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Select Committee on Work and Care

BAILEY, Mrs Claire, Manager, Employment Relations, Aged and Community Care Providers Association [by video link]

HIC KS, Mr Tim, General Manager, Policy and Advocacy, Aged and Community Care Providers Association [by video link]


CHAIR: I now welcome, via video conference, representatives of the Aged and Community Care Providers Association. Would one of you like to make a short opening statement before I invite members of the committee to ask you questions? We can see your faces here in the room, and we have other senators online, so we're hoping all of this works. Thank you for being here, and we look forward to hearing your answers.

Mr Hicks : Thanks very much. It's good to be here. I will make a brief opening statement. The Aged and Community Care Providers Association is the peak body for aged-care providers across the country, across all different service types from home care, through to community care, residential care and retirement living. We represent providers of all sizes, from small organisations through to listed companies and large national not-for-profits. We represent providers of all ownership types, and our goal, as is our members' goal, is to support better outcomes for older Australians.

We come to this inquiry from a very interesting perspective. As an industry we employ predominantly women and those women are often much more likely to have caring responsibilities. We also provide important supports that allow people to continue working and augment the informal care with formal government funded services. The first set of issues for us in relation to work and care is access to care.

We can start with home care, which has been the traditional problem with access, where there's been significant wait times for accessing care at one stage, reaching more than two years to access level 4 home care package. Following on from the royal commission in particular, there's been the release of additional home care packages, and the wait times for home care are coming down substantially, with the estimated wait times in the latest data that was released for the March quarter of this year being three to six months, even for a level 4 package, which is a significant improvement.

However, there is another, less visible, constraint now, which is the availability of the workforce. So people may be offered a package within three to six months, but they will not always be able to access those services because many home care providers are unable to find the staff to deliver them. That is a difficult problem to measure. We don't have good data on the level of access problems within different parts of the country. It is likely to be very variable from one region to another. There are issues with finding providers that have availability because there's no way of easily searching who is available and who is not.

Residential care in general, in metropolitan areas, does not have broad access issues. There is a significant number of residential care places, and in fact occupancy in residential care has been falling. However, there are increasingly concerns about the closure of residential care places in regional areas and more remote areas given funding pressures on the industry and all of those access problems that influence the ability of people to continue working whilst having relatives that require care and support.

We've also seen the delay between someone being approved for residential care and entering residential care growing in recent years. We believe that this largely reflects the increased level of concern around qualify of care in residential care and really highlights the importance of implementing the changes to improve quality that the royal commission has highlighted. Access problems because people are fearful are just as problematic as access problems because the places don't exist. That is something we need to see resolved through the increase in the number of staff, through the additional transparency measures that have been proposed and, in particular, through providing more information on quality of care so people can be confident the services they are going into provide the level of support the community expects. We're well on the way to delivering on that journey; however, funding issues and funding constraints remain a significant challenge, in addition to the actual availability of the staff.

I mentioned earlier that workforce constraints are a significant issue. As employers, aged-care providers are conscious of the need to provide flexible working arrangements in order to support their staff to work and to be able to work the additional hours that are needed to meet the growing demand. However, it is one of those very challenging sticking points here, where we see more and more need for formal care support through the aged-care system, and in particular in the context of COVID. That then can impose obligations on people and requirements for people to come into work that can be challenging when also balancing other caring responsibilities. That's the situation we're in as a sector. I'm happy to take further questions now.

CHAIR: Thank you, Mr Hicks. We've met before, I now recollect. Good to see you again. Is there anything you would like to add, Mrs Bailey?

Mrs Bailey : No thank you, Senator.

CHAIR: I might lead with some questions and then go to Senator Bragg and then Senator White. You have a large workforce within your organisations. You mention the challenges they have. Have you got anything out of your experience that you would like to put to the committee which is helpful in helping your workers balance their own care and work combinations? You have a very large workforce, mostly female. I'm assuming quite a lot of them are part time, possibly to try to balance things. Are there things that some of your employer groups or organisations have done that show good practice as organisations to help people put together their jobs and care as workers?

