Care work is an essential, although often invisible, contributor to Australians’ quality of life as well as to Australia’s economic prosperity. It is delivered through the formal paid care workforce and the informal unpaid care workforce.
While I will focus on the formal workforce, I acknowledge the critical importance of informal carers who represent a workforce 1.2 times larger than the entire Australian paid workforce.
Many Australians – myself included – are informal carers. And I am grateful for the role, which I can only describe as the most challenging and at the same time most rewarding of all jobs.
Almost every Australian will access care economy services at some point in their life. They encompass services starting from birth – such as early child education and care, to health and community care, including mental health, aged care, disability care, family and social services – and all the way to death with palliative care and end-of-life care.
A critical human services sector, the care economy is Australia’s second ranked high-value industry by gross value add and is typically characterised by low levels of innovation and low productivity.
The care economy is the nation’s single biggest employer, with one in every seven Australians paid to work in it. The workforce is largely female and culturally diverse, with almost 60 per cent of work being personal care or support worker roles.
Service providers across the care economy are predominantly not-for-profit organisations, with a small number of large providers delivering most services, and a large number of small providers delivering few services. Small providers are critical for place-based care, particularly in rural and regional settings as well as providing culturally appropriate care.
The formal care workforce is growing at three times the rate of national total employment although care services are experiencing crippling workforce shortages with high worker turn-over and burn-out.
Total government spending in the care economy was $327 billion in 2021-22 and is forecast to reach a whopping 15 per cent of gross domestic product by 2063. Yet care across all care economy sectors is plagued by lack of services – particularly in rural settings – long-wait lists and complex systems that are difficult for participants to navigate, often duplicative, fragmented, and inefficient when moving between care settings.
Care services are challenged by budget constraints, rising expectations of care, growing complexity of care – including the 421,000 people currently living with dementia – and responding to rapid policy reform arising from multiple royal commissions.
Underlying and amplifying these challenges is the growing demand for care services, driven by an ageing population as well as social (fewer informal carers) and economic (rising cost-of-living) forces as more Australians move into paid jobs.
Care as we currently know it is simply not sustainable – we must innovate our ways of working to ensure that quality and safe care economy services can benefit all Australians into the future. An adaptable and skilled formal care workforce is critical, and this is particularly true for the provision of complex care including dementia care.
Role of tech
Technology solutions must be care-led, represent safe and value-based approaches and be acceptable to participants, workers and management.
Technology and data insights have the potential to address sustainability challenges in the care economy. For example, technology can support care workers by automating administrative tasks so they have more time to provide direct care. Data insights can lead to evidence-informed decisions to increase quality and efficiency of service delivery. And artificial intelligence analytics can improve care coordination and navigation as care participants move between different care providers and sectors, promoting participants independence and choice.
Technology solutions available for use in care settings are rapidly emerging with many types of technology currently in early stages of development. However, the integration and adoption of technological innovations into care services has proven challenging and is not for the faint-hearted.
Care providers are under enormous pressure to deliver services and have limited bandwidth to participate in necessary co-design for effective technology solutions. They are also cautious to trial technology solutions that might be disruptive to services and potentially unsafe.
Providers often have low levels of confidence and trust in new care technology solutions, particularly those solutions developed without robust co-design practices and with poor understanding of the practical issues of delivering care, including a poor grasp of the digital maturity of the sector.
The technology-based solutions being developed within care economy sectors rarely achieve scale beyond the ever-growing collection of pilot studies, and do not transfer between care sectors.
Barriers to implementing technology in care are further amplified by the limited digital literacy of the workforce. Typically, care workforce qualifications do not integrate science, technology, engineering and maths skills, resulting in a workforce that struggles with technology acceptance and the poor implementation of technology-based innovations.
There is an important role for workforce education and skills development as well as sharing of best-practice care to lift innovation performance across the care economy, and to drive development and uptake of new fit-for-purpose care technology solutions.
By way of example a technology pilot with good in-principle support by stakeholders that also serves as a cautionary tale regarding technology risk and workforce acceptance is the Australian-first CCTV pilot study undertaken in South Australia in 2021. The study involved 41 aged care residents at two sites to explore acceptability and viability of using non-intrusive audio-visual surveillance and recording devices to monitor residents for care quality and safety measures, including detecting falls for early care intervention.
The evaluation report, published in June 2022, found that whilst the residents and family members were broadly comfortable with the technology, aged care staff and management were less so.
The artificial intelligence-based technology system had high rates of false alerts, overwhelming staff who were taken away from duties to respond to the alerts and causing staff “alert fatigue” with increased workloads.
Overall, the technology was found not yet sufficiently developed for application in aged care, although some valuable lessons and insights were obtained from the pilot. An important insight was that the perceived benefit of the technology solution must outweigh any additional workload for staff.
Ideally, care technology should reduce care workload to enable value-based care outcomes. Technology development in care must take a care-outcome focused approach, working closely with care participants, providers and workforce to co-develop solutions that are safe and effective, and within the skill capabilities of the workforce.
Integrated co-design approach
The Care Economy Cooperative Research Centre brings together researchers, technologists and care service providers to co-develop, customise, implement and commercialise new technologies, data solutions, ways of working and delivering care that will collectively improve care outcomes for Australians.
It will do so in a closely supported and facilitated way, offering a low-barrier-to-entry for service providers and workers to lead innovation and scale-up efforts.
The CRC offers an integrated co-design approach combined with access to safe, realistic and controlled test-bed environments to de-risk technology in partnership with the workforce to achieve a minimum viable product before trialling in live care settings.
The CRC links innovation with increased workforce capability by developing, trialling and establishing evidence-based best-practice workforce training methods and scaling these approaches through our partner networks.
The Care Economy CRC is a national partnership of 53 organisations – research partners, industry partners including care service providers across all care economy sectors, technology providers and training organisations, state governments, a union, regulatory agencies, and other key stakeholders including care participants.
Together we will address challenges facing providers, build workforce capability to maximise the benefits of technology, and accelerate knowledge adoption through shared learnings across care sectors.
The Care Economy CRC will deliver outcomes that mean better and sustainable care for Australians through technology-enabled products and services, boosted workforce education and capabilities, and improved connections between care economy sectors. Find out more on our website and Linked-In page.
Working together we can tackle the challenges facing the care economy and create a brighter future for all Australians.
Carmela Sergi is chief executive officer of the Care Economy Cooperative Research Centre, and director of research, innovation and translation at Basil Hetzel Institute for Translational Research at the Queen Elizabeth Hospital in South Australia
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