FUTURE OF AUSTRALIA’S AGED CARE SECTOR WORKFORCE

Mr Patrick Reid Leading Age Services Australia CEO 02 6230 1676

The voice of aged care

www.

Leading Age Services Australia P: 02 6230 1676 | F: 02 6230 7085 | E: [email protected] First Floor, Andrew Arcade, 42 Giles Street, Kingston ACT 2604 PO Box 4774, Kingston ACT 2604 ABN: 7115 6349 594

2

Leading Age Services Australia (LASA) Leading Age Services Australia (LASA) is the peak body for service providers of retirement living, home care, and residential aged care. LASA is committed to improved standards, equality and efficiency throughout the industry; helping older Australians to live well. LASA advocates for the health, community and accommodation needs of older Australians, working with government and other stakeholders to advance the interests of all age service providers, and through them, the interests of older Australians. LASA represents private, church, charitable and community care organisations, which gives it the unique ability to provide a comprehensive view on behalf of the age services industry to enable all Australians to have access to, and choice of, high quality age services. To assist in achieving this, LASA pursues relevant issues with robustness and vigour in order to maintain and enhance age care services throughout Australia. LASA has a number of offices across Australia allowing it to focus on State and Territory specific considerations and concerns, as well as at a national level. Together LASA presents a strong, unified voice on behalf of the industry to Government and other stakeholders. Thank you for the opportunity to submit to the Senate Inquiry on the Future of Australia’s aged care sector workforce. Should you have any questions regarding this submission, please do not hesitate to contact Ms Emma Patton, National Manager, Employment Relations on 02 9212 6922.

3

Leading Age Services Australia (LASA) ................................................................................................ 2 Introduction ........................................................................................................................................ 4 Terms of Reference ............................................................................................................................. 5 a)

The current composition of the aged care workforce............................................................. 5

b)

Future aged care workforce requirements, including the impacts of sector growth, changes in how care is delivered, and increasing competition for workers ......................................... 5

c)

The interaction of aged care workforce needs with employment by the broader community services sector, including workforce needs in disability, health and other areas, and increased employment as the National Disability Insurance Scheme rolls out. ..................... 7

d)

Challenges in attracting and retaining aged care workers ...................................................... 8

e)

Factors impacting aged care workers, including remuneration, working environment, staffing ratios, education and training, skills development and career paths ........................ 9

f)

Government policies at the state, territory and Commonwealth level which have a significant impact on the aged care workforce ..................................................................... 12

g)

The role of government in providing a coordinated strategic approach for the sector ....... 14

h)

Challenges of creating a culturally competent and inclusive aged care workforce to cater for the different care needs of Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse groups and lesbian, gay, bisexual, transgender and intersex people. . 15

i)

The particular aged care workforce challenges in regional towns and remote communities16

j)

Impact of the Government’s cuts to the Aged Care Workforce Fund .................................. 17

References ........................................................................................................................................ 18

4

Introduction Leading Age Services Australia (LASA) take this opportunity to submit to the Senate Community Affairs Reference Committee a response to the Future of Australia’s Age Care Sector Workforce inquiry. LASA is a strong advocate for sufficient people and resources to meet industry demand via a workforce that is available, inspired, skilled and valued. To achieve this goal, LASA has identified three broad areas of focus that will need to be addressed:   

Workforce development; Workforce attraction and retention; & Review of workforce constraints.

The development of the workforce should ensure quality training and education is available for people interested in joining aged care and also for people already working in the industry. Strategies need to be in place to assist people to maintain and enhance their skills and knowledge to support them in their career progression. Standardised management skills and training packages should be developed and delivered to assist people that are interested in moving in to management roles within aged care. Professional development opportunities, as well as remuneration and work place culture, will assist to make aged care a more desirable career of choice. By working with key stakeholders, including Federal, State and Territory Governments, it would be possible to identify existing workforce constraints and opportunities and work together towards a workforce strategy. This strategy would continue to develop an efficient and sustainable industry that not only supports the workforce itself but also contributes to a high quality system that supports people to age well in Australia.