Mr Hicks : The thing I'd start by saying is that one of the key benefits for an employer of aged care as an occupation is the degree of flexibility it provides to employees. It's an area where work is available locally pretty much around the country. It's an area where shifts are available at all sorts of different times of the day, which can allow people to work around their other responsibilities. In many ways, aged care is one of the ideal employers for people who have a range of caring commitments. The same skills and mindsets of people who are informal carers taking care of their loved ones are exactly the sorts of things that put someone in good stead to be a carer in aged care.

In terms of flexible arrangements, I don't think we're different to other employers. It's about understanding an individual employee's needs and being able to adapt a roster around those obligations. I might throw to Claire to see whether she has any further insights into some of the specific measures that our members might have in place.

Mrs Bailey : As Tim said, we're not too different to other industries per se, but something that has struck me while working in this organisation and in the aged-care sector for nearly the last three years is that there's a very strong driver of availability of rosters built around when the individuals can work and what they can offer the organisation. It's more set in place for part-timers and even for casuals as to when exactly they can work and when they can't. It's not quite as random as in some industries that I've come across over my time working in employment relations. It's a lot more focused on the needs of the employee in that particular way. It can be a juggling act for our members to be able to create rosters in those particular situations, but that's part of what they do. That would be the main point I would make that differentiates us from other industries, but other than that we're fairly similar.

Mr Hicks : I think that's one of the interesting points. Aged care is an industry that's built around a predominantly female workforce, and always has been. It's an industry that's built around a culture of recognising that people can have caring responsibilities and needing to adapt to them. It's not a cultural change that the sector needs to adopt; it's something that's baked into the history of the industry.

CHAIR: How much is the industry reliant on casual workers and agency workers at the moment? What different forms of employment are dominant at work?

Mr Hicks : The general preference of aged-care providers is very much to have permanent and part-time workers because it offers more continuity of care and more reliability of access to staff. In general, patterns of resident needs are relatively predictable. I don't have data readily to hand on trends in the level of casual employment within the industry—however, it does play a significant role in being able to respond flexibly to issues that might arise beyond a particular day. In many ways, that casual pool and access to agency staff is necessary to facilitate the flexibility for other staff. In an area like aged care you have services that need to be delivered, so if you want to enable people to take time off when they need to, you also need to have access to a flexible workforce that can fill gaps within the roster. As I said at the beginning: wherever possible, aged-care providers try to limit the amount of casual and agency staff they use, if it was much more expensive, as an option for them. It is an important part of the way the industry works.

CHAIR: What is your expectation of what the impact will be of a sizeable pay rise if it comes down the tube from the Fair Work Commission? How do you think that will impact the sector when it's decided?

Mr Hicks : It's an important question. People in aged care, as a whole, don't come into aged care for the money—and generally wouldn't because, we know, the pay hasn't been particularly competitive historically. People come into aged care because they enjoy caring for older people, by and large, and also potentially for some of the other benefits of the role in terms of flexibility. A pay rise does several things. We know people don't come into aged care for the money, but for a reasonably significant number of people it is why they leave—that lack of financial competitiveness. A pay rise will significantly help, we believe, with retention of staff.

It's also recognition; it's important recognition. People in aged care need to feel respected, to feel like their contributions are recognised. A pay rise helps show that we as a society value the work all those aged-care workers do. We think that will help significantly with recruitment as well as retention of staff.

Finally, increasing the pay people receive provides access to workers that might not have previously considered aged care as a sector. People come into aged care for non-pay related reasons because the pay has been low. If the pay is higher, then workers who would previously have said, 'No, I'm not going into aged care because it's not competitive' will now consider aged care as an option. We think there's likely to be a significant influence on labour supply if there is to be a significant increase in pay for workers.

However, it needs to be part of a broader change in the sector. It can't be enough on its own. We need to have more sustainably-funded organisations that aren't worried about having enough money to keep their doors open. Nobody wants to work for employers that are having to worry about the budget every month. Equally, we need to have more staff available so people have more time to care, so people aren't feeling under so much pressure. All those things, it is critically important, are to be done together. We have a bit of a chicken-and-egg problem here: to increase staffing numbers, we need to attract more people. That's where the promise of the better future, in part through the pay rise, comes in.

CHAIR: Thanks, Mr Hicks.

Senator WHITE: Where are the skills shortages? What sorts of jobs are we talking about, where the skills shortages are in aged care?

