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Community Affairs References Committee
23/02/2017
Future of Australia's aged-care sector workforce

MIDSON, Mr Stephen John, Private capacity

Committee met at 08:31

CHAIR ( Senator Siewert ): I declare open this public hearing and welcome everyone here today. We acknowledge the traditional owners of the land in which we meet and pay our respects to elders past and present. This is the eighth public hearing for the committee's inquiry into the future of Australia's aged care sector work force. I thank everyone who has made a submission to this inquiry and who is appearing today inquiry. This is a public hearing, and a Hansard transcript of the proceedings is being made. The audio of this public hearing is also going out, being broadcast by the interweb. Before the committee starts taking evidence I remind all present here today that in giving evidence to the committee witnesses are protected by parliamentary privilege, and it is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to the committee. Such action may be treated as contempt by the Senate. It is also contempt to give false or misleading evidence to the Senate. The committee prefers all evidence to be given in public, but under the Senate's resolutions witnesses have the right to request to be heard in private session. It is really helpful if witnesses give the committee notice if they intend to ask to give evidence in private, because we have to reorganise things. If you are a witness today and would like to do that, could you let us know as soon as possible. Finally, could I please ask everybody to turn off their phone or render them inaudible. This committee has a penalty for phones going off, and it involves chocolate. I would like to now welcome Mr Stephen Midson. I would also welcome Mr Jim Collins from the Lower Burdekin Home for the Aged. Do you have any comment to make on the capacity in which you appear?

Mr Midson : I am an approved provider and manager of Palms Aged Care and Mortimer Aged Care.

CHAIR: I will just double-check that you have been given the information on parliamentary privilege and the protection of witnesses and evidence. It was a form you would have been sent by the secretariat.

Mr Midson : Yes.

Mr Collins : Yes.

CHAIR: I would like to invite you to make short opening statements, and then we will ask you some questions.

Mr Collins : I just want to thank the committee for allowing us the opportunity to address the subject of the future of Australia's aged care work force. Lower Burdekin Home for the Aged is a member of Leading Age Services Australia, LASA, and we endorse the submission to the committee No. 222. Our residents are our focus, and no matter what role you perform for LBHA your performance impacts on the resident. It then follows that duties have to be done as well as you can and the effort has to be part of a combined effort to provide excellence in care every day. We believe very strongly that the service we provide is better than anything that might be provided by a large corporate, and we are willing to back ourselves on that statement. Everything expressed in the LASA submission is real for us, and they all have a cost. In going forward, our best platform for defence is forward planning and to encourage stakeholders critical to our success to share our purpose and drive to succeed.

In addition to responding to the committee's questions, there are three points we wish to convey. These are local points. First is that immigration has an important role to play now and into the future and needs to be embraced in order for most rural and remote communities to achieve local aims. Second is that the government is encouraged to look at forgiving HECS for RNs and ENs in exchange for rural and remote service as a first step in a plan to roll out like initiatives for all rural and remote communities, including other professions. Third is that, where there are two or more rural or remote providers agreeing that there are monetary and synergy gains to be made from working together, they be financially incentivised to complete due diligence and deliver the benefits.

We have some statistics that we can present, but I will not read those. They are a snapshot of LBHA's care. We also have some comment in the local context for the LASA submission. Once again we thank the committee for the opportunity to present today.

CHAIR: Thank you. Did you have the statistics you were talking about in a written form that you would like to table?

Mr Collins : Yes, I do.

CHAIR: That would be great. Thank you.

Mr Midson : I would also like to give my thanks for the opportunity to speak today and to provide some information on our perspective on aged care. A little bit of background on our organisation: we are in two aged-care facilities. I am in a unique position where I am a registered nurse, an approved provider and the manager of two aged-care facilities, one located in Brisbane and the other one located in Ingham in North Queensland

What we have found in the aged-care sector is that the same common issues have been bouncing around the industry for a number of years, and those issues generally tend to be that we have an ageing workforce. The average age of the staff in my organisation in North Queensland is 47 years old, and the age is increasing all the time. The age of our qualified staff or our regulated staff is actually higher than the age of our unqualified or unregulated staff, and what we are finding is that our registered nurses and enrolled nurses are getting older and there are fewer registered nurses and enrolled nurses coming into the system.

