by Health Outcomes International). 28 PBI covers many aged care providers, whose workers receive the highest level concessions. 29 We note that the FBT concessions were not necessarily used to increase wage-rates above the market rate, but merely to enable NFPs to offer market-rate wages at a lower cost than the private for-profit sector. 30 Commonwealth of Australia (2010), Australia’s Future Tax System: Part Two Detailed Analysis, Vol. 2, p. 212.

HSU Submission to the Senate Community Affairs References Committee Future of Australia’s aged care sector workforce

Government, however, has abolished the concessions virtually overnight and offered no replacement funding. Furthermore, in the 2014-15 Budget the Government discontinued the Payroll Tax Supplement, which was available to eligible residential aged care providers. Across the four-year forward estimates this change was forecast to save $652 million. Similar to the changes to the FBT concessions, this change will have flow-on effects for wages by further squeezing provider budgets, the largest element of which, is wages.