Frailer residents with complex nursing needs, greater prevalence of mental health issues, increased documentation and a higher reliance on technological skills, and acute workforce shortages are just some of the grievances residential aged care staff have put to the Fair Work Commission.
As part of the ongoing aged care work value case, 72 aged care staff from across the country – ranging from registered nurses, personal care assistants, administrators, cleaners and food handlers – have given evidence before the full bench of the FWC.
“Increased violence and aggression is a significant problem.”
Maree Bernoth is Associate Professor at the School of Nursing at Charles Sturt University in Wagga Wagga, NSW. She formerly worked as a registered nurse and nurse educator in residential aged care facilities.
Since the late 1990s, aged care has transitioned from caring for fairly functioning residents to older and frailer residents with complex nursing needs, Dr Bernoth told committee members.
Residents entering aged care are less mobile, more likely to be incontinent, their skin is more vulnerable and other problems are more likely, such as swallowing issues, she said.
Dr Bernoth gave evidence to the committee that over the past 20 years she has seen a reduction in the ratio of RNs, especially educators and mentors, in aged care. The deficit of RNs in aged care facilities also means that AINs and personal carers are “more required to take on leadership roles.”
She also told the FWC there was a greater prevalence of mental health issues for residential aged care staff to deal with. Personal care assistants or assistants in nursing “do not necessarily have all the skills for this but are being asked to perform this work with little support to help them,” reads the FWC document – a 325-page summarisation of witness testimonies.
Dr Bernoth also told the committee that time spent completing documentation was increasing and requires new technological skills. Increased violence and aggression, particularly resident-to-resident aggression, is a significant problem too, she added.
Meanwhile, Dr Bernoth gave evidence that dealing with residents’ families is “emotionally demanding”. Often care providers do not have good complaint management systems and family frustration is taken out on care staff, she said.
“Personal care workers are doing more than ever before.”
Personal care workers Geronima Bowers gave the FWC evidence about her 15-plus years working in the sector. She said personal carers were not provided with adequate training on how to manage residents with serious illnesses.
At her workplace usually three or four nurses are responsible for 145 residents, she told the committee. In the past more nurses were rostered, but nurses have been replaced by personal care workers “to save costs,” Ms Bowers said.
Personal care workers are doing more work than ever before because residents are entering aged care with more acute health conditions than in the past and many aged care providers are short staffed, she said. Technology is used more than ever, but this is difficult for many personal carers as they lack the appropriate skills, Ms Bowers said.
“Residential care had become more stressful.”
Hazel Bucher gave evidence about her experience spanning 40 years of working in the aged care sector. She told the committee members that the nature of work in residential care had become more stressful during her past 10 years in the sector, noting there are many competing priorities such as creating a homelike environment while also providing clinical-grade service.
Ms Bucher said attracting nurses to the sector is difficult because the type of nursing “is viewed as less important than nursing in acute care and the pay is less.” New graduate nurses usually leave the sector after a few months, she said.
“Required to perform extra duties, despite working the same hours.”
Donna Cappelluti gave evidence to the FWC about her seven years working as a food services assistant in residential aged care.
She said that it is becoming much more common to serve food to and interact with residents exhibiting behavioural problems, including aggression. She told the committee that she has asked management for training on working with residents living with dementia but none has been provided.
Ms Cappelluti told the committee that there was supposed to be a nurse supervising the servery during dining times. However, the nurses and personal care workers are usually too busy, so if a situation escalates, a nurse or personal care workers needs to be called to assist, she said.
She also provided a summary of her duties and said that in the past two-to-three years, due to COVID-19 and a greater focus on food hygiene and quality, she has been “required to perform extra duties, despite working the same hours.”
“Personal carers are performing work previously provided by physiotherapists.”
Judeth Clarke, a personal carer in a residential care facility, told the FWC that she was required to complete “onerous paperwork”. There are fewer nurses on shift than in the past and outlined insufficient nurse-to-resident ratios at her facility, she said.
Due to reductions in nursing staff, personal care workers have assumed additional duties that only nurses performed in the past – such as monitoring residents for adverse drug reactions. There is often a wait for assistance from a nurse because they are in high demand, she told the committee.
Ms Clarke also gave evidence that personal carers are now performing reablement work previously provided by physiotherapists.
“Never known the job to be as hard or complex.”
Sally Fox – an extended care assistant in home care and residential care settings – also described the changes to her role, including the dramatic increase in workload. She told the FWC that this is due to two factors: the reduction of ECAs rostered and the significant increase in residents who are unwell.
She said that she has never known the job “to be as hard or complex as it is now.” Ms Fox added that the financial stresses she experiences is due to low wages and that it is common for her to have to pay for things on credit card, to slowly pay them off.
“RNs now spend more time in the office.”
Wendy Knights gave evidence to the FWC about her experience working in residential aged care for 12 years as an enrolled nurse. She, too, spoke about pay and said it “barely meets her expenses.” This, in combination with high workloads and sometimes dangerous conditions, causes staff retention issues.
Ms Knights observed that registered nurses used to be on the floor much of the time, however, owing to an increased administrative workload RNs now spend “more time in the office.”
“Staff are increasingly time poor because hours have stayed static.”
Ross Heyen is a cleaner in a residential care facility. He told the full bench of the FWC that the “complexity and seriousness” of residents’ health conditions have increased, including more entirely bed-bound residents and others who cannot perform basic tasks such as getting out of bed, toileting or showering.
Staff are increasingly time poor because their hours have stayed static, he added.
Mr Heyen gave evidence about the staff-to-resident ratios at his workplace. He stated that he has been alone in the wing that he cleans with residents who are agitated or have fallen – including residents with dementia – and it is difficult to perform his duties when there are residents requiring urgent care and attention.
He provided examples of times he had witnessed residents in risky situations because no staff were available to answer their call for assistance, and so, while not his job, he had checked on them.
When staff call in sick, they are regularly not replaced, Mr Heyan said, “because no one is available,” and this results in overwork for other staff on duty.
Staff turnover is also a problem, he said, with staff leaving due to the “extreme workload, low pay and confronting nature of the work, lack of appreciation from management and being upset about the conditions residents are subject to.”
The work value case has arisen from a claim the Health Services Union made to the FWC on behalf of the aged care workforce. It subsequently received the support of the United Workers Union and the Australian Nursing and Midwifery Federation.
Soon after their appointment aged care ministers Mark Butler and Anika Wells successfully asked the FWC to extend the deadline to make a submission to August. A determination by the FWC on the aged care work value case is expected at the end of the year or early 2023.