Mr Hicks : At the moment, as you would all know, we are in one of the tightest labour markets we've ever had in Australia. There are challenges recruiting staff of all sorts, from hospitality through to clinical roles, from nursing through to allied health. There's virtually no area where there is difficulty recruiting people right now. Having said that, there are areas where the difficulty is more severe. One of those areas, in particular, is registered nurses in residential aged care. We have a need to recruit a significant increase in the number of registered nurses coming from the staffing targets that are coming out of the royal commission. We estimate it's more than a 40 per cent increase in registered nurses that will be required in the next 12 months in order to meet those targets. That's going to be an extremely difficult, if not impossible, task for many aged-care providers.

There are also significant difficulties recruiting personal-care workers, particularly in the home and community care space. That partly derives from the fact that there's generally higher pay available in the disability sector, owing to some changes to the SCHADS award that were made historically. There's a degree of specific pay disparity for personal carers working in that community care sector, in ageing versus disability. Even within organisations that can be an issue where people want to work in the disability side rather than the aged-care side because the pay rate is different. It's just a reflection of the immense growth in demand in that sector. There's been a massive increase in the number of home-care packages over the last three years. That's helped reduce the wait list, but it's created these labour market shortages. There's been a similar increase in the scale of the NDIS; there's a huge increase in demand there that's creating great difficulties for people in recruiting staff.

We can't underestimate in all of this the influence that COVID has had on the sector—the amount of pressure that's placed on people in terms of their willingness to work longer hours and to increase their rostered hours. That COVID burden, which seems like it's going to stay with us, creates significant difficulties in recruiting people into direct-care roles.

Senator WHITE: On that point about COVID: during COVID, did the sector lose a lot of workers who were on temporary visas?

Mr Hicks : The sector has traditionally employed a significant number of people who were recent arrivals to Australia. Migration is an important part of the workforce for the entire Australian economy, not just aged care. It's an important part of the broader healthcare workforce. Significant numbers of registered nurses come in through migration programs. One thing that aged care has relied on significantly is people who are relatively new arrivals in the personal care workforce. That workforce evaporated when the borders were closed, and that contributed to the overall labour market shortages. As the borders are reopening, in theory, some of those pressures should be relieved, but the overall demand for additional workers and the competition from other parts of the labour market mean that, in fact, notwithstanding those borders being opened, the feedback from our members is that the labour market shortages across the board are only getting worse.

Senator WHITE: The Jobs and Skills Summit focused on a range of issues about skills shortages. Was there anything that came out of that summit that you think will benefit your sector?

Mr Hicks : We think there's a range of initiatives there that have the potential to deliver benefit to the aged-care sector, in particular the examination of migration pathways in the increase in the size of the migrant intake; that's going to be an essential short-term measure. At the end of the day we need to be a sector that can attract people who are already living in Australia to work in aged care. That's the sustainable workforce for the sector, and it already makes up the majority of people working there. In the short-term, as we're trying to meet the demand of increased numbers of people in home care and increased numbers of staff in residential care, those migration pathways are going to be absolutely critical to fill the national gap.

Senator WHITE: What have you seen in the sector that you would regard as good retention strategies from the employers and members of your association? What things have you seen work?

Mr Hicks : I might throw to Claire on that one. I go back to some extent to the previous response to say that it's not that different, in aged care, from other sectors. It's about understanding the concerns of your staff and responding to them. It's about providing the supports they say they need. It's about being flexible and responding to their particular needs in a particular circumstance. It's not exactly a magic bullet. Claire may be able to offer some more thoughts there.

Mrs Bailey : I think some of the better practices we've seen relate more to handling and showing employer values put forward by the organisation themselves. Those employers who properly understand the employee value statement they've put forward, and put forward one where people feel included and feel they're listened to and feel their needs are addressed in the workplace—I think those ones have been more successful. Getting them in the door in the first place is certainly a big part of that—and then, of course, retaining them after that. Obviously, a lot of the employees do work for multiple employers across the industry as well. So it's interesting that if they're not moving out of the industry they may well be moving to other employers within the industry, or doing more hours with a particular employer and that sort of thing. So, yes, it's interesting when you're looking at turnover and where they go after they finish with one particular employer.

