5.1
Most Australians will have the experience of combining their job with using paid care—whether childcare, aged care or disability care services. The committee's Interim Report focused particularly on the early childhood education and care (ECEC) system and how its operation affects workers who rely on it, and how it shapes—and limits—participation in paid work.
5.2
The Interim Report showed that there are long‑term national and personal economic and wellbeing impacts for people combining work and care, particularly women. The report showed that workplace shortages, job insecurity, feminised work, inflexible working conditions, low paid jobs and shallow classification structures impair 'the ability of working carers to balance their various responsibilities'.
5.3
Further evidence received since the Interim Report was tabled reinforces that evidence, showing how low pay and job insecurity are major problems and have contributed to a model of care provision which has resulted in high-cost services and service 'deserts'. Moreover, in general ECEC services do not cater for those parents who work outside normal business hours, including those undertaking shift work. Alongside childcare, this chapter especially considers the impact of unpaid care on disabled people and older Australians.
The value and conditions of paid care
5.4
In its Interim Report, the committee discussed the interaction of paid and unpaid care, with particular reference to ECEC. This section expands on that discussion by examining pay and conditions across the paid care sector, including in aged and disability care, and with regard to insecure work and rostering practices.
5.5
It is also important to acknowledge, as did many submissions to this inquiry, that wages and conditions in the care sector are inextricably linked to the overarching funding infrastructure, which is complex and inadequate.
5.6
Similarly, the options and conditions for women in paid employment can be limited as a direct result of their informal caring roles. The point was made by the Centre for Future Work at the Australia Institute that 'one of the main reasons women with caring responsibilities are located in casual work is because they are worker-carers'. The Centre noted the issues with institutional supports for carers:
The contribution of their unpaid care work to our society and economy are barely recognised in institutional supports. When carers enter the labour market they are further disadvantaged because of their unpaid care work, as they obtain casual and other insecure work with no access to leave that could support them manage work and care.
Intersection of formal and informal care
5.7
Both paid and unpaid care form part of the broader care economy, as Ms Luz Myles from Soroptimist International explained:
When we talk about the care economy, we're talking about care work done at home, which is invisible and unpaid, and we're also talking about work done outside the home, which is done by people who are in care work and are care professionals—disability care, childcare and all the other contexts of that occupation.
5.8
To properly understand the interaction of work and care in Australia, it is necessary to consider both sides of the care economy, including the experiences of those employed within the formal care sector.
5.9
It was suggested to the committee that a significant proportion of informal carers are also employed in the formal care sector. That is, they both provide informal unpaid care to their families as well as work in paid care jobs. According to the National Foundation for Australian Women, 'formal employment in the care sector is often designed so that it is one of a limited number of options available to those with informal caring responsibilities'. Work in the paid care sector also provides an opportunity for carers to be paid for the skills they have developed through unpaid care work.
5.10
Pay and conditions in the care sector are also of relevance to the large number of working carers whose informal care work is undertaken in collaboration with one or more paid care workers. Often, it is the quality and availability of paid care that dictates when, where and how much working carers can work in their paid roles. For these carers, the challenges of combining work and care are directly related to the availability of staffing in the formal care sector.
5.11
In addition, pay and conditions within the formal sector are reflective of the structure of the care system as a whole. Any effort to consider the adequacy of care wages should recognise the structure of the care economy to ensure that people delivering care are properly remunerated for their work. The Antipoverty Centre summarised this issue and said:
To ensure people who receive care are treated with dignity, those who provide that care must also be given the resources and support to themselves to live a dignified life.
Understanding value in the care sector
5.12
As observed by the Edith Cowan University Centre for Wellbeing + Work, care workers are 'paid less for their time relative to those in other sectors, [while] at the same time they end up generating more value for the community'. In this sense, the care sector is illustrative of a flawed understanding of value in the Australian labour market.