5

Terms of Reference a) The current composition of the aged care workforce Over the last few years, the age services industry has undergone significant change to comply with new policy directions. The industry will continue to grow and redefine itself over the coming decades to ensure that older Australians can live well and receive services when and how they need it and in a place of their choosing. Specifically, between 2013 and 2018, 1 in 4 new jobs created will be in the community services and health industry; that is, 229,400 extra workers will need to join the workforce. In 2012 there were 350,000 workers in aged care, by 2050 there will need to be 1.3million. The community services and health workforce comprises a variety of people, with care and support services delivered by 1.4 million paid workers and 2.7 million informal carers (Australian Institute of Health and Welfare [AIHW] 2015). While nurses are often in demand, their shortage and higher costs have meant that lower skilled community care workers or (residential) personal care assistances make up a vast majority of the direct care workforce (81 per cent and 68 per cent in each sub-sector respectively); the importance of such care workers has increased over time (Centre of Excellence in Population Ageing Research [CEPAR] 2014). The workforce, overwhelmingly female, is ageing, with a median age of 50 in community and 48 in residential care, and even higher for Registered Nurse (RN), at 50 and 51 respectively. Almost 60 per cent of the direct care workforce is 45 years and older (National Institute of Labour Studies [NILS] 2012).

b) Future aged care workforce requirements, including the impacts of sector growth, changes in how care is delivered, and increasing competition for workers Impact of growth on workforce requirements As outlined in the Intergenerational Report (Department of Treasury 2015a), the structure of Australia’s population will continue to change. This has important implications for the demand for health and aged care services and retirement incomes. A greater proportion of the population will be aged 65 and over. The number of Australians in this age group is projected to more than double by 2054-55 compared with today.

Both the number and proportion of Australians aged 85 and over will grow rapidly. In 1974-75, this age group represented less than 1 per cent of the population, or around 80,000 people. In 2054-55, it is projected that 4.9 per cent of the population, or nearly 2 million Australians, will be aged 85 and over.

6

These changes, and changing population demographics, will have a direct impact on the requirements, skills and composition of the aged care workforce.

Impact on workforce requirements with changes to how care is delivered A significant policy direction for aged services is consumer directed care (CDC). CDC is a way of delivering services that allows consumers to have greater control over their own lives by allowing them to make choices about the types of care and services they access and the delivery of those services, including who will deliver the services, where and when. The implications for workforce development by approaching care delivery from a CDC perspective is wide-ranging, not only in the staff required, but with the skills required to meet the changing care delivery models. A more responsive, flexible workforce is needed to ensure consumers can access the type of care and services they want, including by whom the service will be delivered and when. Many home care providers have reviewed care models, staffing structure, and the concomitant required skills of staff to cater for the introduction of CDC. Over time, the CDC service delivery model will impact residential services and this will significantly alter care delivery models, staffing mix and numbers, skill mix, work patterns and subsequently workplace instruments. This is easily articulated; far more difficult to implement. The scope of practice for clinical staff and general care workers will need to be reviewed and demarcation limitations will need to be considered. LASA supports the quality delivery of age services and seeks a workforce with the right attributes and attitude for working in aged care. Qualifications and specific skills can be obtained but attributes and attitude are a reflection of the person, and far more difficult to measure in a recruitment and employment phase. Whilst basic care tasks will continue to be required, it is the manner in which staff carry out such tasks that determine whether the person feels they have been cared for and heard. In order to offer choice and service, workers will need to be able to use their judgement, make decisions, and do so flexibly. They need to engage with the older person and their families, and show a level of emotional intelligence and pastoral sensibility, in order to support them and respect their dignity. It is anticipated that there will be growing need for some professionals, such as pastoral care practitioners and counsellors so the needs of the whole person are met, not just their physical needs.

Impact of increasing competition on workforce requirements Age services already compete with other industries for a sustainable workforce which will only exacerbate as the pool of available workers dwindles. An adverse view of aged care is not helped by negative comments about the industry from the Government, and amplified by media. Such comments are upsetting to the current workforce and discourage new entrants. This is further compounded by funding cuts resulting in a workforce that feels undervalued and under resourced. With a competing market for workers, age services need to demonstrate attraction and retention models that provide quality training, career prospects, a supportive, safe and well-resourced workplace, job status and recognition.