We also have issues related to low pay that are due to low funding. At the moment, we are going through an enterprise bargaining agreement process with the QNU. They are demanding parity, which is impossible to achieve in the aged-care sector with the funding that we have. We have higher numbers of unregulated staff. If we are thinking of a normal day, over 70 per cent of our staff are unregulated staff. And we have a higher turnover of staff because people generally tend to use aged care as an opportunity to fill in while they are waiting for a public sector or higher remunerated position.

At our facility in Brisbane we have a high number of students and a high number of overseas born staff, and here in North Queensland we have had to resort to 457 visas to attract regulated staff to fill gaps that we were otherwise unable to fill.

There are a number of other things I will speak about as we go further through, but one of the issues is the high compliance cost of the ACFI and the constraints on the role of the enrolled nurse, which I will be speaking about today. But, as my opening comments, those are the issues that I think the Senators need to be aware of. Thank you.

CHAIR: Thank you. You have raised some really big issues that have come up again, but it is really important for us to also get a regional, rural and remove lens, so I am really pleased that you have picked those issues up as well. Senator Polley, do you want to kick off?

Senator POLLEY: Thank you both for giving up your time to be here. I was actually thinking that 47 is a pretty young workforce for those who are unregulated, as you referred to them, compared to what we have heard from other providers throughout the country. But there has been one common theme running through this inquiry, and that is the lack of uniform training. I wondered if you could give us your perspective about whether or not new people coming onto the floor in a home are actually trained and ready to work on that floor.

Mr Midson : I am a registered nurse. I have been a registered nurse for well over 30 years, which in some respects is embarrassing—it has been so long. What I find is that any of the new graduates that we get do not have any practical or theoretical knowledge of working with aged care. They do not do any of those subjects at university. If they are an elective at university, they choose not to take them, because they take the more—

CHAIR: sexy ones.

Mr Midson : I was thinking of another word, but yes.

Senator POLLEY: I have used that word with this committee because I think aged care is very sexy!

Mr Midson : What we find is that none of the new graduates—we have only had a very small number of new graduates, who stay with us for a very short time while they are waiting for a graduate nurse program with Queensland health, about which they very honestly say when they are recruited that that is what they are waiting to do—have ever done any work on aged care or, if they have had placement at an aged-care facility, it has not been beneficial to their career. So I do not think that there has been any real uniform training. It is actually one of my points further down that we will be speaking about later: we need to make it a stream and we need to be encouraging people. I agree with the relaxation of the HECS fees for people who not only are in rural and remote areas but also have done specialised training.

Senator POLLEY: What about those people who have cert. III? What about their training? Are you finding those people job-ready when they come to you?

Mr Collins : We do not have very many that actually hold a cert. III when they come and start working for us, so that is the first problem. If we had policy where we demanded cert. III as a prerequisite to coming into service, we would have easily 30 per cent fewer staff.

Senator POLLEY: Do the carers that you have in place have any formal training?

Mr Collins : When they join, no, not up to that point. Once we take them in, yes, we take them through the training. Basically, it is on the job. We encourage them as best we can to complete their cert. IIIs, and they do that in the context of the working environment.

Senator POLLEY: Would the majority of your employees be Aboriginal and Torres Strait Islander?

Mr Collins : No, the majority of employees are Caucasian Australian in the unregulated. In the regulated, it is predominantly 457s—18 of them out of a complement of 24.

