Mandated ratios could improve the health of older aged care workers

Cropped shot of a young female nurse caring for a senior woman sitting in a wheelchair in a nursing home

Mandating the minimum hours of care residents living in aged care homes receive per day can improve the health of older aged care workers and quality of care, according to a new report.

Undertaken by the Brotherhood of St Laurence and University of Melbourne, the Improving the health of older aged care workers study investigated the health concerns of older aged care workers, focusing on carers, in a bid to uncover policy reform options to improve job quality and care delivery.

The study surveyed 20 aged care workers over the age of 50, including 17 women and three men, from across Victoria, New South Wales and Queensland.

Nine of the participants were Personal Care Assistants (PCAs), seven were Health Care Workers (HCWs) and four performed other roles.

A mix of face-to-face and phone interviews gathered data looking at the link between employment and health, life circumstances such as care responsibilities, the types of employment contracts, cultural background, housing tenure, relationship status and gender.

Conducted by Dr Aaron Hart (University of Melbourne), Dr Dina Bowman (Brotherhood of St Laurence) and Professor Shelley Mallett (University of Melbourne and Brotherhood of St Laurence), researchers focused on the aged care sector because of the crisis facing the workforce and their interest in “progressing systemic change”.

The higher rates of involuntary retirement among older aged care workers, influenced by factors including informal care responsibilities, physically demanding work and poorer pay and conditions, formed one of the study’s key considerations.

Other concerns highlighted the critical need to maintain and develop the aged care workforce, and the erosion of employment conditions within aged care when the sector is conceptualised as a marketplace.

“In residential aged care, the increase of private operators has contributed to a cultural change in the sector, with the introduction of profit-oriented management,” the report notes.

“This has led to some providers gaming the level of care criteria to increase the subsidies collected, and the government has responded by introducing savings measures in the 2012-13 and 2016-17 budgets. As a result, aged care workers have endured waves of austerity measures.”

The study’s findings propose three measures that could improve the health of older aged care workers and potentially extend their working lives:

  • Mandatory minimum hours of care per client in residential facilities
  • Employment conditions to improve ‘time and income capability’
  • A professionalisation agenda with three elements – professional registration to enhance autonomy and care quality, clinical supervision to address emotional depletion and training and supervision for specialist roles

“Our findings point to a lack of balance between the interests of service providers and the needs and entitlements of people who give and receive care,” the report reads.

“This imbalance has had unintended social and economic consequences, including compromises in the quality of care and longevity of the workforce.”

The report found staffing levels that allow carers to spend sufficient time with residents are essential, recommending mandatory minimum hours of care in residential facilities.

“Frictions between competing time priorities caused feelings of shame, guilt, frustration and anger among the workers we interviewed,” the report said.

“When describing their preferred care practices, workers told us they liked to take time to develop an understanding about the people in their care.

“They used stories and questions to identify individual preferences and situations. They tried to keep up morale, especially when it seemed as if the older people felt hopeless.”

Aged care workers told researchers their work often felt hurried and impersonal and that there was insufficient time to listen and interact with residents.

“You only have a short amount of time to facilitate your job…I don’t feel like I am carrying out the job well, I get a little bit stressed…My husband has noticed that I am a little bit [grumpy] if I don’t have a break in between my shifts,” one participant said.

The report found mandating minimum hours of care in residential aged care is “necessary to counter the logic of economic efficiency that drives neglectful practice”.

It cites the Australian Nursing and Midwifery Federation’s (ANMF) calls to mandate a minimum 4.3 hours of nursing care for each resident per day, labelling the proposal “reasonable and warranted”.

Delving further into employment conditions, researchers found most study participants had low time and income capability.

About one-third had informal care responsibilities and most struggled to recover from a physically demanding shift, especially those who had been in the sector the longest.

Some workers reported they often performed direct care tasks throughout their entire shift, meaning paperwork could only be completed without pay after they had clocked off.

About three-quarters were on permanent part-time contracts, leaving many without enough hours to earn a sufficient income.

The report calls for several policy measures that could extend worker time and income capability, and improve health as a result, including wage increases, penalty rates for flexed-up hours, written notice of roster changes, sufficient paid hours to perform roles, minimum contract hours and paid transit time between home care sites.

Lastly, researchers propose a professionalisation agenda to “shift the demarcations between professional and unskilled work” so care quality and job quality can be improved and roles made more sustainable for older workers.

To achieve this, they suggest three interrelated elements must be adopted – professional registration to enhance autonomy and care quality, clinical supervision for emotional depletion and supervision and training for role specialisation.

Many participants reported feeling disempowered by their place in the staff hierarchy and that their status as ‘unskilled’ diminished care and job quality, according to the report.

“To [people in the office] we’re just cleaners and people that give [older people] showers,” one participant said.

Researchers argue that the formal registration of aged care workers, which could fall under the National Registration Accreditation Scheme in an individual category, would improve their health and employment conditions and the quality of care they are able to provide.

Further, researchers also advocate for clinical supervision, a space for critical reflection on practice and learning, as a means to sustain workers emotionally and build their status as professional carers.

Specialist roles across care teams should also be developed to enable better opportunities for transition.

Specialist roles might include continence, falls prevention, occupational health and safety, podiatry, manual handling, staff wellbeing and wounds and skin integrity, the report outlined.

Ultimately, researchers say their findings underline the need to increase the value and status of aged care work and to find a better balance between the costs of providing services and the needs and entitlements of people who give and receive care.

Failing to implement measures such as better pay and entitlements will likely result in many older workers facing increased poverty and economic security.

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