‘Lost our focus’: increased regulation distracting sector, expert says

The ramping up of regulation in aged care over the past two years has led to providers and staff losing autonomy in their roles, an employment relations professor has said.

In July last year, aged care minister Anika Wells announced the sector's reforms, including a new Code of Conduct for staff and providers.

Wells received national criticism earlier this month after 'secretly' changing home care package manual rules.

Yet, employment relations senior lecturer Dr Matthew Xerri from Griffith University said that constantly increasing the number of rules is taking away the ability of organisations and workers to provide quality care.

"As much as it tries to maintain a quality level, our current regulatory framework actually puts pressure on the industry," Xerri explained.

"It's reducing the sector's autonomy – everyone is basically reading off scripts.

"We seem to have lost our focus."

Aged Care Insite spoke with Xerri about how we could raise the quality in aged care through leaner regulatory models rather than further restrictions and policies.

ACI: Can you explain why more rules could lead to decreased care delivery in aged care?

MX: Aged care services are very limited in what they can do because of the regulatory framework. On one side, we're hearing horror stories and reports that the quality of care in aged care is poor. And on the other side, you've got a regulatory framework designed to maintain that quality of care.

Every time we see a report from the Royal Commission, the results are similar – that aged care is underfunded and lacks transparency and accountability. The government also responds to this in the same way. It says, 'okay, let's increase the regulation.'

But that's the problem here. Some regulation is necessary, but by constantly increasing the burden and the amount, it's taking away the ability of organisations and workers to provide quality care.

It seems that we've lost our way and focus.

The focus is no longer on delivering care but on maintaining profit level, and for not-for-profit organisations, it's minimising costs. 

All of this extra red tape and paperwork they have to follow and do leads to reduced autonomy, confusion around policies and more time spent on correcting mistakes and trying to understand new guidelines.

As much as it tries to maintain a quality level, our current regulatory framework actually puts pressure on the industry. This is because the government brings every policy down to specific detail, and the providers and employees lose their autonomy in the role. 

They're basically forced to read off of scripts.

If we keep doing that and we're not getting the outcomes we want, there should be a time when people realise that more regulation is just making the problem worse.

What are some of the fundamental issues behind this regulatory framework?

A part of the issue is that we're still contracting out these services, so while we can do that, we'll have to continue to rely on this regulatory framework. Adopting a leaner approach in which we service in Australia might reduce the heavy regulatory framework is worth considering.

As we know, the government contracts services to private companies, not-for-profit companies and a range of public companies. Once the government hands it over to the contractor, they have a very limited ability to control how the services are implemented. 

Because there's no specific requirement around how they'll implement their procedures and policies, we end up seeing this underfunding flow through. 

Plus, it takes away from the organisations' ability to maintain their profits.

Overall, we see managerialism and underfunding in the sector. The facilities are often understaffed, and we see this in how employees feel undervalued. 

So, everything stems from this austerity policy development. Even though the government has increased funding for aged care, it will just have a superficial effect on the industry.

Do you think the pay rise will make much of a difference?

It's not going to do very much at all. 

Let's look at current pay. Current pay for an aged care worker on the award is $23,57 – that's the same level for a contract cleaner.

While any pay rise is welcomed, it's going to do a little to improve the perception of our aged care workers and how valued they feel in their roles.

The 15 per cent increase in July will take us to $27, 11. Whether that's a good increase or not – it's not for me to say – it's certainly not the percentage they're asking for.

Generally, aged care workers are expected to do more and more what's above their pay. 

There's this diminished opportunity for them to provide meaningful and holistic care because they've got these administrative boundaries, and not to mention, they're also not trained well enough.

The training needs to be improved to be able to deliver the care that they want. 

All these things together impact morale and how satisfied employees are with their jobs. And this is why we see so many leaving every year.

It all stems from how they're treated.

But on a deeper level – it's not about their pay. Yes, it might attract some of them to take up the work in the first place. But the central issue is how they get into the workforce, and there's so much shock about the job, the expectations and poor conditions.

The pay increase is just one small thing. 

A more holistic approach is needed if we want to attract more and retain our good quality workers. And that's going to need to look at all those things like the work conditions – the opportunity for development. 

One of the big things that keeps someone in a role is that opportunity for development and the perception that the organisation cares about your wellbeing. 

And of all of the research that's been done, one of the loudest things that I hear is the organisation doesn't care.

Would having fewer rules and regulations would improve aged care?

There's definitely a balancing act – I'm not by any means suggesting that we remove the regulatory framework.

I can only speculate on what it would look like if the regulatory framework were to be reduced. 

But what I can say is that, right now, the framework is not working. 

We still have just as many issues with quality as we did under previous governments, and it's getting worse and worse. 

It's all about how and which framework is implemented, and the current burden of paperwork that needs to be completed and the red tape associated with that is too much.

We can get better in the way in which we operationalise the framework.

We should streamline the amount of paperwork as much as possible and try to reduce that burden on each one of the facilities. That would be a good start.

We should also reassess the quality framework and identify what it's currently not working.

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