Mr Midson : We try to make certificate III a mandatory requirement, and again I echo the sentiment that it makes it very hard to recruit staff. When they do join us, we then pay for people to gain three levels of qualifications. Every year we pay one person to go from cert. III to enrolled nurse and we pay for one person to go from enrolled nurse to registered nurse with the proviso that they work for us afterwards. Unfortunately, not one of them has worked for us afterwards. They get their qualification and they disappear—that day, usually. We also pay for five staff to get their certificate III every year, and they generally keep on working for us. By doing that, we actually make sure that all of our staff have got certificate III.

Senator POLLEY: There has been a lot of talk from the government and the previous government about having a national workforce strategy. We know that it is obviously going to take a commitment from the sector as well as government leadership. I thought it was actually a good idea in relation to removing the HECS or at least providing a considerable discount for those people who are going into those areas where we obviously need the medical professionals. Have you got any other suggestions from your experience of being a nurse for all of those years regarding how we can build up that workforce, identify the skills that they have and make sure that they are remunerated accordingly?

Mr Midson : The remuneration is very difficult because we are all operating under our bargaining agreement or an award, and it makes it very difficult to reward somebody for gaining a qualification. With the people coming through university and with the specialist training they have got in aged care, most of it tends to focus on the more extreme levels of aged care. So, if they ever do a university qualification, they do something related to dementia training, which is at the extreme end. At the lower end, which is often the skills that we need, we actually need people who can understand the unique needs of older people—how to encourage an older person to shower, for instance. Those are the skills that most registered nurses and enrolled nurses coming from university do not have. They do not possess that skill. They do not possess the ability to negotiate with an older person in order for that older person to do some of the normal activities of daily living.

So that is the level that we would be looking at. If we could either give them increased credit points, when they are doing university training, for gaining those things or get more industry-appropriate training at university level, that would be really worthwhile for the industry. But I have to say that sometimes our registered nurses coming through are focused on resident rights and not necessarily focused on resident needs. We have instances where residents do not have showers for extended periods of time because it is their right to say no. That makes it very difficult to run an aged-care facility with new graduates.

Senator POLLEY: What role do you see the government needing to play in developing this workforce strategy?

Mr Midson : Very minimal. In my opinion—and this is perhaps my political bent—the role of government should be to set policy. The role of the industry should be to make that policy happen. And so it is very difficult in my opinion, for the industry when the government sets the criteria for qualifications. The industry should be setting the qualification criteria, and by doing that we get more flexibility. The role of government should be to do thing like inquiries like this and then feeding that down to industry, which should then take that information and so something with it.

Mr Collins : I would like to add one aspect of dynamic—the word 'sexy' was used before. I think the drive with the education when it comes to health is about rehabilitation, improvement, getting back on your feet, being active again. The reality of residential aged care the way that they receive it now is that people are appearing at the acute and subacute end of their lives, and we are managing decline—we are not managing improvement—and, ultimately, death. If there is a big gap, it is probably the curriculum working through the idea that managing health is not all about and will never be about successfully rehabilitating everyone; it is just never going to happen. If there can be some focus or some redirection within the syllabus to actually take account of the fact that we all do die and start from that as a premise along with how we go about dying and the extraordinary lead times that accompany that process, I think we would be better informed.

Senator POLLEY: There is no doubt there has been and will continue to be a significant change from those who perhaps go into residential care and live there for five years or so to those now going in only for months.

Mr Collins : Correct.

Senator POLLEY: What sort of training do you have in your facilities now to deal with that palliative care role?

Mr Midson : We always accept—and I encourage my staff to assess a reasonably slow stream of palliative care. What I mean by slow-stream palliative care is knowing that there is inevitability. When I first joined the aged-care sector 20 years ago, most of our residents would live in the aged-care facility between two and four years. Now I have residents who come in and my worst has been a resident who lasted for 18 hours. They regularly live a lot shorter in an aged-care facility. They are far more acute. Their clinical needs are far greater than they were 20 years ago. We train our staff to make sure that they do rapid, regular and continuous assessments of residents and to always treat them as slow-stream palliative care with the emphasis on meeting the palliative care guidelines for all of our residents.