5.13
Professor Alan Duncan of the Bankwest Curtin Economics Centre argued that traditional productivity measures do not adequately capture the full range of benefits derived from the care sector. Ms Shelby Schofield, Chief Economist at the Office for Women, agreed that traditional economic frameworks struggle to properly account for the value of formal care work.
5.14
It was put to the committee that the perceived value of care work is further undercut by a widespread expectation that this type of work is—or should be—done for altruistic and non-financial reasons.
Equity and value in the care sector
5.15
A central theme of this inquiry, discussed in detail in Chapter 2, has been the feminised nature of unpaid care work. This gender disparity extends to the paid care workforce, of whom an estimated 80 per cent are women.
5.16
As evidence to this inquiry has repeatedly shown, feminised work is widely undervalued. Paid labour in the care sector is no exception. In fact, low remuneration in the formal care sector can be seen as an extension of the undervaluation of women's unpaid care work, as Ms Schofield explained:
Because women provide and have always provided unpaid, free care work in the home and in the community, that sets an expectation in society that that work is not worth being paid for.
5.17
Wage disparity and underpayment within feminised sectors, such as in childcare, aged and disability care, also serve to widen the gender pay gap, as the financial consequences are predominantly borne by women.
5.18
The extent of the disparity in the care sector means any improvement to wages and conditions is likely to have an important effect in improving gender equality in the workforce as a whole. The Australian Council of Social Service put it to the committee that '[s]trengthening the care economy will also improve the gender pay and work gap that plagues Australia's labour market workforce generally'.
5.19
As well as being overwhelmingly female, the formal disability and aged care sectors are disproportionately comprised of migrant and culturally and linguistically diverse workers. Research suggests that within the care sector, migrant workers have 'poorer quality' jobs than their non-migrant colleagues. The committee was told that:
You can actually look at the hierarchy and see that migrant women, women from a non-English speaking background or Indigenous women do the nursing assistance, disability care and support work. It's because that's the only job they can get.
5.20
Some suggestions were put forward for engaging disabled people in care roles. For example, the chief executive officer of social enterprise JFA Purple Orange noted that a program to employ disabled people in the aged care sector would provide social and financial inclusion for workers, while simultaneously addressing a labour shortage in care provision and freeing up informal carers to pursue their own paid work.
Wages and conditions in formal care sectors
5.21
In its Interim Report, the committee highlighted the inadequacy of wages in the care sector. Since then, the committee has heard overwhelming agreement that wages in the care sector are too low and must be increased.
5.22
As has been noted throughout this inquiry, there are several factors that contribute to low wages in the care sector, including the feminised nature of the work, the inadequacy of overall funding, and the complex funding environment. In addition, evidence to this committee shows that the lack of flexibility from employers and the entitlements in the National Employment Standards (NES) means many workers with informal care responsibilities cannot engage with paid care work in a way that best supports their circumstances.
5.23
Low wages must also be understood in the context of the undervaluation of care work, as canvassed extensively by this inquiry. This undervaluation has flow-on consequences for remuneration in the sector. Both Professor Duncan and Mr Chris Twomey pointed to ECEC as a clear example of the type of work that would attract far higher remuneration if wages reflected the full range of benefits created by the work. This structural inequality must be addressed in the view of many witnesses.
Award structures
5.24
There are several awards relevant to the care sector. The Social, Community, Home Care and Disability Services Industry (SCHADS) Award 2010 covers employers and employees in the following sectors:
Crisis assistance and supported housing
Social and community services (such as social, welfare and youth work)
5.25
Other relevant awards include the Aged Care Award 2010, the Health Professionals and Support Services Award 2010 and the Nurses Award 2010. ECEC workers may also be covered under one of a variety of awards including the Children's Services Award 2010, Educational Services (Schools) General Staff Award 2020, Higher Education General Staff Award 2020, Local Government Industry Award 2020, as well as the SCHADS Award.