7

The introduction of innovative technologies across the spectrum of care and service delivery will and must be a major focus in the coming years. The increasing use of telemedicine, monitoring systems that enable people to stay at home, and communication systems that are point in time and easily transported will need to be developed to support the workforce. A recent Aged Care Financing Authority (ACFA) report indicated that for some service providers (specifically in rural and remote areas) there is scope for improvement in operations and performance. Strong leadership and management, along with a willingness to find innovative collaboratively solutions for financial viability are likely to see improved financial results. It is not only care and service delivery staff that require improved skills; boards and management will also require a range of new skills (Aged Care Financing Authority [ACFA] 2016). Attracting RNs into aged care is a particular challenge, and it is important to develop and fund an aged care graduate nursing programme. Recent funding for such a programme in Victoria ceased, despite significant positive outcomes for both participants and employers. LASA supports future leaders in aged care. Investment should be directed towards providing the opportunity to bring young leaders together from across sectors and engender peer support. Aged care leadership requires a mixed set of skills, from financial management to leadership, as well as knowledge of regulatory and legal frameworks, health economics, governance, and Information Technology, all of which is underpinned by compassion and ethics. Aged care leaders are incredibly talented, juggling an essential understanding of business management, clinical care and aged care and government regulation, but more are needed. Opportunities and support need to be available to people from other industries to assist them to upskill into aged care.

c) The interaction of aged care workforce needs with employment by the broader community services sector, including workforce needs in disability, health and other areas, and increased employment as the National Disability Insurance Scheme rolls out. LASA is aware that the broader community services industry, be it disability, child care or others will be competing for workers at the same time. There is a shared skilled set across the community services sector, indeed LASA appreciates that those working in disability are often a huge asset to aged care organisations as the industry works through current reforms. Ultimately however, the aged services industry needs to grow its own pool of staff with the right skills, attributes and attitude required across the community services sector. LASA is of the opinion that skills can be taught or modified to suite the ever changing care and service delivery models, but people with the right attributes and attitude are the most desirable to work with older people and those most vulnerable. The scope of practice for RNs and enrolled nurses (ENs) is clearly defined, however many of the aged care legislative requirements restrict what a particular level of nurse can do. For example, the Aged Care Funding Instrument (ACFI) has little or no place for the EN and they are restricted to practice as if they were general care workers; why then would they want to work in aged care? For example, the ACFI requires that specific clinical care requires a nurse specialist or consultant

8

even though RNs with gerontological experience and knowledge can adequately meet the care needs of a resident.

d) Challenges in attracting and retaining aged care workers Skill shortages The NILS Report identified that three quarters of residential facilities and half of community outlets reported skill shortages in one or more occupations (NILS 2012). Of the skill shortages in residential facilities, two-thirds reported RN shortages and a half reported Personal Care Attendant shortages. Of the skill shortages in community outlets, a third reported Community Care Worker shortages and 15 per cent reported shortages of RNs. Reasons given include: lack of specialist knowledge; slow recruitment; and geographical location. Each of these causes was identified by a third of the residential facilities and community outlets reporting a skill shortage. Only 15 per cent identified low wages as a cause of skill shortages. The National Aged Care Alliance (NACA) identified in the 2015 Blue Print Series the need for an integrated approach to workforce planning and remuneration across health, aged care, disability and community service sectors. This requires the Australian Government to work with stakeholders to co-design a definitive workforce development strategy to ensure a sufficient future workforce to meet the service needs of the health, aged care, disability and community service sectors (including in regional, rural and remote areas). NACA suggested the strategy should work towards greater coordination across the social services sectors and should focus on recruitment, retention, education, development and remuneration to ensure that the workforce needs of each of the sectors are met (National Aged Care Alliance [NACA] 2015).

Strategies to attract and retain an aged care workforce A number of strategies that have been found to be successful include:     



Maintaining a safe environment; Offering an effective orientation process; Having effective leadership and management in place; Encouraging an effective workplace culture; Minimise, clarify and improve efficiency of documentation and other processes (23 per cent of direct workers in the community and 16 per cent in residential services spend less than a third of their time caring); and Acknowledgement and valuing staff through: o Work / life balance / flexible working conditions; o Status and image; o Pay ; o Education and training; and o Maintaining capacity to effectively respond to industrial relations / employee relations matters.