One of the hardest things we have, though, is the inexperience of our qualified staff who come through, who frequently have never actually ever seen anybody die. For them, it is an enormous challenge to see their first dead person, whereas when I trained I trained in hospitals. That is how long ago I trained. It was very different in my day. I hate to say that—it makes me sound incredibly old!—but that is what it was generally like in my day.

So I think that we really need to focus on that slow-stream palliative care. I agree with you that the focus is often about getting residents moving, but that generally tends not to be the case. Residents need to be cared for and provided with relief from all of the symptoms in slow-stream palliative care as much as we can. That is what we need to focus on.

Mr Collins : And to sort of box it up and say one thing is going to work is not the way to go. I think it is to be very conscious of the fact that everybody is going to have their own journey. The reality is that, by the time they have made it to residential aged care, it is at that point in the journey where it is beyond the family to care for them, and they generally require 24/7 attention. Whereabouts in that 24/7? Who knows? But that is our environment now.

Senator POLLEY: Mr Midson, in terms of the turnover of staff, you said that you provide some opportunities for further training but people then leave, just like hairdressers do their apprenticeships and then go off and start their own salon or work elsewhere. What can we do to ensure that there is some retention? It should not be, 'Well, we'll go and work in aged care because there are no other jobs.' We want people who are going to be there providing that care in their professional roles because they are committed to that sector. What else can be done?

Mr Midson : I think the main reason a large number of our staff leave is wage parity. It is the inability for us to match Queensland Health's rate of pay. That is one of the biggest problems we have. What we have is staff who do three things when it comes to their wages—and that seems to be the greatest incentive for staff. The first thing is that they take multiple jobs. So I have a number of staff at my facilities in Brisbane who, even though we encourage them not to, work seven or even eight shifts a week. So they work for us for four shifts. They then work for other providers for four shifts. And on occasions they work two shifts in one day. That is because the wage rates are below. We pay nine per cent above the award, but we are still 11 per cent below Queensland Health's rate of pay. So that is the first thing—getting some form of parity. I still remember the CAM and SAM system, where there was the ability for us to demonstrate that we were paying at a certain level based on our funding.

The second thing is that we have to make people really believe that by doing aged care they are doing something really important. People sometimes feel like they would like to go on machines that make noises. In aged care we do not have machines that go 'bing'. We just provide care. So I regularly say to our registered nurses involved, 'This is real nursing. This is what you really do as a nurse. You look after people through the continuum of care.' So we need to encourage them to do that.

So the first thing is parity. The second thing is making it so they can only work five days a week because they get a reasonable living wage. And the third is about making sure that they feel valued in the aged care sector.

Mr Collins : I agree with all that. Can I also add another dynamic from a small community. Most families these days have two income-earning partners. If we are advertising a position for a registered nurse, for instance, and there is perceived not to be an opportunity for the partner—there may be one—to gain work then they will not come to the Burdekin. It is a really subtle dynamic. It is not something that we experience in isolation. It is every industry throughout our area. So we have two dynamics at play. If we are successful in encouraging a registered nurse to come in, we do train them up. We must be doing a pretty good job, because they are readily employable as soon as they finish with us. They will find a job anywhere else they go. Generally the reason for going is to go to a bigger centre so the partner also has an opportunity. The flip side to that is, if somebody has come to town—and an example I use is a mill engineer—then the mill engineer's partner may be looking for something to do either part-time or casually. Then we have an opportunity with that partner at that point. So it is a subtle dynamic but it is a community problem. If two partners cannot get work then chances are we cannot get them started.

Senator IAN MACDONALD: Thanks Jim, if I may call you that.

Mr Collins : Yes, sure.

Senator IAN MACDONALD: As you know, my Apex Club supplied your first chairman for a number of years, and you have looked after both my mother and my sister in both Ayr and Home Hill. So I am very well aware of the work your home does. This inquiry is across Australia, but it is important that the committee gets an understanding of the difficulties of both Ayr and Ingham in what work force issues you have. I am wondering if you could just explain to us the nature of your work force. How many are locals? How many are mums and dads? One of my relatives currently works in the kitchen, I think.