5.26
Evidence to the committee suggested that the structures across these awards for the care sector are rudimentary and compressed, with arbitrary distinctions between roles and sometimes as little as a few cents separating junior and senior positions. Classification structures are shallow and do not appropriately distinguish, or reward varying skills, qualifications or experience and the definitions are often imprecise. The operation and application of awards is often unclear, with Professor Charlesworth saying:
You have possibly three levels, which you may or may not be paid at; the award is entirely opaque as to when you need to be paid at what level.
5.27
By way of example, Ms Jennifer Marsh of the Gladstone Community Linking Agency outlined the operation and complexity of the SCHADS Award, and how the SCHADS Award can actively work to limit female participation in the workplace and to earn an adequate income:
The direct support workforce is therefore, in many organisations, casualised. This casualised work in turn makes it difficult for the primary female workforce to gain financial sustainability and independence. It can have a direct impact on borrowing capacity and is a barrier to home ownership, which may have lifelong impacts and reduce retirement earnings, leading to vulnerability and homelessness amongst that female workforce. Flexibility in work arrangements is required to enable the needs of employers, the workforce and customers to be met.
5.28
Other structural issues were also raised with the committee, including that agreements do not have efficient and effective assurances of gender equity and that they are not designed to facilitate career progression.
5.29
The awards may also amplify existing flaws in the sector. For example, Ms Annie Butler from the Australian Nursing and Midwifery Federation (ANMF) pointed out that the definition of 'part-time' employment used in certain nursing awards enables employers to offer low-hours contracts that do not reflect the actual hours worked. Many such workers then find themselves working additional hours without penalties or predictability and control, and are unable to secure, for example, a mortgage.
5.30
A similar point was made by Ms Louise de Plater of the Health Services Union, who said that care awards were different to those in male‑dominated sectors, such as manufacturing and road transport, where part‑time working days and times are determined at the commencement of employment; any time worked outside of this agreement attracts overtime rates. However, Ms de Plater observed that this wasn't the case in the caring sector:
… that's not the case in the awards that cover aged care. In road transport and manufacturing, there's a real disincentive for employers to offer low hour contracts because, if they have to flex that worker up and offer additional hours, they have to pay a penalty—pay them at the overtime rate. The lack of that requirement in the aged-care award just means there's no disincentive. Why would an employer bother offering more hours if there's no disincentive there for them to simply offer a low-hour contract and then just offer employees more hours week to week? They just pay ordinary hour rates. There's no disincentive there for them to do that.
And, to some extent, it suits them to keep the workforce underemployed and insecure, because—and I'm not saying this of all providers—if you've got that sort of desperation, that hunger, in the employees to always be seeking out more work, you're less likely to get employees seeking flexible work arrangements or even using leave.
5.31
Ms de Plater told the committee that award reform is 'really the only avenue' to ensure that care workers' time and skills are properly valued.
Skills and classifications
5.32
Witnesses drew the committee's attention to a widespread but inaccurate perception that care work is unskilled. Professor Charlesworth observed that the distinction between 'skilled' or 'unskilled' care labour is based on technical statistical categories rather than a robust qualitative assessment of the work. Professor Ian Hickie AM reiterated that care roles are 'not unskilled roles. They're actually skilled roles and skilled workforces.' But Professor Hickie explained that proper institutional support was not in place to foster and promote these skills:
Employers are not required to provide the education and training or the predictability that results in a more sustained workforce that's also building its skill level over time, particularly in a lot of the areas where we need more skilled workers: childcare, health care, aged care …
5.33
The committee also heard that some job classifications often focus narrowly on the performance of certain tasks to the exclusion of the complex other skills required. Ms Marsh summed up the range of other skills involved in performing care support work:
… the workforce needs to be skilled enough to identify a change in a person's condition, provide the immediate first response support to an emergency or medical event, respond to challenging behaviours, utilise skills to limit challenging behaviours, use support plans to de-escalate situations, and ensure quality documentation is prepared for customer records for handover, for order and review purposes.
