What is preventing better quality care for older Australians?

There is absolutely no doubt that aged care funding needs urgent reform. Starting to tackle the true issues around funding — including user contributions, sustainability and equitable funding for regional and remote providers — are all necessary and positive moves. However, factors such as the right model of care, organisational culture, empowered people and correct workforce design, also play an important role in ensuring that providers can deliver the level of care we rightfully expect for older Australians, writes CHRIS MAMARELIS, CEO of Whiddon.

In 2019, when called as a witness at the Aged Care Royal Commission, l spoke to the core premise of what we do at Whiddon — providing relationship-based care. We know the forming of these deeper and richer relationships between care recipients and caregivers is integral to the delivery of quality care.

It is an unfortunate reality that the current focus on mandated care minutes and 24x7 registered nurse requirements is directing the focus onto compliance, rather than driving quality care and truly meeting the needs of residents.

As a sector on the verge of significant reform, this marks an important inflection point. We must ask ourselves, is this driving the right behaviour — and the right incentives for providers — to create the best possible, person-centred care for our older Australians?

The risks to quality care

The most current aged care data released in the UARC Aged Care Sector Report draws attention to some serious risks to quality care.

More than 78% of providers are not currently meeting their mandated care minutes. In addition, they are struggling to comply with the 24x7 registered nursing requirements, particularly on overnight shifts. This has coincided with a dramatic 400% increase in the proportion of direct care time provided by casual third-party contractors.

As providers are required to direct more funding to care roles, which are becoming increasingly more cost-intensive, some providers may be forced to choose between meeting their care minutes through expensive agency staff and delivering other core supports such as wellbeing programs, hospitality and maintenance services.

l believe that what is of even greater importance than the conversation on the cost of casual third-party contractors is the impact on the delivery of quality care in a system that is becoming increasingly reliant on agency staff (quality over quantity).

Back in 2022, the Productivity Commission reviewed the quality effects of agency staffing in residential aged care. At the time, agency or contractor staff represented a small percentage of our total aged care workforce.

Whilst the report stopped short of any directions around caps on the use of agency staff by aged care providers, it did identify that providers with a greater reliance on agency care staff have “poorer quality, as perceived by residents”. It recommended that future research should assess the risks of using temporary workers versus having staffing shortfalls in terms of how it impacts quality care outcomes.

Given the drive to meet care minutes targets and a huge spike in the use of agency staff across the sector, it seems high time that this assessment is now a priority.

There is no disputing agency and contractor staff have an important role to play in aged care.​ However, the difficulties created through intermittent work schedules, increased workload for permanent staff and the impact on resident relationships suggest contractors should be used as a short-term measure for staffing gaps — not part of our core aged care workforce.

Aged care in regional and remote homes

This is even more relevant for our critical regional and remote homes, identified in the recent UARC report as already experiencing the highest rates of sustainability concerns. The reason these matter is because quality, continuous care means providing a pathway for older Australians to stay connected to their beautiful local communities, families and history.

It is well documented that these homes face far more challenges and costs in areas such as employment, transporting and sourcing food and supplies, maintenance and general support. If we are serious about quality care, we need to ensure we are throwing our support behind our regional and remote providers, to ensure local high-quality care is always an option.

So, what is required? How can we ensure that eagerly awaited reform and recommendations from the Aged Care Taskforce deliver on the primary goal of the original Royal Commission — quality care?

Workforce design

We need to work towards workforce design that supports and incentivises quality care. This may include exploring improved commercial arrangements with nursing agencies and contractors, at a global or industry level. Royal Commission Recommendation 87 speaks to safeguards to ensure that providers are prioritising permanent, direct employees. Given this emerging issue, is it time for the Commonwealth to consider regulating the labour hire sector attached to aged care?

What is clear is that continued investment in our workforce is critical to ensure that our direct and indirect care employees are fully empowered, remunerated and rostered in a way that supports relationship-based care.

Rather than directing funds towards a mandated compliance model, let us invest directly in the people caring for our elders with improved clinical training, dementia education, digital literacy, leadership and wellbeing programs. Further, and given the influx of overseas workers, directing funding to support those transitioning to working life in Australia is another key area that will enhance our services. The priority for regulators and providers alike needs to be holistic, person-centred care rather than perpetuating the battle between providers to simply fill rosters. Are older Australians genuinely benefiting from this?

It’s also about regulating agencies further to stop price gouging and working collaboratively across health, NDIS and aged care to address our shared challenges, such as increased competition, compliance burden and workforce retention.

And finally, reviewing our supports for regional and remote care of older Australians needs our unwavering commitment and attention. With over 34% of Australians living in rural or remote areas of Australia, it is incumbent on current providers and the government to work together to improve the sustainability of our care offerings in these communities.

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