CHAIR: There is not a conflict of interest, is there?

Senator IAN MACDONALD: No, not at all. Can you give us a general outline? And Stephen—again, if I may call you that—later I am going to ask you if you can compare Ingham to Brisbane, as you would be the classic witness to be able to give both explanations. Jim, can you explain what and who your workforce is and how difficult it is to get and retain them? For the committee, could I say that Ayr and Home Hill are communities of 10,000 and 4,000 and the district is about 20,000, so it is a large small country area.

Mr Collins : It is a large small country area with two towns—one is Ayr, the other is Home Hill. The facilities that we have are based in each community. Altogether there are 173 bed licences. At this stage we are working feverishly to try and repurpose one building to capture a very significant swing in intake, and the swing is towards dementia. We have 28 beds for dementia presently; we need to build that to 40, if we can, by the end of April. We are repurposing one building basically to bring 12 people in the community who are looking for that type of support more or less now.

Senator IAN MACDONALD: You might need to make it 41 when I get out of Canberra and become an inmate in your home!

Senator POLLEY: I would suggest you would be full at that stage.

Mr Collins : The door is always open. That is the first dynamic; it is having fixed infrastructure trying to respond to the swings in the care. The second thing is that we will take a significant reduction in income as a result of the changes to ACFI; there is no avoiding that. Our worst case scenario was probably going to be about 12 to 14 per cent, basically coming in over the course of two years.

CHAIR: Is that even with the changes that were made?

Mr Collins : The idea is they are not paying any more, either.

CHAIR: Yes, with the indexation, too.

Mr Collins : We are going through enterprise negotiations at the moment, so our workforce would be looking for somewhere in the order of a two to 2.4 per cent increase at a minimum on what they have got, for example. Parity with Queensland Health is another story altogether but, given that about 75 per cent of our income is actually driven to wages, then 2.5 per cent means less money if everything else is capped.

Employment-wise we have a pool of staff between full-time, part-time and casual of 214, which places us as the third-largest single employer in the Burdekin. In addition to that, the services that we offer are everything from food, laundry and cleaning through to the care services. We regard the front end of the business as the care so, if we are going to take a haircut in funding, we are going to have to try and find that from the back end. We have had significant work done on our internal financing and ways forward to cope with a 10 per cent cut. There is probably nothing that we can do that is not going to hurt, but we have to find a way through anyway.

One of the major things that we have been pointed towards is collaboration—trying to work with the likes of Bowen and Proserpine in order to do things where one of us might do the meals for all three facilities and another facility might have the expertise in property management, so they do the property management for the three areas.

One particular example that I would like to point the committee is in New South Wales on the New England Tableland, where they are setting up a collaborative group that they have termed NIACC as an indication as to how that might work as a model, and hence our request that, if there is something that can work among a group of providers and they see that there is actually some benefit or synergy in there, they be supported in getting those benefits, because I cannot see where the 10 per cent is going to come from otherwise.

The second part to the dynamic of our employment is that nearly all our registered nurses are coming in from overseas. We literally cannot afford to have too much more tightening in the immigration area.

Senator IAN MACDONALD: Are they all on 457 visas?

Mr Collins : No, not all of them. Quite a few will identify as permanent Australians as well. They will achieve permanent residency when they are here, and we are very excited for them when they become Australians. Unfortunately, like every other Australian, they like the coast, some sunshine and some waves, and at that point they are no different to anybody else, so we wish them well as they are going. As I said, we think we do a very good job in training them, because once they have had time with us in the aged environment we turn out good people, so they are readily employable, and good luck to them. We are very grateful to have had their support whilst they are with us.

