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Royal commission gives pause to reflect on reform


The Royal Commission into Aged Care is a welcome development for many reasons including the opportunities it provides to reflect on the achievements as well as the oversights of the reforms in home care, Dr Beatriz Cardona writes.

Dr Beatriz Cardona

The new aged care quality standards with an emphasis on empowering service users and positioning them at the centre of their care decisions constitute a positive development which if properly implemented should translate into better services and person-centred care.

The quality standards include eight benchmarks, each consisting of a consumer outcome, a statement of expectation for the organisation and the organisational requirements to demonstrate that the standard has been met.

They require organisations to make significant investments in resources, including infrastructure, staff training, linkages, coordination, equipment, systems and partnerships.

During the consultations with service providers, consumer groups, peak organisations and individuals, it was recognised that these extra resources were essential to ensure service providers could be ready for full implementation of the standards and framework from 2019.

The Department of Health is developing guidance materials and information sessions to help services better understand the standards and what they need to do to comply.

A shift for service providers

The shift in the standards from what service providers need to do to how it should be done and what outcomes should be achieved, represents a significant change in how service providers interact with consumers and deliver services.

Standard 4, for instance, requires that each consumer gets safe and effective service and supports for daily living that are culturally safe and meet their needs, goals and preferences, and optimise their independence, health, wellbeing and quality of life.

Meeting the various components of this requirement involves investment in infra-structure, processes and resources including systems and tools to identify goals, clinical and social care needs as well as instruments to measure outcomes in these areas.

Staff also need training and support in areas such as cross-cultural communication, wellness and reablement, conflict resolution and risk assessment. Issues such as continuity of care would also become more prominent given that it plays a key role in consumers’ experience of quality of care.

This example highlights some of the challenges services, will face when transitioning to the new standards, particularly small organisations with limited resources.

Need to invest in the aged care workforce

The shift to individualised funding and a marketised approach to aged care raises key challenges that so far have not been adequately considered and addressed throughout the reforms, and are likely to come under scrutiny from the royal commission.

One of these concerns the capacity of providers, especially small and rural organisations, to invest resources in the training, support and retention of care workers, who ultimately will be the ones responsible for the delivery of care as required by the standards.

A market driven model of care fundamentally seeks to minimise costs and increase profit by carefully rationing and monitoring the time, resources and services provided to each client.

An area that is often undermined by these competitive pressures is staff training, retention and development. The experiences in the disability sector under the NDIS, as research by Flinders University has shown, have been marked by concerns about pay, staff retention, increasing levels of casualisation and the de-professionalisation of the workforce.  In relation to aged care sector, the senate inquiry by the Australian Government into the future of Australia’s aged care sector workforce in 2017 concluded that:

The aged care workforce, which is the focus of this inquiry, is being significantly affected by ongoing issues with pay and conditions. Workers often struggle to secure competitive pay and conditions, relevant and timely training, and have fewer career and advancement opportunities than may be available in other comparable sectors. They also face, in the changing aged care sector, greater insecurity as the model of service delivery changes. For regional and remote workers, these challenges are felt more acutely, particularly in relation to training and professional development, and insecurity in the face of the introduction of CDC.

The recommendations from the senate inquiry include the development of an agreed industry-wide career structures across the full range of aged care occupations and clear steps to address pay differentials between the aged care and other comparable sectors including the disability and acute health care sectors. These two recommendations have been noted but not supported by the Australian Government as they point out that workplace relations is a matter for individual employers and subject to the jurisdiction of industrial tribunals while the current national Skilling Australian Fund should be able to assist the vocational and career needs of the aged care workforce.

Working conditions and quality of care

The relationship between the quality of working conditions and the quality of the care is acknowledged among academics and service providers. It is also acknowledged that quality of care is a good indicator of positive consumer outcomes including quality of life and health outcomes, another factor raised in evidence before the royal commission.

It is therefore essential to invest in the training, retention and up-skilling of the workforce who will ultimately be responsible for the delivery of care as required by the standards. Positive consumer outcomes, including improvements or maintenance of health and wellbeing and quality of life, require a combination of 3 key elements:

  • a quality workforce
  • good quality of care
  • quality of consumer’ participation and input

The new aged care quality standards require these three elements to come together through targeted investment in each area.

Service providers under pressure

The standards represent a much needed and welcome development. They have however been introduced at a time when, as national and international research shows, market driven models of social care provision are placing pressures on service providers and driving changes in work organisation and employer practices, with potential to degrade the jobs of the very people responsible for implementing them.

The current trend in the disability sector shows that the shift of jobs from the government to not-for-profit and private sectors does not bring a transfer of similar working conditions. Training opportunities have also diminished and casual contracts replace permanent employment.

Achieving the full potential and aspirations contained in the new aged care quality standards will require a thorough commitment to quality in its three key dimensions – a quality workforce, able to deliver quality of care through quality engagement with consumers and their carers.

Under the current model there is a risk commercial considerations will continue taking priority over the needs of frail older people and care workers, most of them fully committed to quality of care but increasingly forced to abandon aged care due to unrealistic workloads, poor working conditions and remuneration.

Unless we address the fundamental flaws with this model we risk the new aged care standards becoming a pointing reminder of our failure to the most vulnerable people in society.

Dr Beatriz Cardona is a research fellow Macquarie University and a sector support worker with The Multicultural Network.

To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. We will also be issuing regular Royal Commission Roundup reports which you’ll receive in addition to your weekly e-newsletters.

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