industry & policy
Eye on quality
workforce
The aged and disability care
sectors should be on the
same page in the quest to
have the best qualified staff.
By Michael Fine
T
he increasing march towards marketised models of aged
care poses new challenges for service providers and care
workers, just as it does for consumers. But when viewed
alongside the emphasis on consumer choice in the NDIS, it
seems like we are heading rapidly in the same direction.
Although developments in the two major national programs
of human services in Australia seem to be inevitably converging,
there remain substantial differences that cannot be ignored.
Perhaps the most critical issue is the workforce – the people
who ultimately provide the care that consumers need.
For many years, the ageing and disability sectors have
approached the workforce issue from radically different
perspectives. In ageing, the emphasis has been on
demonstrating professional competence wherever this is
required. While few, if any, qualifications beyond a police record
check and a driver’s licence are necessary for staff in many areas
where personal care is involved, professional competency is
essential. For staff, this means recognised qualifications. For
services, approved service status is essential.
In the disability field, another model has gained preference –
the personal assistant without professional qualifications is often
preferred. Qualifications are typically portrayed as an obstacle, a
learned rigidity and indifference to the consumer.
Now that disability and ageing seem to be converging,
the differences are once again to the fore. On one side of
the emerging chasm are professional associations and trade
unions arguing for maintaining or developing high standards of
competency and pay.
Clare Kermond reported in The Age that two parent groups
had expressed concern that the rush of new providers to the
NDIS could lead to poorly qualified, inexperienced people setting
themselves up as disability workers. Another NSW group was
alarmed about newcomers with good will but few qualifications,
becoming NDIS providers. Unions and disability advocates have
also been issuing warnings about the lack of quality safeguards
for the NDIS. They have been calling for tough minimum
standards for workers and strict national requirements for
registration, accreditation and minimum qualifications.
On the other side, there are many calling for an Uber-style
disruption to the labour market, abandoning regulation and
allowing the competition to drive down labour costs, thus
providing consumers with choice as well as risk.
A report by the Centre for Independent Studies calls for
shedding existing regulation and rigidities in aged care to
allow consumers to accept greater risk, and to promote other
measures that will further foster competition and drive down
wage and administrative costs.
Figures from Better Caring Pty Ltd (submitted to the recent
Senate inquiry) are presented which show that under the existing
model for level 4 Consumer Directed Care (CDC) packages
(10–12 hours’ care a week), direct care staff receive just 34 per
cent of the annual total cost of $48,906 paid for the package.
The remaining 66 per cent is consumed by administrative and
case management fees and by the provider’s margin on the
services delivered.
The solution most highly recommended by the report is to
promote P2P (person to person) internet platforms and apps
which allow consumers to purchase the kind of services they
desire directly from care workers. Overhead costs are estimated
at around just 15 per cent. Sadly, the report’s author does not
look at the evidence that could support his case.
We know what the results can be. Care.com already operates
this sort of model in the US and internationally, including in
Australia. You can check out the results – it’s simple enough, like a
dating site for consumers and staff.
Along with aged care, the Care.com site also helps match users’
child care, housekeeping and pet-care service needs. And at first
sight, the approach looks great.
However, while the average cost of aged care in this country
is said to be $23.46 an hour, some of the staff listed on the
Australian site charge as little as $9 and $10 an hour. The reviews
revealed on the Care.com homepage by online business review
service SiteJabber are an eye-opener, with 737 of the 852
submitted reviews being just