9

In a CDC model of care and service delivery, changes may need to occur to ensure that evidencebased best practice is still able to be delivered. This could be supported by advanced roles for RNs, and a more creative use of skill mix across nurses, care workers, allied health and other staff including activity and pastoral care officers. This includes moving from a medical model (especially in residential care) and changing a task oriented role to meeting the outcomes that the care recipient wants and directs (Australian Centre for Evidence Based Aged Care [ACEBAC] 2010). Career pathways can be enhanced when an organisation focusses on key areas including professional practice and professional development. The Magnet hospitals spoken about in the 1980s were able to attract and retain staff because of a new management focus, ensuring they had well-prepared and qualified leaders and staff. Changing from task oriented roles to providing care and service when and how a consumer wants it will require a paradigm shift in thinking, however the rewards for providing quality care translates to staff who want to work for an organisation. Career advancement often mirrors the acute health sector. For RNs, in particular, generally only one way of advancement is via a management pathway. To encourage advancement for the traditional clinical pathway, that is, Clinical Nurse Specialist, Clinical Nurse Consultant and Nurse Practitioner models will need to be varied as the traditional trajectory may not be fit for purpose in the aged care setting, especially in community care. Aged care has historically been seen as a ‘less attractive’ industry to work in, however that perception is slowly changing and many staff have been working in aged care for very long periods of time, with some areas reporting below average turnover rates. With the predicted growth in the numbers of staff required, innovative measures to attract and retain staff are required.

Aged care can offer a favourable work-life balance as many staff work on a part-time basis, however maintaining direct care staff requires new and innovative measures (CEPAR 2014). Attraction and retention strategies can be costly, and require leadership and skills that are not available across the industry. Support and investment is required to make attraction and retention strategies accessible to all providers of aged care services.

e) Factors impacting aged care workers, including remuneration, working environment, staffing ratios, education and training, skills development and career paths Remuneration While remuneration is a factor that does not support attraction of direct care workers (many of whom could earn more in other industries) this is one area that providers have little capacity to impact, given that, on average, 60 – 80 per cent of subsidy income is directed to wages. Attracting workers from other industries will become commonplace. For example, nurses undergo the same qualification standards, it is up to the age services industry to demonstrate how those qualifications can be tailored to the older person, and show the value of working in the industry. This will always be difficult when remuneration in other sectors is dramatically different.

10

Working Environment – Fair Work System Applications to amend modern awards in the age services industry will have a significant impact on the industry and labour costs. Specifically, and referring to applications before the Fair Work Commission advanced by the Australian Council of Trade Unions, LASA notes their intention to vary all modern awards and require four hour minimum engagements for casual and part time staff. In community care, existing minimum hourly starts/payments under relevant modern award reflect both client needs and funding limitations. If a client requests, or is assessed as requiring, only one hour of home care, the government will only fund one hour of home care and/or the client will only pay for one hour of home care. The notion that an employee be paid for 4 hours, to provide one hour of home care, is not sustainable. It fails to take into account the needs of the community care industry, and the manner in which community care service delivery occurs in 2016.

Staffing Ratios In a recent LASA submission to the Queensland Parliament on ratios in residential services, LASA referred to the Productivity Commission’s report Caring for Older Australians (Productivity Commission 2011, p206) which states: “While there are superficial attractions to mandatory staffing ratios, there is also downsides. An across-the-board staffing ratio is a fairly ‘blunt’ instrument for ensuring quality care because of the heterogeneous and ever changing care needs of aged care recipients – in the Commission’s view it is unlikely to be an efficient way to improve the quality of care. Because the basis for deciding on staffing levels and skills mix should be the care needs of residents, it is important that these can be adjusted as the profile of care recipients changes (because of improvements/deteriorations in functionality and adverse events, etc.). Imposing mandated staffing ratios could also eliminate incentives for providers to invest in innovative models of care, or adopt new technologies that could assist care recipients.” The report goes on to say that a study should be undertaken to identify the funding required for the delivery of complex health care needs and the allocation of funding by a service, including staffing requirements. LASA, in concert with the Productivity Commission, is of the opinion that staff ratios are a blunt instrument that do not take into account the changing care needs of residents, nor acknowledges the broad ranging skills that the aged care workforce requires, especially those of an RN, who predominately plans, coordinates and directs care and services for aged care workers and other professionals across the spectrum of service delivery. To address care recipient needs, robust human resource management and roster design should ensure appropriate staff skill mix to meet both clinical care and daily living needs for all residents, as well as recruitment and retention strategies to attract and retain people with suitable attributes and attitude to the age services industry.

