Workforce key to addressing aged care sector problems

The future age care workforce must receive adequate, ongoing training and aptitude and capability challenges must be addressed, according to an industry expert.


Workforce issues and the use of restraints, which can range from medication to limiting access to mobility aids, were discussed on 18 November by industry, advocates and academics at a Future Social Service Institute (FSSI) and Office of the Public Advocate event – Humane staff required to deliver cruel care? The dilemma of restrictive practice in aged care.


FSSI is a collaboration between RMIT and the Victorian Council for Social Service (VCOSS).


Director Micaela Cronin said the comment in the Commission’s recent preliminary report Neglect that workforce issues were relevant to every aspect of the inquiry stood out.


“This is a vulnerable workforce that’s often disempowered and not adequately trained, working very long shifts and feeling like they are not resourced to address the issues in terms of the complexity of dementia,” she said.


“Currently there are about 365,000 people diagnosed with dementia. In the next 30 years that will more than double to about 900,000.”


Cronin said the current workforce was predominately female (80%), low skilled with most workers undertaking Certificate III and IV or having no qualifications at all, ageing and facing increasing demands due to growing vacancy rates.


“There are significant workforce challenges that we need to face around capacity, so the number of people that we have and the levels of staffing, attributes, so people who have and bring compassion, and capability, so the level of training, qualifications, knowledge and skills around very complex issues,” she said.


Cronin shared her family’s experience, saying like many attendees she had personal and professional experience with the sector.


She read from her mother’s submission to the Aged Care Royal Commission detailing the family’s concern about the lack of respect for and abuse and violation of the rights of her grandmother Ruby, who was taking 16 regular medications for “behaviour management” in the months before her death in 2013, as well as talking about her father who had recently moved into aged care.


“I think there is a whole lot of work around knowledge building within the workforce but also just how stretched people are with time and what they believe is their role … and if it’s not to sit and talk to people sometimes and make sure they build a bit of a relationship so they that they know someone’s name it really makes me very sad,” she said.


Cronin said FSSI had done a pilot re-writing the Certificate III and IV, and found people with lived experience needed to be involved in their development.


The Royal Commission report highlighted moves by employers to “tick and flick” online training, with Cronin saying, “There is also a need to refresh and keep giving people access to lifelong learning and professional development over time”.


Victorian Public Advocate Dr Colleen Pearce said the report detailed instances where restrictive practices which were inhumane, abusive and unjustified.


“Unfortunately, the use of restraints is all too common in aged care in Australia and … there has been little progress in nearly 20 years in addressing this issue,” she said.


Pearce received an honorary doctorate from RMIT last year.


Head, Health Law and Ageing Research Unit at the Monash University Department of Forensic Medicine Professor Joseph Ibrahim said the workforce formed over the last 15 to 20 years was a “distraction” and what was missing was a big picture view of the model of care that society would accept.


“We think that having good staff who are well-intentioned is enough to lead to good outcomes,” he said.


“At the minute we are not treating people as people. We are asking doctors questions about medication rather than the fundamental issue of, `Why is this person displaying a responsive behaviour? Is it permanent? Is it temporary?’”


Ibrahim said despite evidence that restrictive practices killed people, they were very easy to rationalise in a clinical environment and enormous culture change and leadership from nursing and medical professionals and the community more broadly was needed to put human rights front and centre.


“Nursing staff believe they are stopping people from falling, from impulsive behaviour, from intrusive behaviour or leaving the facility,” he said.


“You only need one instance of something to have gone wrong and the person is forever labelled aggressive.”


The panel also discussed the new aged care amendments introduced into federal legislation earlier this year and the complexities around informed consent.


20 November 2019