5.34
Classification structures are a further example of the difficulty of valuing care work. As Professor Duncan explained it is difficult to link remuneration directly to outputs, if the full benefits of those outputs are not understood or recognised.
Fair Work Commission findings
5.35
There have been some recent, positive developments for wages in the care sector. The Fair Work Commission (FWC), in its recent decision in relation to the wages for aged care workers in various sectors, remarked on the gendered nature of care and the impact of this on women in engaging with the workforce:
Gender-based undervaluation of work in Australia arises from social norms and cultural assumptions that impact the assessment of work value. These assumptions are impacted by women's role as parents and carers and undertaking the majority of primary unpaid caring responsibilities. The disproportionate engagement by women in unpaid labour contributes to the invisibility and the under recognition of skills described as creative, nurturing, facilitating or caring skills in paid labour.
5.36
The FWC found that for direct care workers (such as registered and enrolled nurses), the 'evidence establishes that the existing minimum rates do not properly compensate employees for the value of the work performed'. However, the FWC was of the view that the evidence for 'support and administrative employees' was not as 'clear or compelling'. Because of this, the FWC decided to support an interim 15 per cent increase in wages for direct care workers only.
5.37
Changes in the objects of the Fair Work Act 2009 (Fair Work Act), resulting from the passage of the Fair Work Legislation Amendment (Secure Jobs, Better Pay) Bill 2022 in December 2022, are designed to promote job security and gender equity, and to ensure that these objects are taken into account when performing functions or exercising powers under the Act. The legislation has improved Australia's workplace relations system more generally, with provisions promoting equal remuneration, providing additional protections against sexual harassment and discrimination, prohibiting the extended use of fixed term contracts, and expanding the circumstances under which employees can access flexible work arrangements and resolve any disputes.
5.38
In particular, the Fair Work Act is now expected to promote equal remuneration by requiring the FWC to evaluate work value 'free of assumptions based on gender, and include consideration of whether there has been historical gender-based undervaluation of the work under consideration' and without the need for evidence of a 'male comparator'. The establishment of a Pay Equity Expert Panel and a Care and Community Sector Expert Panel within the FWC to determine equal remuneration cases and certain award cases are also expected to encourage gender pay equity, particularly in the care sector.
Pay for all hours worked
5.39
Low remuneration across the aged and disability care sectors is compounded by the fact that many care workers are not paid for time spent travelling, on call, completing administrative tasks or undertaking training. For example, a study cited by the Social Policy Research Centre found that approximately 15 per cent of the total hours worked by community sector workers were unpaid.
5.40
Unpaid travel time is especially noteworthy given how many workers are required to arrange their own transport to and from individual homes and residences. The Assistant National Secretary of the Australian Services Union told the committee that some care workers are 'out of the house for 12 or 14 hours but maybe there are only six hours of paid work in there'. Professor Charlesworth remarked that '[i]t's hard to think of any other occupation in which travel is an integral part of the job where this is not on paid time'.
5.41
Casual and on-demand workers may also be required to be on call, unpaid, for extended periods of time. The committee heard that securing 10 to 15 hours of paid care work may require being available and on call for up to 24 hours.
Conditions
Use of gig platforms
5.42
The committee heard that the use of on-demand gig platforms is especially prevalent and increasing in the care sector. While gig platforms can provide more flexibility and give care recipients more autonomy to select their carers, this may come at a potential cost to workers.
5.43
Gig platforms generally require workers to engage as self-employed independent contractors, meaning they have no leave entitlements and are responsible for paying their own taxation and superannuation. Some care sector platforms also charge registration and usage fees.
5.44
The committee was told that care work obtained via gig platforms leaves workers without the usual workplace protections, such as those that might apply in the case of unfair dismissal or workplace injury. It also eroded the predictability, certainty and security of working hours and incomes.