The third area is that when we go back through and say, 'How come we weren't successful in filling a role with a person from Australia?'—in particular, with regulated staff, people fresh out of uni—we are sort of at odds as to just what it is. We know that we will regularly attract interest from the major cities, and we even placed one as recently as January, only to find out at the beginning of February that she had found a job in Ipswich instead, and that is where she went. So we have that dynamic to play with as well. We do not want to dwell on our problems; we want to try to solve them, and we know that in the past there has been—and still is within health—incentivised support from educators whereby, once having achieved their degree, they then are bonded or have to find employment for two years or so in a regional or remote area. We still think very strongly that that is worth pursuing. It may not help us directly, but I am sure other rural and remote communities would get advantage from that.

Coming back to NIACC and that idea of collaborating, we are looking at the ways that others have approached their workforce issues. We are looking to again realign our care, but one dynamic that I suppose we really struggle with because we do not have a pool of casual people to draw on is that we have to structure our shifts such that it meets more or less high demand. If there is a weakening in that demand—for example, our occupancy drops five per cent or something like that—we still are committed to those shifts, to putting those people up, just in case they are needed.

The final point is that, when a family comes in and we promise them we will do the best we can with what we have, we talk about how much it actually costs us to have one person available to look after a resident. We need roughly 5.5 people just to have somebody sitting there 24/7, 365 days of the year. So that is three shifts, and then there is coverage for those shifts, leave and those sorts of things. That is an absolute minimum. Then the workplace issues come in. It might be that a resident needs four people to assist them to mobilise, so at a minimum, in the structure of the shift, we need four times 20 in order to cover that area.

One of the questions that was raised was: how much does it cost to provide care, and would staffing ratios and those types of things assist? I do not think so. It is more fluid than that. But there is a basic cost and, whilst I do not have an answer for you here at the moment, I think, in the process of the inquiry, it would be good to get an understanding of that and then build into the expectations of government, when you are legislating, that you cannot ask for more than what you are prepared to pay for at the end of the day.

Senator IAN MACDONALD: You have talked about your skilled staff. What is it like in a smaller place to get non-skilled staff: your cleaners, your cooks?

Mr Collins : We have had reasonable stability in hotel services, admin and maintenance. The turnover is really in the assistant and nursing ranks. We have a complement of about 114, I think. We turn over 25 to 27 of those every year. The retention is more a consequence, though, of the dynamic of partnership as opposed to—

Senator IAN MACDONALD: And that is very important. In the limited time left I do want to ask Mr Midson the same question. But, before I go on to that, the Warrina in Innisfail raised with me a very interesting point. If you are selling your house, the value of the house you sell to come into the home depends on the amount you can charge to someone coming in. This is very untechnical, I might say. You might, say, sell a house in Brisbane but the same house in Ayr or Home Hill would be about half the value, which means your capital funding would be much, much less than for somewhere in Brisbane. Is that right, and do you have a solution for it? Could I hear very quickly from you, Jim. Stephen, you, having both, might be able to comment on that as well.

Mr Collins : The consumer is going to have to pay. We try to peg our services roughly at what the government have said. If they are saying it is $55 per day, for instance, that they are prepared to pay for the rental component then it is $55 for us as well. It just does not change. If the individual cannot sell their house or cannot quite make that amount of money then they pay a contribution, a partial deposit, and then have to make a decision as to how they pay the balance.

Senator IAN MACDONALD: That is less funding you have got to work with, which a Brisbane home may not have.

Mr Collins : It is less funding, massively less in some instances

Senator IAN MACDONALD: Stephen, could you start on that and then perhaps give a comparison of Brisbane and Ingham.

Mr Midson : First of all, in Ingham we have a 44 per cent concessional resident ratio. In Brisbane we have a 51 per cent concessional resident ratio. What we find in Brisbane is that residents who come to us generally have been through the community care program. During that community care program, in the two to five years they have been going through that, they have divested themselves of all their assets. We then find that people come in to us in Brisbane with no assets.

Senator IAN MACDONALD: The rellies have got them all.