Mr Hicks : I think, in many ways, being a good aged-care provider is about being an organisation that cares, where part of your DNA and your purpose is caring for your residents. That's got to be your guiding principle. And that's part of being a good aged-care provider. Crucially, it's being a good employer and retaining staff. If you demonstrate that you care about your staff, and you demonstrate that not just through what you say but through your action and through the supports that you provide to them, then that helps immensely with the retention of your employees as much as it does with delivering quality care to the older people that you care for.

A lot of it is also just being an organisation that's able to manage the pressures that the sector is facing, because those pressures, at an organisation level, transmit through to the employees. People of various organisations have done have done various things with bonuses, other sorts of retention payments and things of that nature. There are various government schemes there. Those can be effective, but I think that in many ways they're more about the demonstration of recognition than they are about the direct financial incentive that they offer.

CHAIR: I wanted to pass on the thanks of Senator Bragg and Senator Askew, who haven't got questions for you but thank you for your submissions and your time. I just have a couple of questions which I'll sneak in before we finish. I'm wondering what observations you might make about how the changing participation of men and women in work in recent years has affected their ability to help care for the people in either home care or in residential care. I'm thinking about the growth in participation of women, for example, and whether that means their ability to come to share the care that an institution provides is affected. For example, we've had a couple of comments from individuals who might be described as 'sandwich carers'. They've got young kids and they've got a parent in residential care, and they really struggle to get there. Are you seeing changes in the amount of support families are able to give their loved ones in different forms of care?

Mr Hicks : I think it's really difficult to see that as a trend distinct from other things. What we've seen, generally, is that fragmentation of social support and social participation. People are more mobile now; people are less likely to live in the same city as their parents as they were a long time ago. That creates issues with access to support. People are a lot less likely to volunteer and participate in community activities as they used to be, and that also affects the level of visitation and the levels of involvement and volunteering within aged-care services. And all of that's related to changes in family structures and changes in the nature of work. Does that have implications broadly for who can be an informal carer? In part; but of course many people who are carers are already retired. So whilst there are many people who are in work, many people who are informal carers for their older relatives are people in their 60s who are caring for relatives in their 80s.

I have no doubt that the trend you've identified does create challenges for some people. We can see in some of the research overseas, where there's a much higher proportion of people who are cared for at home, that that issue of the burden, predominantly on women, to be both carers and workers is a significant concern and the subject of significant public debate. We haven't seen too much debate and discussion about that in Australia. I think in part that's because we have more access to residential care. That's not such an issue here. You don't have things like six-month delays to find a place in residential care. But there's risk that may emerge as we have more and more home care and we have a potential reduction in the number of residential care places.

CH AIR: Very interesting. Thank you. This is my last question. A lot of us now talk about a care economy as if the workers who provide care are kind of interchangeable across the care sectors, and we've heard a little bit of conversation today which suggests that is happening. Is that your view—that there is a lot of mobility across those different care jobs? You've made some reference to it, but is it real that people easily move across disability care, aged care and child care, or not?

Mr Hicks : I'm not sure I'd say it's easy or interchangeable, but it is a move that can be made. I'm trying to think of an analogy with another workforce. There is a distinct set of skills and experience that's involved in both understanding the different systems and providing care to the different client groups. There are some significant differences in philosophies and in people's typical needs, and that means it's not possible for someone to turn up to a job with a different client group without doing any sort of relearning or retraining.

Having said that, I think it's probably analogous to the difference between aged-care and healthcare settings. A nurse moving from a hospital setting into a residential care setting is doing quite a different job with quite different skills, but there's also a significant degree of transferability, and that's probably how I will describe it. As to how much movement there is backwards and forwards, it would be great if we had more data on that. At the moment it's all pretty anecdotal.

CHAIR: It would be interesting to map it and know a little more about whether it's a good or bad thing too. Thank you so much for your submission and for your time today. We really appreciate your appearance. If you've taken any questions on notice, we'd appreciate hearing any further information by 29 September. Thank you very much for your time.

Mr Hicks : Thank you very much, Senator. Thank you, everyone.

Mrs Bailey : Thank you, Senator.

Proceedings suspended from 12:17 to 13:0 3