11

This position is supported by the Victorian Government’s Department of Health’s report Innovative workforce responses to a changing aged care environment (ACEBAC 2010, p.4), which states: “… [This paper] contends that a more diverse skill mix could achieve quality resident outcomes and, with contemporary leadership and staff development, replace task oriented traditional care with person-centred, interdisciplinary, evidence-based practice. In reviewing the literature on ratios, little evidence could be found to sustain an argument in favour of them. Staffing methodologies are called for that take account of a broad range of variables and contexts… The skill mix includes RNs, ENs, PCAs and activity offices, alongside medical, allied health and specialist services.”

Education and training The NILS Report (2012) demonstrates that the age services industry is well educated with more than 85 per cent of direct care workers having some form of post-secondary qualification, which is above the national average. There has been a substantial increase in the proportion of Personal Care Assistants and Community Care Workers with Certificate III and IV qualifications. The report continues stating (NILS 2012, p.7): “Direct care workforce displays a strong commitment to training and up-skilling. Around 20 per cent of this workforce is currently studying, 80 per cent of direct care workers had engaged in one or more training courses in the previous 12 months, and more than half had been involved in continuing and professional development. In addition, direct care workers are gaining specialised qualifications in ageing and aged care (e.g. gerontology, palliative care), particularly those in clinical or care manager roles.” However the report identifies quite extensive variation between workplaces in relation to management skills and training. This variation impacts on direct care workers’ satisfaction with their workplace and the extent to which they feel valued and prepared for working in aged care. Specific issues were raised associated with the provision of community direct care:    

Training is often based on residential care and not relevant to the community sector; Out-of-pocket costs (mobile phones, petrol and care related costs) can be borne by workers; The safety issues associated with working alone and going into private homes; and The tension between meeting client needs and protecting workers/employers.

In saying that, job satisfaction is reported as being high across all areas identified in the NILS report with the exception of pay. Although the NILS report identifies a well-qualified workforce, there has been consistent complaints within the industry that some of the Vocational, Education and Training (VET) Sector graduates are not job ready following completion of a course and that there is inconsistency

12

standards of training. The Department of Education and Training are in the process of seeking comment on the Quality of Assessment in vocational education and training; an initiative long overdue. The recently published ACFA report showed that rural and remote providers pay more for training as they had to cover the transportation and accommodation costs for training providers visiting an area and for trainees to attend training in larger regional centers or cities. The ACFA report also noted some providers described (in rural and remote areas) that there is often no issue with attracting staff, but it can be difficult to attract quality staff (in terms of qualifications, experience, attitude and competence). The report continues that providers tended to hire inexperienced staff due to need, but then had to invest in significant training for all staff, from the cooks to the personal care workers and EN positions to ensure they are satisfactorily skilled. Additionally, in more remote regions, providers often experience limited access to RNs. A number of providers noted that they are reluctant to use agency nurses and staff as there is a perception that the care is not personalised due to lack of rapport with the residents. It is also very costly for the provider to employ agency staff. ACFA continued that training for staff is seen as important by management, but they sometimes have difficulty in attracting staff to undertake the training. Some providers encouraged training as an incentive mechanism. It was also noted that training can be quite time-consuming to undertake, and due to lower staffing numbers, staff do not have sufficient time to undertake the training (ACFA 2016). Although the ACFA report was specifically designed to review rural and remote providers, these findings are often seen across other geographical areas. Curriculums and the structure of courses for ENs and RNs often restricts participants, for example a more flexible approach could be seen where current ‘block’ placements might be replaced with part-time placements spread across a year.

