Quality, not just quantity: How government investment into care work could grow the economy

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The undervaluing of caring work is a key driver of gender inequality. In today’s analysis, Kathy McDermott of the National Foundation for Australian Women (@NFAWomen) provides a summary of their submission to the Royal Commission into Aged Care Quality and Safety. They argue that investing in social infrastructure is economically savvy, providing supports for our biggest-growing industries while also tackling the gender pay gap.

The potential in a social infrastructure investment strategy

Aged care is a women’s issue.  Around 2 in 3 people using aged care are women, and women also make up just under 90% of the aged care workforce (see page 61).

It is not surprising, then, that the aged care workforce presents yet another case study in skewed budget thinking. Work in the sector is undervalued for the same reason that all social infrastructure is undervalued compared to hard infrastructure – it is work that has in the past been largely done by unpaid women outside national accounts.

In practice, this means that the government’s annual budget net operating and capital expense reporting treats spending on hard infrastructure such as roads as an investment, even when the financial returns are implausible, but spending on social infrastructure, such as child care, aged care or disability care, as a cost. Yet such spending increases productivity and growth for current and future generations, as well as increasing the number of women in the workforce. Furthermore, the caring sector is one of our fastest-growing, leading some economists to suggest it could displace mining as the engine room of the Australian economy.

In our submission to the Aged Care Royal Commission, NFAW argues that rather than using punitive welfare measures to drive women into the aged care workforce, policy-makers should invest in its underpinnings as important social infrastructure. These include terms and conditions in industry awards, skill valuation, training and qualifications and the intersection of each with the other and with other caring services in the sector. 

Caring work is one of Australia’s largest growth industries. Serious investment will reap social and economic dividends. Photo by  Matthew Bennett  on  Unsplash .

Caring work is one of Australia’s largest growth industries. Serious investment will reap social and economic dividends. Photo by Matthew Bennett on Unsplash.

Principles for effective reform

Because patchwork reforms in aged care are not likely to be any more successful than such reforms usually are, NFAW has articulated a set of principles that we think should apply in reforming the aged care workforce. These are that:

  • Social infrastructure is at least as important to national well-being as hard infrastructure. Treating social infrastructure as a cost and hard infrastructure as an investment distorts government decision-making and undermines the future of the sector.

  • The aged care workforce is critical social infrastructure. At present there are significant shortages in aged care workforce, particularly in regional Australia and amongst higher skilled roles.

  • Aged care infrastructure needs to be rebuilt from the ground up, with a shift in focus from attributes of existing and potential workers to structural factors that underpin greater consistency across aged care and related caring sectors--consistency in levels of qualification and recognition of qualifications, in wages and in other working conditions. Uneven and fragmented reforms are counterproductive.

  • Flexibility in aged care should not be focussed simply on filling rosters on a given day. Flexibility also requires the capacity to grow the sector and to respond to innovations to improve quality, such as mandated ratios of nurses to patients; accessible and effective complaints mechanisms for residents and family members, mandated unannounced inspections by those responsible for standards, and so on.

  • Employees will enter and remain in the industry, embrace reform and sectoral change and invest time and money in new skills only if they are assured of a reliable employment foundation including stable and secure working conditions, a proper valuation of skill sets, and relevant, recognised and, wherever possible, portable training.

  • A strong sector should not be built by passing the problems of casualisation, forced self-employment, and undervaluation of work on to other parts of the caring sector such as disability support and child care.

Practical changes can right historic shortfalls

Our recommendations go into detail about how these principles could be made to apply in practice. We argue, as a threshold matter, that providers of programs such as Newstart, ParentsNext and Job Assist be monitored to ensure that participants being steered into the aged care sector receive career counselling to ascertain their suitability for the sector.  They should also be presented with other choices that may be available/more suitable for the applicant.

In terms of increasing attraction and retention in the sector, we recommend that minimum qualifications should be re/established as a means of recognising the actual value of these workers and demonstrating to the community that this segment of the workforce is not unskilled.

The complex skills and competencies required to undertake aged care work in both residential and community-based settings should be ‘unpacked’, remunerated, and formalised through industry training.

Consideration should be given to increasing qualification levels to at least Certificate 4 and preferably diploma level, and priority given to developing career pathways for workers who have obtained qualifications at Certificate 4 level. The wide range of these qualifications should also be reviewed to identify those which could be consolidated into a career path towards a further qualification in the formal tertiary education system. Consideration should be given to the future professionalisation of care work, similar to the trajectory that was taken by Nursing. 

Both training and award-based remuneration should be harmonised nationally and wherever possible be made portable to provide consistency across the sector and related caring services, so that women are able to move readily between states and between jobs in those services.

There is always considerable danger that a harmonisation process will be used as a rationale for reducing pay and entitlements to a lowest common denominator. That is why the process should begin with a work value exercise and clearly sequenced qualifications.

Since there is no unified system of training or recognised management qualification in the aged care sector, the Commission should scrutinise management practices that shape conditions of employment offered to workers.

At the same time regulatory protection for part-time workers, who make up most of the aged care workforce, should be reviewed to ensure that entitlements are truly pro-rata to those of full-time workers, not only in wages but also in working time conditions. Under this heading, research should be undertaken to clarify whether the replacement of casual employment by part-time work in the sector is masking the use of part-time provisions to produce an effectively casualised workforce. That is, are staff being treated as casual in their working time arrangements and permanent in their pay rates, perhaps by changes made to scheduled working hours at short notice and increases to hours at ordinary time rather than overtime rates. Recent research reports that job stress is very high for home care workers, for example.

These measures intersect to support each other and should be thought of as a package. Above all, however, they should be thought of as an investment, not a cost.

You can read the National Foundation for Australian Women’s full submission here.

This post is part of the Women's Policy Action Tank initiative to analyse government policy using a gendered lens. View our other policy analysis pieces here.