Some aged care providers are reclassifying lifestyle staff as Personal Care Workers (PCWs) to get around meeting their mandated care minutes targets, a Senate Inquiry has heard.
The Community Affairs Legislation Committee is examining the proposed new Aged Care Act – Aged Care Bill 2024 [Provisions], introduced to Parliament last month.
Unions representing aged care workers including the Australian Nursing and Midwifery Federation (ANMF) and Health Services Union (HSU) yesterday gave evidence at a hearing in Melbourne, highlighting their significant concerns with the Bill. These include no direct mention of care minutes, unfair civil penalties for aged care workers found to breach the code of conduct, the absence of a positive worker registration scheme, as recommended by the Aged Care Royal Commission, and the abandonment of provisions for a Worker Voice.
“We want to see structures, legislation, reforms put in place that see the capacity for the delivery of genuine, high-quality, safe care, across the sector for all older Australians, whoever you are,” ANMF Federal Secretary Annie Butler said.
Care minutes
From 1 October 2024, the mandated sector average requirements increased to 215 minutes of care per resident per day, including an average of 44 minutes of care from a registered nurse. Recent changes, however, enabled providers to employ enrolled nurses (ENs) to fill 10% of care time specified for RNs.
HSU Assistant Secretary Lauren Hutchins told the committee that the union’s members were reporting attempts by some providers to reclassify lifestyle and leisure staff as PCWs to meet their mandated care minutes.
“Those particular roles are very important to the social aspect of care,” she said.
“Trying to redefine those [roles] for the purposes of care minutes, is problematic on so many fronts.”
Currently, just over 40% of aged care providers are meeting both their RN and care minutes requirements, Ms Hutchins stressed. Workers are best placed to identify the reasons why, which is why unions believe a Worker Voice is so important to achieving greater accountability.
“Something isn’t working,” she told the committee.
“Even the best attempts to get to the current standard isn’t working, and what we don’t know about that is why. It will be workers who will be able to provide that information.”
Ms Butler said care minutes were established to stipulate the amount of direct care work carried out by nurses and PCWs. Care minutes must be preserved and expanded to include an additional requirement and definition specifically for allied health staff, she told the committee.
“We need to define personal care worker minutes, enrolled nurse minutes and registered nurse minutes in the current system, and we need more,” she said.
Regulation of the care worker workforce
The Aged Care Royal Commission recommended that the Australian Government establish a national registration scheme for personal care workers. But the proposed new Aged Care Act failed to adopt a robust, Australian Health Practitioner Regulation Authority (Ahpra) based regulation scheme for the currently unregulated care worker workforce.
Ms Butler said like the national registration scheme nurses and midwives have worked under since 2010, implementing a positive registration scheme for care workers was critically important to achieving consistent, quality aged care across the country.
“That means that if you are putting your mother into residential aged care, or if you’re an older person getting care services at home, you know that wherever you are in the country, that you are getting a person who has a certain standard of practice and care, and that you know you can be safe and confident in the level of care that is going to be delivered,” she said.
Ms Hutchins said a positive registration scheme would recognise personal care workers as a skilled workforce and create pathways for continual professional development.
“It means that a worker can say, very proudly, I’m a registered personal care worker, I’m recognised as such, and take that skill from one workplace to another.”
Financial penalties for aged care workers
Under the draft Bill, individual aged care workers face new civil penalties, including fines of up to $78,000, if found to breach the code of conduct.
In its submission to the inquiry, the ANMF raised concerns that the meaning of a ‘responsible person’ is neither sufficiently robust nor defined to ensure that registered nurses, who are managing day-to-day direct care in an operational sense yet have no organisational authority, are excluded from the definition. In many instances, members report that they are unable to comply with their professional obligations and expected standards of practice, or to provide safe care, as a direct result of decisions made by their employers, over which they have no control, the ANMF added.
Ms Butler told the committee that RNs in charge of daily shifts often don’t have control over operational decisions being made, such as inadequate staffing. Imposing penalties on aged care workers was “completely unreasonable” and would weaken attraction and retention to the workforce due to fear over consequences.
“Too often, an individual is identified as the cause when, actually, it’s a systems failure.”
Introducing a positive registration scheme that care workers must meet in order to maintain registration would solve the issue and remove the need for civil penalties for individual employees, Ms Hutchins argued.
“A positive registration scheme means that you don’t then have to have in place those penalties for the individual. The biggest penalty is that you lose your registration, and you cannot call yourself a registered personal care worker,” she said.
“A personal care worker fundamentally wants to ensure the best quality care for a resident, or in home
“Ultimately, the responsibility for that care should be part of the team, however, someone is responsible. It is not the worker who is being directed to work in a particular way.
“We absolutely think that the penalties implied to the individual are unreasonable. They should be removed.”
Worker Voice
In its submission, the ANMF expressed its disappointment over the planned abandonment of provisions for a Worker Voice and Quality Care Advisory Body, describing the reforms as crucial for integrating worker feedback into the delivery of aged care services and ensuring providers remain accountable.
Ms Butler told the committee strong enforcement mechanisms regarding compliance related to direct care work, RN 24/7, and care minutes, were essential and that a Worker Voice aimed to give workers an opportunity to have discussions about a range of issues like workloads and staffing levels.
“This is not about trying to persecute or find punitive approaches to providers,” Ms Butler explained.
“It’s actually trying to build collaborative relationships between the workforce and the employers and about getting care improvement and developing that together.”
Asked what would improve attraction and retention of aged care workers the most, Ms Butler told the committee that there were a number of factors that should be looked at, including improving practice environment, creating more genuine career pathways, utilising nurse practitioners more strategically, offering better incentives, especially in rural and remote areas, and investing in the existing workforce, particularly enrolled nurses and the vital contribution they provide to skills mix.
“Our members consistently report that the most critical, it doesn’t matter where they work, what sector they’re in, the most important thing is their safe workload and the capacity to be able to deliver the care that they’ve been educated to, and is part of their professional being, to know that they’re delivering their best care,” Ms Butler said.
“In this case. it’s care minutes, staffing ratios, safe reasonable workloads, wherever they are. Obviously, they need to be paid and rewarded properly and we’ve gone some way to now achieving that.”