f) Government policies at the state, territory and Commonwealth level which have a significant impact on the aged care workforce Changes to government policies at the State, Territory and Commonwealth level have significant financial impacts to the age services industry and flow on effects to funding available to develop training, development, career path, wages and other attraction and retention strategies required if they are going to meet the growing demand for services in the future. Specifically, LASA focuses on some of the following changes:      

Removal of the Dementia and Severe Behaviors Supplement; Removal of Payroll Tax Supplement; Ineffective red tape reduction policies; Proposed changes to Fringe Benefits Tax; Superannuation reform; and Retention of redundant NSW legislative requirements with regards to 24/7 RNs.

13

Removal of the Dementia and Severe Behaviours Supplement In mid-2014, the Dementia and Severe Behaviours Supplement in residential services was ceased despite investment made by the industry to deliver enhanced services. With an estimated 52% of people living in permanent residential care having a diagnosis of dementia, which is roughly 85,000 people (2010-11), with almost half of the permanent residents with dementia also having a mental illness diagnosis (AIHW 2012). This highlights that dementia services are no longer ‘niche’ but rather a core component of care and service delivery for residential services. However, for people that have severe Behavioural and Psychological Symptoms of Dementia (BPSD) their families and carers need additional support. Early data from the Severe Behaviour Response Teams (SBRT) indicates that they are meeting their KPIs but it is unclear whether this will continue as demand increases. LASA is concerned where the workforce for the SBRT will come from.

Removal of the Payroll Tax Supplement The Aged Care Payroll Tax Supplement was abolished on the 1 January 2015. The removal of this supplement was implemented with no industry consultation and results in an average loss of approximately $2,350 per annum per resident, or around $155 million for the 66,000 people affected. This is a subsidy that would have been spent on care delivery, through the aged care workforce. The original principle of the supplement was to remove the significant inequity in the age services industry which results from the levying of state payroll taxes on private providers only. This was seen as an important principle, given that all providers operate under the same Commonwealth subsidy payment and fee structures, and all are required to provide the same high standard of care and accommodation to care recipients. Many aged care providers are exempt from the tax, however 37 per cent of all residential providers and 10 per cent of home care providers are not. The removal of the supplement will result in the competitive neutrality of the age services industry being compromised and places the Aged Care Sector Committee’s Statement of Principles in jeopardy, whereby providers will be unable to compete on an even playing field where quality, value and performance are the criteria for service delivery (Department of Social Services [DSS] 2014) & (Aged Care Financing Authority [ACFA] 2015).

Red tape reduction policies Significant administrative burden, amplified by the pace of aged care reforms, and a lack of support, including the provision of basic information, means that red tape reduction strategies need to be implemented so they may start to achieve their objectives. Administrative burden is also added to through: failure of government technology and payment systems to operate effectively; and duplication of accreditation (across residential aged care, home care, disability and mental health). There is even duplication within aged care, for example, the differences between Commonwealth Home Support Programme and Assistance with Care and Housing for the Aged HSP forms.

14

Fringe Benefits Tax LASA has supported the retention of tax concessions on salary‐packaged entertainment benefits for staff working in age services, and has stated that the current caps on living expenses be increased to support people working in the industry. In its submission to Treasury on the issue, LASA recommended the federal government consider the broader social and economic benefits of granting all organisations in high growth industries, including age services, disability and community services, equal opportunity in terms of accessing grants, concessions, supplements and FBT exemptions.

Superannuation reform LASA is of the opinion any review of the retirement income system must also consider options for financing care and accommodation that meet the changing needs of older Australians. The Productivity Commission report released on 7 July 2015 about superannuation policy identified a number of elements of the current retirement income system that warrant a holistic review (Productivity Commission 2015).

24/7 Registered Nurse Despite Commonwealth legislative requirements articulated for example, in the Accreditation Standards and the Schedule of Specified Care and Services in the Quality of Care Principles on staffing and care delivery processes, NSW currently has contrary legislation to other states in relation to the requirements of registered nurses (General Purpose Standing Committee No. 3 2015). State differences, whether it is related specifically to RNs or any other important area of service delivery, equates to multiple systems, duplication and confusion. These state differences must be contained.

