Raising the standards

The government decided against registration for personal care workers in its recent aged care reforms, but that doesn’t mean the debate has ceased. Antonia Maiolo reports.

From cleaning and washing clothes, to cooking meals, to shopping, showering and grooming, Justine Minton does it all in her job. For 3½ years she has worked as a personal care worker (PCW) to the elderly.

“I love it, I really connect with the elderly, I get a lot from my relationship with them and I believe they do also,” says Minton, who works for Benetas Anglicare Aged Care Services in Melbourne’s southern region.

It took Minton two days per week over four months, and a hundred hours of professional placement, to receive a Certificate III giving her the skills to become a carer to the elderly.

Apart from her usual tasks there are times where she has gone beyond her role to provide care. “There have been many occasions where I’ve gone in and cooked an entire meal,” she said, as well as providing emotional support over a cup of tea.

However, with the rapid growth of the ageing population the demand for carers like Minton will increase. “We always want to do more,” she said. And certainly workers like her will be doing more, as PCWs and assistants in nursing (AINs) are projected to provide the bulk of care to our growing elderly population in their homes and in residential centres.

Underpinning the workforce

Whether PCWs should be registered and licensed was a question that featured heavily in the submissions and representations to the Productivity Commission during its recent Caring for Older Australians inquiry.

A key concern raised was that as fewer registered and enrolled nurses enter and remain in the aged care industry, responsibility for care of the elderly will fall on PCWs and AINs, creating a fear amongst some that without licensing, practice standards in facilities could deteriorate.

“Registration will give them the same practice standards,” says Yvonne Chaperon, assistant federal secretary of the Australian Nursing Federation. Chaperon believes registration for PCWs and AINs is necessary for the “protection of the public”.

“At the moment if an AIN gives the wrong medication and a resident becomes unwell … that AIN could leave that job and go down the road and join another nursing home,” Chaperon says.

Lack of accountability

Chaperon said without registration PCWs and AINs never have to be accountable for their actions, whereas a registered nurse is reported to the board and will have their professional conduct assessed.

Tracey Osmond, CEO of the College of Nursing, agrees that licensing would be a positive move forward in “protecting some of our most vulnerable members of the public”.

Osmond says licensing gives employers the ability to “trace and track individuals that they might be seeking to employ”. She says the biggest problem is that unsafe and unethical behaviours are unable to be traced, “the stories are many…where someone has been sacked from a facility and they turn up at another facility two weeks later and get another job.”

Not a popular option

However, the concept of licensing was rejected by a majority of stakeholders in their submissions to the Productivity Commission and as a result the final report handed down by the PC last August dismissed licensing as a solution for the sector. Unsurprisingly, the government subsequently did not adopt it as a workforce measure in its Living Longer, Living Better aged care reforms announced on April 20.

Sue Lines, assistant national secretary of United Voice, is one such stakeholder who disagrees with the concept of licensing for PWCs and AINs.

“Problems in the sector in terms of the quality of care won’t be addressed through a licensing system.” She also believes licensing ignores an “already existing legal means” by which to sanction individual behaviour that is criminal or negligent.

Speaking on behalf of a union that represents thousands of aged care workers, Lines said the biggest risk to consumers, workers and employers in the sector is the low rates of pay. “If we continue to undervalue these workers as a society, then ultimately it will be older Australians who suffer.”

On that point, Chaperon agrees. “Registered nurses and enrolled nurses are leaving the sector because they are paid up to $300 a week less than their colleagues who work in public hospitals.”

However, she adds that a “good solid aged care system” would come not only as a result of the wages gap being closed but also with the licensing of PCWs and AINs.

Cost a key factor

Some believe the costs associated with licensing for PCWs and AINs could deter potential workers from the industry. Currently under the Nursing and Midwifery Board of Australia the national application fee for nurses who wish to become registered for general admission is $160.

Chaperon suggests the individual employee would pay. Osmond concurs, but says that needs to be “commensurate with the salary levels that those people have”.

However, Lines says that “for an industry to burden PCWs, who earn a little over $18 per hour, with the additional cost of licensing is economically and socially unjust”.

For Rod Young, the chief executive of Aged Care Association Australia, a model incorporating the individual, employer and government contributions would deliver a better skilled workforce. “If you were to make qualifications a pre-requisite to employment it would likely create even greater pressures on the industry’s capacity to attract workers,” Young says.

More workers needed as population ages

Life expectancy rates reveal that the proportion of Australians over 65 years of age will grow. With this forecast comes a need to keep workers in the industry and to also attract new workers as the requirement for PCWs and AINs in the industry is set to increase, Young says.

“The number of workers we are going to have to attract into the industry over the next 30 years is going to climb from less than 300,000 to 600,000 in 2040, so it is necessary for us to look at how we are going to attract people,” Young says.

Chaperon thinks licensing is “a very attractive option to people”, knowing that they have defined practice standards, standardised training and the option to enter into enterprise bargaining agreements.

Osmond agrees. “I believe that a vast majority of those people who deliver excellent care will welcome this … in fact providing them with an additional layer of verification.”

Striking a balance

Lines says that with licensing there will be a greater difficulty in recruiting and retaining workers without gains in workforce quality. With the cost of licensing falling squarely on the PCW workforce, it is likely that the industry will experience greater difficulty in recruiting and retaining workers without gains in workforce quality, she said.

Young agrees with both perspectives, that there is a need to raise the skill level of workers but “not to frighten them off and make it too difficult to enter the workforce”.

However, Young rejects a one-size-fits-all approach, saying there needs to be stratification among carers with different levels of skill for different tasks. He gives an example: “If someone is coming into a household and doing a weekly cleaning job, do we need that person to be a licensed carer, in that situation I would suggest you probably don’t.” Young says that a restructuring of the workforce may not be the answer but it needs to be considered.

Sector divided over licensing question

* Licensing has been suggested by some as a mechanism to improve the quality of aged care
* An argument in favour is that it would provide uniform skills
* The Australian Nursing Federation says licensing of personal care workers would allow them to have the benchmark education and make them accountable for their practice
* Catholic Health Australia says licensing will do little to address workforce pressures and closer attention to remuneration and workforce supply would provide greater impact
* Alkira Aged Care says registration of all workers would negatively impact on staff recruitment and retention

Workforce challenges

* The demand for aged care workers is expected to increase over the next 40 years
* The Productivity Commission calculated there would be a need for 980,000 aged care workers by 2050
* There are concerns about the capacity of some registered training organisations to deliver trained personal care workers with enough practical experience to deliver quality care with limited supervision
* The sector overall has a high staff turnover rate; with about one in four personal care workers having spent less than a year with their current employers
* Relatively low remuneration of workers is raised as an issue in attracting and retaining workers
* Amaroo Care Services advised the PC that “it remains a sad indictment upon our social values when an entry level zoo keeper attracts a base rate of $19.50 per hour for tending to animals when an entry level personal care worker only attracts $15.90 per hour”.