5.45
In addition, the algorithms used to sort and display content on gig platforms can amplify existing bias and discrimination. Associate Professor Angela Knox, Professor Philip Bohle, Professor Chris Warhurst and Dr Sally Wright told the committee that care platforms can encourage clients to select care workers on the basis of unrelated and potentially discriminatory factors such as their personal interests or their cultural and religious background.
5.46
Mr Robbi Williams, Chief Executive Officer with JFA Purple Orange pointed to how the gig economy interacts with the provision of services under the National Disability Insurance Scheme (NDIS):
I think that the best part about the gig economy, in the NDIS, is that it potentially provides the opportunity for better matching between a particular worker who's got a particular set of interests and whatnot and someone who they can then be matched with. The downside of it … is that you can get ripped off.
5.47
This needs to be weighed against the cost to workers. For example, Ms Abbey Kendall, Director of the Working Women's Centre South Australia (SA) stated that the gig economy has 'some of the most exploitative workplace conditions' in the country, based on experience at the Working Women's Centre in SA.
Rostering
5.48
The committee heard that workers in the care sector are particularly susceptible to unfair rostering practices, especially those who do not have secure jobs.
5.49
According to Associate Professor Natasha Cortis and Dr Megan Blaxland of the Social Policy Research Centre, a survey of 2341 disability support workers conducted just prior to the pandemic showed that '45% of disability support workers said their shifts change unexpectedly, and 29% said they were often called in to work at inconvenient times'. This undermines predictability in terms of pay and working time. In addition, it should be noted that on average these disability support workers contributed 2.6 hours of unpaid work per week, most commonly to complete documentation and to communicate with supervisors.
5.50
Witnesses suggested that care workers are routinely 'bullied' to take on additional hours to meet service gaps. Mr Kevin Crank, an Industrial Officer with the Queensland Nurses and Midwives' Union argued that for workers in the care sector, this is the most disadvantageous aspect of rostering: 'a right for them to request roster flexibility isn't going to help them a whole lot, because actually what they need is stronger rights to say no'.
5.51
Professor Charlesworth concurred, noting that many care workers are simply not given the option to decline shifts, even at very short notice:
I've sat beside rostering clerks. When somebody calls in sick, they see that so-and-so is green [available], and they say, 'Right, Mary, you're on. It's six o'clock in the morning and you've got to be at Mrs Kerfoops's at seven.' No choice. She's simply got to go.
5.52
This makes combining work with care of others at home—or having a predictability to life beyond work—very difficult. Ms Marsh explained the nexus between rostering flexibility and the needs of people receiving the care:
Both the NDIS and aged‑care funding models have consumer choice and control at the centre of the model of care, in response to reforms over recent years. Due to the changing nature, needs and requests of NDIS participants and aged-care recipients, rosters change at extremely short notice. The employment instrument does not meet the needs for this required flexibility and negatively impacts the ability to meet continuity of care obligations for our customers.
5.53
Unpredictable rostering also has flow-on effects on unpaid carers trying to arrange their own schedules of care and work.
A sector in crisis
5.54
It was made clear during the inquiry that low pay and poor conditions are key factors in the 'serious workforce sustainability problems' in the care sector. The Australian Council of Trade Unions (ACTU) summarised the situation:
One in three disability workers currently wants to leave their job, three in four ECEC educators plan to leave in the next three years, and over 60,000 aged-care workers leave every single year. The consequences of understaffing in the care sector have a snowball effect of building the inequity for already-disadvantaged communities: the women who work in these sectors, the women who rely on these sectors, and the clients of these sectors.
5.55
While this chapter has necessarily focused on paid care work and carers, the impact on care recipients of these conditions cannot be overlooked. High turnover inevitably results in poor quality and a lack of continuity of care. This affects the lives of those receiving care.
