Survey shows falling staff numbers

The residential aged care workforce fell by more than 45,000 between 2020 and 2023, a new report reveals.

Released last week by the Australian Institute of Health and Welfare, the 2023 Aged Care Provider Workforce Survey shows that, last year, there was an estimated 273,000 people working in residential aged care in 2023 compared to 277,671 in 2020.

The AIHW’s biennial workforce survey provides detailed information on the size, composition and characteristics of the aged care workforce in residential and home care settings.

Survey statistics – comprised from data supplied by 598 residential aged care services – show a quarter-of-a-million staff (90 per cent of the workforce) were directly employed in 2023 – 6 per cent lower than in 2020 (88 per cent).

Almost 80 per cent of the total number of staff – 217,000 – were employed in direct care roles.

Of those, there was an estimated:

• 200 nurse practitioners
• 6,800 allied health professionals and assistants
• 36,800 registered nurses
• 17,000 enrolled nurses
• 156,000 personal care workers.

The allied health statistics are quite significant: the allied health workforce in the residential care sector in 2023 fell from 11,200 in 2020, a decrease of 42 per cent.

Dr Chris Atmore – policy and advocacy senior advisor at the Allied Health Professions Australia – told Australian Ageing Agenda the finding “accords with the decrease in average allied health care … to most recently just over four minutes per day.”

Dr Atmore told AAA a major reason for the fall in numbers is the lack of any mandatory targets for allied health services, unlike care minutes for nursing. Another significant contributing factor is the failure of successive governments to implement the royal commission recommendations concerning allied health. 

“At present there is no consistent process across facilities for identifying and meeting residents’ allied health needs, and no associated monitoring of whether this is being done,” Dr Atmore said.

Elsewhere, the survey shows fulltime equivalent roles involving nursing and personal care staff decreased from 123,400 in 2020 – when the last survey was published – to 111,000 in 2023.

However, while the numbers of FTE nursing and personal care staff positions decreased over this period, the total estimated number of nursing and personal care staff increased by 8 per cent from 195,000 in 2020 to 210,000 in 2023.

As the AIHW analysts note: “This increase in nursing and personal care staff numbers over time is likely explained by an increase in agency/subcontractor staff from an estimated 275 RNs in 2020 to 5,400 in 2023; 95 ENs in 2020 to 1,600 in 2023; and 1,000 PCWs in 2020 to 17,600 in 2023.”

Home care

The survey – commissioned by the Department of Health and Aged Care – shows more than a quarter-of-million people were working in the home care sector in 2023 – 170,000 staff employed through the Home Care Packages Program (up from 80,340 in 2020) and 97,900 staff employed through the Commonwealth Home Support Program (up from 76,096 in 2020). A total of 267,900 home care workers.

Of those 170,000 staff in HCPP during 2023, 128,400 were employed in direct care roles. Drilling into the stats, the AIHW found there was an estimated:

• 100 NPs
• 1,700 Ens
• 5,500 RNs
• 7,100 allied health professionals and assistants
• 114,000 PCWs.

In contrast to residential care, the HCPP saw a marked increase in the numbers of allied health workers – up from 3,700 in 2020, an increase of 90 per cent.

FTE positions involving nursing and personal care staff in home-care settings also increased dramatically since the last worker survey in 2020 – up from 24,900 to 43,000 last year.

From 2020 to 2023, the proportion of permanent part-time nursing positions in HCPP decreased from 51 per cent to 42 per cent, and from 51 per cent to 37 per cent for PCWs.

However, the proportion of permanent full-time nursing positions in HCPP increased from 18 per cent to 22 per cent, and from 3 per cent to 6 per cent for PCWs.

The number of casual/fixed term positions rose the most during the period – from 3 per cent to 22 per cent for nursing staff and from 8 per cent to 40 per cent for PCWs.

Commonwealth Home Support Program

Of the 97,900 people working in CHSP in 2023, 63,149 were employed in direct care roles:

• an estimated 49 nurse practitioners
• 4,100 RNs
• 1,200 ENs
• 7,800 allied health professionals and assistants
• 50,000 PCWs.

Similar to HCPP, CHSP saw an increase of allied workers in 2023, up from 4,900 in 2020 – a 60 per cent rise.

FTE positions involving nursing and personal care staff also increased from 19,060 in 2020 to 22,500 in 2023.

From 2020 to 2023, the proportion of permanent part-time positions in CHSP decreased from 65 per cent to 54 per cent for nursing staff and from 71 per cent to 34 per cent for personal care workers.

The proportion of permanent full-time positions in CHSP, meanwhile, increased from 16 per cent to 24 per cent for nursing staff and from 2 per cent to 6 per cent for PCWs.

As with HCPP, there was a dramatic shift in the proportion of casual/fixed-term positions in CHSP increasing from 1 per cent to 19 per cent for nursing staff and from 4 per cent to 52 per cent for personal care workers.

The home care data was comprised from 360 HCPP and 321 CHSP services.

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