Other State variations, for example, in the number of public holidays, impacts how businesses can budget. Aged care is governed by federal legislation and yet state legislation can impact how business is conducted. This is also seen in the example above on the state variations around 24 hour RN requirements in NSW and also the requirements of nurse ratios in Victorian state owned facilities.

g) The role of government in providing a coordinated strategic approach for the sector Coordinated approach LASA advocates for a coordinated strategic approach that is consistent, and comprehensively articulated to key stakeholders. Consultation around adequate time frames for education and implementation of changes must be provided to ensure the industry can up-skill, prepare and launch new programmes, processes and systems.

15

Workforce strategy LASA advocates for a workforce strategy to be co-designed with Government, age care providers and key stakeholders. A workforce strategy should consider areas that both providers and governments can impact. This includes:      

Immigration; The Vocational, Education and Training (VET) system (ensuring graduates of age and community service courses are work ready); The scope of practice of workers; Having a flexible and responsive workforce (especially in a consumer directed model of care and service delivery) that is not impeded with historical workplace instruments that do not reflect current practice; Recognising that workers can practice across the industry within aged care, disability, mental health and primary health sectors; and Raising the ‘image’ of working in the aged care sector.

The industry has to be sustainable to ensure sufficient staff are available to enable consumers to have care and service delivery when, by whom and where they direct.

h) Challenges of creating a culturally competent and inclusive aged care workforce to cater for the different care needs of Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse groups and lesbian, gay, bisexual, transgender and intersex people. There is great opportunity and benefit to be gained through government supporting the development of a culturally competent and inclusive aged care workforce. LASA is founded on principles of inclusion, representing all providers of care to older people living in Australia. We further demonstrate that principle by supporting a diverse and inclusive industry that provides excellent care to all older people, enabling timely access to high quality services of their choice, regardless of their culture, background, location or entry point. Supporting the education of the aged care workforce to address the diverse care needs of older people has multiple layers of benefit. For example, in an increasingly culturally diverse workforce, cultural awareness training works to help better support clients and their families, but also to support staff relationships across the workplace. Further, any opportunity given to support the industry’s capacity to care for the growing client base identifying as culturally and linguistically diverse, through initiatives including language services and cultural sensitivity training, will have the double benefit of increasing collective capacity to build productive working relationships across markets. This supports the age services industry being positioned to capitalise on opportunities presented by free trade agreements and other international market opportunities.

16

LASA sees similar magnification of outcomes in the LGBTI Aged Care Training delivered through the National LGBTI Health Alliance (National LGBTI Health Alliance 2014). This programme implements a free national workforce training programme to build the skills of the aged care workforce to provide inclusive, accessible and appropriate care to each population of older people within ‘LGBTI’. This training has seen an improved understanding of the particular care needs of these clients by those participating and recognition of the distinct, but sometimes overlapping needs of each population within ‘LGBTI’. Furthermore, the training has also provided a safe space and opportunity for attending staff to share the challenges they themselves have faced as a person in one or more LGBTI populations, some for the first time. Projects such as this also support communities. Feedback from staff that have attend the training, highlights the impact it has had on their relationships with LGBTI friends and family members. This increased consideration and awareness is also valuable for clients visiting friends and family in care. The age services industry works hard to provide a safe and caring environment for all older Australians and seeks for the community to know that the services are safe and inclusive. LASA notes that special skills and assistance are required for the best care of older people, including those that are homeless or subject to abuse. Supplements and training support for staff supporting people in these situations are critical in ensuring a good quality of life for all older Australians. Organisations committed to care for older Indigenous people can find it difficult to engage an Indigenous workforce. It is at the entry point, supporting the completion of initial training and shifts that presents a barrier. The age services industry are looking to other industries to learn from their successes. For all entry level staff, it would be useful to access funding that enables their appointment as supernumerary to cover the costs of initial training time.

i) The particular aged care workforce challenges in regional towns and remote communities As mentioned above many challenges faced by providers is only exacerbated in rural and remote regions. Attention needs to be focused, and funding invested, in attracting and retaining the workforce in rural and remote Australia. Incentives for both employers and employees should be developed so as to improve and increase workforce participation and size in locations where these difficulties are evident. The recent ACFA report referred to above highlighted the very specific problems facing rural and remote providers and broad consideration should be given to addressing the particular problems highlighted in that report.