Mr Midson : The relatives have got the assets, and they have had very good financial advisers. We thought it would be the other way round, but the amount of RADs that we hold in Brisbane is half the amount of RADs that we hold in Ingham. It is a lot less. It is a significant struggle that we have in our facility in Brisbane. As well as being the approved provider and the manager, we actually own the buildings as well. My wife and I put everything on the line and we bought both buildings. It was a very difficult task to prove to the bank that we were capable of buying those buildings. Our projections were nowhere near right. We projected that it would be the other way round, but it was not.

Just looking at our staffing: we have 52 staff in Ingham and we have 41 staff in Brisbane. Of our qualified staff, we have only one 457 visa; the rest of them are locals. There are three aged-care—

Senator IAN MACDONALD: Where is that? In Ingham?

Mr Midson : It is in Ingham. I will do Ingham first. There are three aged-care facilities in the Ingham area, and four if you consider Cardwell as well. Generally, staff rotate between those. Qualified staff always think the grass is greener on the other side of the fence, so they will rotate from us to Blue Care to Canossa to Rockingham and then back, so we regularly get rotating staff. That is okay—that is fine—I think that we all accept that that happens.

We have 38 assistant nurses, of whom one is Aboriginal-Torres Strait Islander. The rest of them are local. There are no 457s, because they do not qualify as a 457 visa to come and work for us as an assistant nurse. All hotel services are local. In Brisbane they are all local. There are no 457 visas, because we do not qualify in Brisbane to employ 457 visa people.

We do not have a head office. I hot desk wherever I am. I use my iPad and my laptop. I find available space. We do not have staff to process payroll. We outsource that to an independent contractor who used to be an employee. We set her up in her own business. She does the payroll. She lives at Mundubbera, which is as far away from Brisbane as you can get.

Senator IAN MACDONALD: As it is from Ingham.

Mr Midson : As it is from Ingham, that is right. We have one IT person. We wrote our own software. I actually sat down five years ago and started writing code and wrote my own care management software, because we could not afford to buy it. So we wrote our own care management software that was cloud based. I have already done my care plan reviews on my iPad this morning. All of my reviews, all of our documentation—everything—is cloud based. For both of our services we have 1½ admin staff and that is all we have, so we are very lean and very mean, but we get the job done, because we have realised the benefits of cloud based work. We do not have anything on site. We do not even own a filing cabinet. In my entire business we do not own a filing cabinet, we do not own a photocopier. We got rid of them all, gave them all away. It was an enormous challenge.

That is the only way that we have been able to handle the 10 per cent reduction in income. I was telling Jim before briefly that with the changes to indexation from 1 January already we have shown a 1.2 per cent reduction in our income so far this year already. We are in EBA negotiations at the moment with the QNU, who are demanding parity. We will offer them 2½ per cent, because we know that with any less than that they will mount an industrial campaign against us, so we have to make sure we give them a realistic amount of money, so we are offering them 2½ per cent for three years—7½ per cent over three years is what we are offering. That will take us down to basically a return on investment for us. Because we are the owners of the business our return on investment is 0.1 per cent.

Senator IAN MACDONALD: You are better putting your money in the bank, even with the pittance the banks pay you these days.

Mr Midson : My bank manager gives me the great delight of regularly telling me that he allows me to keep working there, but that is what we do. We chose to do this. This is a choice that I have made, therefore it is a choice that we do. Having said that, we enjoy doing it. Enjoy the fact that we do help people through slow-stream palliative care. Enjoyment is perhaps not the right word, but we get satisfaction from it.

Senator IAN MACDONALD: Can I get you to comment on collaboration with all of those different homes in Ingham and Cardwell—it is not that all that far away.

Mr Midson : It is an excellent idea. In a previous life I worked as a consultant developing similar things. The problem is that it works well in theory but you have huge territorial issues. You have territorial issues about things and then you have the logistic issues. I think it is a great thing to look at. It will not work in Ingham, unfortunately, because we are private for-profit and the other people in the town are non-profit, so immediately there are issues relating to a range of issues. Because we are non-church affiliated they find it difficult to do any work with us.

