The Aged Care Quality and Safety Commission needs an overhaul

What has this to do with the Aged Care Quality and Safety Commission? Many aged care providers report a level of fear and anxiety when dealing with the Aged Care Quality and Safety Commission. Although not universally the case, aged care Executives, facility managers, nurses and personal care workers invariably report feeling anxious and fearful in their interactions with the Commission, limiting the carer’s ability to be kind and attentive.

In other words, the Commission’s behaviour is directly opposed to the outcome it is tasked to achieve, through its impersonal and daunting behaviours with providers and their staff.

Having a Commission operate with an iron fist in a velvet glove would be welcome, however the current punitive approach has a direct negative bearing on the care provided to older Australians. This alone requires immediate action from Government to overhaul the Commission and introduce a kinder and more attentive culture to enhance outcomes for providers and consumers.

Replacing Refundable Accommodation Deposits (RADS)

In 2021, we prepared a paper on the intersecting consumer, labour and capital markets that aged care providers operate within. This identified the structural flaws in the aged care sector and highlighted the need for efficient use of capital by approved providers. The intention to remove Refundable Accommodation Deposits (RADS) as a method of providing capital to providers is questionable, but what is a viable alternative?

RADS provide a mechanism for consumers to be involved financially in the accommodation they choose, and a low cost source of capital for providers to use to invest in services and facilities for older Australians. With approximately $33b in the national RAD pool, alternate sources of funding seem hard to find. Government sponsored capital insurance schemes seem – at best – an added cost to providers, many of whom are struggling post Royal Commission and working through COVID-19.

A clear approach to the capital requirements of the sector is essential in forward-planning the development of new facilities, the much discussed consolidation of providers, and more importantly, how consumers can effect choice by the investments they make for their aged care accommodation.

Structural deficit in labour supply for aged care services

The structural deficit in the aged care labour market has been reported prior to the Royal Commission into Aged Care Quality and Safety. This structural deficit has two serious dimensions: the supply of labour for nurses, personal care workers and support staff; and the remuneration differential between aged care and other care services, including disability services, primary, acute and sub-acute care services.

Aged care workers were being paid significantly less than their peers in other care sectors, and with furloughed staff, shortages and poaching by those services, the aged care sector is in crisis. The primary, acute and subacute sectors are paying incentives to aged care workers to “swap ships” exacerbating the problem.

While the Government insists there is no crisis, we estimate that the shortfall of nurses in Australia is at 25,000 with 9,000 of those in aged care services. This shortfall has developed from a lack of investment in net overseas migration and insufficient investment in attracting school aged children into STEM careers. Migration has stalled due to COVID-19 and will remain so post-COVID as “source” countries, those countries who typically supply nurses to Australia, cope with their immediate impacts of COVID-19 and the subsequent recovery. There is a moral issue in attracting nurses from source countries at a time when they’re in the greatest need at home. Investments in attracting school aged children into STEM education will take years, as we first need to garner the interest of primary school children so they choose STEM in subsequent years that enable them to study STEM programs at University.

COVID-19 has exposed and multiplied this structural problem in the labour market.

The Government needs to invest in fast-tracking STEM education for students to transition into courses that allow them to study STEM at University; create better programs to enable nurses to regain registration after absences from their career; and fund the aged care sector at a sufficient level to compete for resources with the disability sector, and the primary, acute and subacute health services.

In 2019 we engaged 121 senior executives in the aged care sector together with Leading Aged Services Australia to set out a platform for what the industry could be like after the Royal Commission which resulted in The Future of Ageing Report. We fundamentally believe this Report sets a strong foundation for a service sector that supports and promotes greater quality of life care for older Australians as they progress through their twilight years.

Sadly, the current approach by Government and the Aged Care Quality and Safety Commission falls very short of that dream.