Aged care crisis shows a disaster waiting in workplace ‘flexibility’

Despite efforts by the government and media outlets to portray the Morrison government as the saviour in Victoria’s aged care crisis — complete with military medical teams — it is a scandal made in Canberra, and one that this government wants to make significantly worse.

The problem of aged care workers working at multiple sites — increasing the risk of transmission between facilities — has worsened in recent years as for-profit operators have used workplace laws to reduce work hours.

Aged care is a very different workplace from what many Australians are used to: according to 2016 figures only about 12% of personal care attendants and allied health professionals in the sector have full-time jobs, and only about 22% of its registered nurses do. And in 2016 about 10% of aged care workers worked more than one job.

Industry sources quoted in the media said that figure was now 20% to 30%, although how rigorous that estimate is isn’t clear in the absence of a further workforce census.

There are claims by sector experts that the census understates the level of casual and non-standard work contracts.

Since 2010 private, for-profit residential aged care facilities have gone from 35% of all facilities to — by mid-2019 — 41%, mainly at the expense of religious facilities. Private companies have also doubled their share of home care providers to 20% since 2016, again mainly at the expense of religious institutions.

During that period of growing private sector service provision, there’s been a big shift from casual work to part-time. At the start of the decade nearly 20% of sector workers were casual. But that had fallen to 10% by the time of the 2016 workforce census. Workers on part-time contracts increased from 72% to 78%.

United Worker Union national director of aged care Carolyn Smith said this reflected a shift by employers to short-hour contracts, in which workers are offered very short shifts or work a minimal number of hours — in some cases as low as 10 hours a week.

“Employers have worked out how to use regulations so that workers don’t even receive casual rates,” she said. “Workers are forced to work in two or three facilities to make a living.”

This is backed up by changes in the views of aged care workers. The level of workers reporting wanting more hours in 2016 rose to over 30% — despite constant demands for more workers.

The Health Services Union, which covers aged care workers in Victoria, has directly linked underemployment with the problems of workers in multiple sites.

“The problem of underemployment in aged care has been around a lot longer than this virus,” its national assistant secretary Tim Jacobson said last week. “And it is no surprise to us that it is now leading to issues with the pandemic.”

Casualised workforce here to stay

It’s not just unions lamenting the changes in the sector: one aged care operator told a 2016 parliamentary inquiry  — one of many reviews over the years — that: “The casualisation of the workforce is, unfortunately, something that we are all contending with at the moment, and I think we will see more and more pressure on that. We cannot guarantee hours for staff because the clients change their minds or go into hospital.”

This points to an unintended consequence of the push towards making aged care more client-centric so seniors and their families are more empowered in the choices they make and where they spend their money for services.

Both providers and sector experts told the inquiry that this “consumer-directed care” model created uncertainty for providers and might lead to casualisation given they can’t rely on block funding.

Smith said that was a problem primarily in the home care sector, where service providers were often engaged for limited services by clients, though she said providers had also increasingly taken a “task-based” approach to employment, engaging people for specific and limited roles in residential facilities around key moments such as meal times.

The sector faces the challenge of rapidly — almost instantly — reversing the trend towards placing workers on short contracts to minimise costs in order to prevent the problem of workers becoming vectors of infection for the very people they care for and care deeply about.

While the Morrison government scrambles to do that, it continues to talk about the urgent need for more flexibility in industrial relations, including better enabling employers to impose short-hour or zero-hour contracts on workers — exactly what is going to lead to the tragic deaths of dozens more senior Australians who have contracted COVID-19 in aged care facilities.