17

j) Impact of the Government’s cuts to the Aged Care Workforce Fund LASA strongly opposes the cuts to the Aged Care Workforce (Development) Fund, which has jeopardised innovation and may put quality at risk. The reduction of available funding to support training and education, in conjunction with the decrease of Aged Care Service Improvement and Healthy Ageing Grants Funds, the concerns around the Severe Behaviour Response Teams and the loss of supplements is not supportive to the industry (Department of Treasury 2015b). An available, accessible and appropriately skilled workforce is a fundamental requirement of the growing age services industry. Sourcing and maintaining a sustainable workforce is therefore a significant issue. Residential, home and community care providers continue to struggle to access appropriately skilled and available staff. All providers need support, funding and new initiatives so as to adequately fulfil current and future staffing needs. Some good pilot projects have been funded, but funding normally goes to a single organisation that does not have a long term commitment to build the capacity of the entire industry. Consideration should be given to the ability for these successful projects to be scaled up and the project outcomes and recommendations being made publicly available. With cuts forecasted to the Vocational Educational and Training (VET) system, subsidised Certificate III and IV training of personal care workers and support workers may no longer be offered to people wanting to enter the sector. Often, these are people that would otherwise find it difficult to join the workforce and find the funds to undertake these qualifications. LASA supports the work of the Aged Care Sector Committee, and particularly the Workforce Committee, however would strongly lobby to have a system-wide workforce strategy implemented that recognises the limited funds now available since these funding cuts were implemented.

18

References Aged Care Financing Authority 2015, Report on the Impact of the 1 July 2014 Financial Reforms on the Aged Care Sector – Quarter ending 31 March 2015, Department of Social Services, Canberra Aged Care Financing Authority 2016, Financial Issues Affecting Rural and Remote Aged Care Providers, Department of Health, Canberra Australian Institute of Health and Welfare 2012, Residential aged care in Australia 2010-11: A statistical overview, cat. no. AGE 68, AIHW, Canberra. Australian Institute of Health and Welfare 2015, Australia’s Welfare 2015 no. 12, cat. no. AUS 189, AIHW, Canberra. Centre of Excellence in Population Ageing Research 2014, Aged Care in Australia: Part II – Industry and Practice, research brief 2014/02, CEPAR, Sydney. Department of Health and Ageing 2012, The Aged Care Workforce, 2012 – Final Report, prepared by the National Institute of Labour Studies, NILS, Adelaide. Department of Health (Victoria) 2010, Innovation Workforce Responses to a Changing Aged Care Environment, prepared by the Australian Centre of Evidence Based Aged Care, ACEBAC, Melbourne. Department of Social Services 2014, 2013-14 Report on the Operation of the Aged Care Act 1997, DSS, Canberra. Department of Treasury 2015a, 2015 Intergenerational Report - Australia in 2055, Department of Treasury, Canberra. Department of Treasury 2015b, Budget Paper No. 2: Budget Measures, Department of Treasury, Canberra, viewed 30 June 2015, http://www.budget.gov.au/201516/content/bp2/html/bp2_expense-20.htm General Purpose Standing Committee No. 3 2015, Registered Nurses in New South Wales Nursing Homes, NSW Parliament, Sydney. National Aged Care Alliance 2015, Enhancing the quality of life of older people through better support and care, NACA Blueprint Series, NACA, Canberra National LGBTI Health Alliance 2014, Silver Rainbow – LGBTI Ageing and Aged Care, National LGBTI Health Alliance, Sydney, viewed 3 March 2016, http://lgbtihealth.org.au/ageing/ Productivity Commission 2011, Caring for Older Australians, Report No. 53, Final Inquiry Report, Productivity Commission, Canberra. Productivity Commission 2015, Superannuation Policy for Post-Retirement, Commission Research Paper, Productivity Commission, Canberra.