This week, the Fair Work Commission commenced landmark hearings into whether Australia’s aged care workforce should receive a 25% pay rise, to bring their pay into parity with disability and hospital workers.
Undoubtedly, these hearings will tell us what we already know: the aged care workforce is overwhelmingly female, underpaid and undervalued. Its workers are often asked to work in facilities with unsafe levels of staffing that contribute to neglect and care failures. Rates of burnout are high, with a looming exodus of more workers; a recent survey revealed that one in five workers are contemplating leaving aged care within the next year.
Confronted about his perceived failure to address longstanding workforce issues in the sector during the leaders’ debate last week, the prime minister made a jaw-dropping statement that evoked his infamous phrase about not holding hoses in its sheer disavowal of authority. “We can’t just make nurses fall out of the sky,” Morrison said, implying that the federal government is incapable of exerting any influence over the recruitment or retention of nurses, or improved working conditions in aged care.
This is patently untrue. More than 20 inquiries into the aged care sector over the past decade have handed down a slew of recommendations about how to address aged care workforce issues, including pay rises, staffing minimums, training opportunities, and more nurses. There’s no lack of effective solutions to the problems in aged care – only a lack of political will to enact them.
The royal commission offered several key recommendations to address working conditions in aged care, including mandating the presence of a registered nurse on-site at all times in aged care facilities, and the introduction of minimum staffing minutes per resident per day. The importance of 24/7 RNs in aged care facilities is irrefutable: RNs are highly trained, and because they can dispense pain medication, their presence reduces hospital transfers and enhances the quality of palliative care. Yet in its formal response to the royal commission, the Morrison government postponed the implementation of minimum staffing minutes by over a year, and has only committed to funding RNs for 16 hours per day from October 2023.
In the face of Labor’s commitment to fund 24/7 RNs, the government has mounted the fatalistic argument that there aren’t enough nurses in the workforce, and that regional aged care facilities may have to close if such a standard were introduced due to a dearth of staff. While it’s true that there aren’t presently enough nurses in the aged care system – the Department of Health projects that an additional 14,000 nurses will be required to meet the requirement of RNs 16 hours a day, and an additional 2,500 nurses to enable 24/7 RNs – the real question is why the Morrison government has failed to recruit the workforce it has long known would be needed, and why it has allowed so many regional aged care facilities to close under its watch.
Rather than offering any meaningful solutions to these workforce issues, the Morrison government and its ministers seem intent on relishing the difficult task they will hand Labor if it wins government. Bafflingly, the health and aged care minister, Greg Hunt, has sought to criticise Labor for supposedly backflipping over the fact that they may need to recruit overseas nurses to fulfil its promise of 24/7 nursing, saying that Labor “doesn’t have the nurses or doctors for [Albanese’s] election promises … they will have to import them after his Shadow Minister ruled that out only days ago”, and describing Labor’s commitment to mandating 24/7 RNs by 2023 as posing “profound risks to care and rural services”. Coming from a minister who, as recently as October last year, was championing his own initiative to recruit 2,000 overseas doctors and nurses to help Australia cope with the Delta wave, the critique is as hypocritical as it is misguided.
The federal government’s Aged Care Workforce Action Plan 2022-2025 states it will create 33,800 new vocational and educational training places and 15,000 jobtrainer places, among a range of initiatives aimed at attracting workers to the sector. However, even if all these training places were filled, there will be a shortfall of 19,200 workers across that four year period from the projected 17,000 additional workers Ceda modelling shows will need to enter aged care every year over the next decade to deliver safe standards of care.
Hunt’s comments belie his ignorance of an obvious truth: our aged care system would collapse without overseas nurses and carers, who make up a significant and ever-increasing proportion of the workforce. The federal government’s own Aged Care Workforce Action Plan concedes as much, noting that “migration pathways are also important in the supply of aged care workers.” In 2011, 31% of aged care workers were born overseas; by 2016, this proportion had jumped to 37%. It’s now estimated that 40% of new aged care workers entering the workforce are migrants. Rather than crowing about Labor’s reliance on migrant workers, Hunt would be better to ask himself why such a significant proportion of our existing aged care workforce comes from overseas, and why these mostly female workers are so overworked and underpaid.
It’s critically important that Australia develops a sustainable aged care workforce and that more local nurses and carers are incentivised to enter the sector, but this outcome won’t be achieved by attacking Labor for relying on migrant workers who play such an important role within it today and will make their contributions in the future. It will only be achieved by meaningful reforms which address the underlying challenges in recruiting and retaining aged care workers. The aged care workforce issues are not insurmountable – but it remains to be seen whether the political apathy is.
• Sarah Holland-Batt is an advocate for aged care reform, commenting and writing on policy issues for a range of mastheads. She is a professor of creative writing at QUT, and the Judy Harris writer in residence at the University of Sydney’s Charles Perkins Centre. Her most recent book is The Jaguar (UQP, 2022)