There are some things that I believe that we need to look at in the future of the aged-care workforce. There is an arbitrary restriction on the role of the enrolled nurse that makes it very difficult in rural and remote areas to get accurate funding under question 12.4a of the Aged-Care Funding Instrument. It requires a registered nurse to do 20 minutes of massage. As a registered nurse I cannot do a 20-minute massage better than anybody else, therefore it is an artificial divide that in my opinion and in the opinion of a number of people in the industry does not need to be there. It is almost an artificial construct made by the government, almost to penalise people. I cannot get registered nurses sufficient to do clinical care, therefore I cannot get registered nurses sufficient to do massage, therefore I cannot make a claim under question 12.4a, which means that immediately my funding is reduced, even though the care is being provided. That is an enormous issue in aged care. If there is something that the government can do about looking at that—I am raising it at an industry level. I am speaking next week with the CEO of LASA and the CEO of AXA about this issue because I think it is a very simple change that would make it so much easier for us in rural and remote areas.

Senator IAN MACDONALD: Are you having the same issue, Jim? I see you nodding there.

Mr Collins: I agree 100 per cent.

Senator IAN MACDONALD: Can you make sure you contact me about that, and I will speak to the minister about that next time. I use Jim because he is in my home town.

Mr Midson: Certainly, the other thing is—

CHAIR: We are going to have to wrap up. I want to go to ACFI and the point that you just made. What is your opinion about reviewing the whole of ACFI as an instrument?

Mr Midson: I have been in the industry a long time. I have been in the RCI, the RCS, the ACFI. I have been actively involved in all three of them. Any instrument that seeks to try to define clinical care and ascribe funding to that will inevitably fail because people work on ways to get around it. The government changes that have happened have been due to people working out how they can increase their funding in the past by very clever companies coming in and offering to increase their funding through a small loophole. The ACFI in itself is not a bad instrument—it does not work too badly—but we are struck with two issues with the ACFI. The first is that the ACFI is based on Medicare funding, and we have almost a six-week lag in funding that we get for a resident after that resident has come into the service. So if a resident comes into my service today we then have to wait 28 days before we can lodge an application for funding for that resident. In those 28 days we get minimal funding for the resident, barely enough to pay the electricity bill. After 28 days we are allowed to lodge the ACFI, but inevitably that is in the middle of the month, so we then have to wait until the end of that month or the end of the following month to get income. So we often have a six-week lag, sometimes as much as a 12-week lag, between when we get the resident into the service and we get funding that reflects the care that we are providing for the resident. That makes it extraordinarily difficult, especially with the rapid turnover we have of residents, who are coming into the service quicker and dying quicker and so therefore we have residents we have to replace. That is another issue—I know that I have run over time.

CHAIR: Thank you. Are there any final points that either of you want to make?

Mr Midson: No.

Mr Collins: No. Just what is in the LASA submission is the basis of what we are supporting, for sure, and we would like to see that dialogue continue at that level.

CHAIR: Senator Polley assures me she has a yes/no-answer question.

Senator POLLEY: Do you believe in having a national register of all those working in an aged-care residential facility or caring for people in their homes? Does everyone need to be registered across the nation?

Mr Midson: No.

Mr Collins: No.

Mr Midson : It would be a logistic nightmare.

Senator IAN MACDONALD: Why no?

Mr Collins: Define carer. I am at home looking after my mum. You are paying me a carers allowance. Do I have to—

CHAIR: Anyone going in to deliver community care in people's homes—what is alarming to many is that you could have four or five different people going into that elderly person's home. That is without all of those who are working in a residential care facility.

Mr Collins: That is, agreed, an issue, but I do not think—

Mr Midson: That is an enormous issue, and I think it is going to become a bigger issue over the next couple of years.

CHAIR: I am going to have to draw the line here. Thank you very much. We have your information already. You did not take any homework, so I would get out while the going is good.