5.56
Chief Executive Women summarised well some of the steps that governments could take to ensure a viable, well-remunerated and supported care workforce into the future:
Both State and Commonwealth governments can play an important role in ensuring decent wages and secure employment for the care workforce, including teachers and nurses. These industries require strong professional pipelines, where young workers are excited to build their career. Investment in the care sector will help address the persistent gender pay gap and workforce participation gap in Australia for a diversity of women, noting significant numbers of migrant and refugee women work in these sectors. Investment in the care sectors will create jobs, boost the economy and ultimately lead to resilient sectors better equipped to meet the demand and respond in times of crisis.
The value of informal care
5.57
Excluding parental care, the number of unpaid carers engaged in the care of an older person or disabled person in Australia is significant. In 2018, 2.65 million—or one in nine—Australians provided ongoing assistance to someone with disability or an older person.
5.58
Primary carers of disabled people or the aged are most often partners (37 per cent) or parents (27 per cent) of the people they care for. They spend on average of less than 20 hours per week (44 per cent) or 40 hours or more per week as primary carer (33 per cent). One‑third of them spend between 10 and 24 years as a primary carer.
5.59
The contribution of unpaid carers to our society and economy is considerable, with estimates suggesting that informal or unpaid carers provided approximately 2.2 billion hours of care to disabled people and older people in 2020. In terms of their contribution to the economy, estimates suggest that to replace the care provided by these particular carers, the Australian Government would have to spend approximately $77.9 billion per year.
5.60
There remains, however, a lack of data and qualitative research on informal caregiving arrangements in Australia, including the patterns and types of care provided and the availability of formal supports for carers and how they impact the ability of carers to participate in the workforce. This is especially the case in relation to those who care for the aged or those with disability.
5.61
The Centre for Disability and Research Policy noted in this regard that:
… longitudinal research that is needed to critically examine the ways in which people who provide care to people with disability modify their work arrangements over time to reflect the changing needs of the person(s) that they support.
5.62
In its Interim Report, the committee raised concerns regarding the availability of relevant data with its first recommendation directed at addressing this gap.
Economic impacts of informal care
5.63
Despite the important contribution that unpaid carers make to our society, they face significant socio-economic challenges throughout their lives and at retirement. The committee was told that in 2018, 60 per cent of carers relied on a government pension or allowance for their personal income.
5.64
Evidence to the committee illustrated that in many instances, informal carers must forgo opportunities to engage in the paid labour force to provide care for a relative with disability or elderly family member. While this care may be provided by a person out of love, it comes at a significant, long-term cost to them. In this regard, Dr Dinesh Palipana described to the committee her mother's contribution to her own care:
… my mother was forced to give up her career in the local government. For many years, she cared for me without working until I became a doctor. Today, she supports other people with disability. However, my mother has no economic incentive for her ongoing contribution to my care. Rather, she does it out of love. I can comfortably say that this is the case with many informal caregivers from who we as a nation benefit from … Because of my mother's efforts, I am now able to do other things like to work as a doctor, to hopefully make a contribution to our people and economy.
5.65
Carers New South Wales (NSW) told the committee that unpaid carers face significant barriers to entering and remaining in the workplace, particularly given limited employment initiatives. The demands of caring responsibilities coupled with workplace inflexibility 'commonly lead to reductions in work hours or leaving the workforce entirely, resulting in gaps in employment and subsequent lapsing of skills and qualifications'. It also clearly reduces labour supply.
5.66
The Carer Wellbeing Survey revealed that the longer a person is an unpaid carer, the less likely it is that they will participate in the paid workforce. The lack of carer-friendly work policies and practices in many workplaces is reflected in the decline in the number of carers over time, as Ms Alison Brook of Carers Australia explained:
Forty-seven per cent of those who had been a carer for five years or more were employed, compared with 61 per cent of those who had been a carer for less than a year. When asked if their employer was understanding of their carer obligations, 17 per cent reported that they were not very understanding and 41 per cent reported that they were somewhat understanding, which, as you can see, leaves a gap.
5.67
Because of the difficulties involved in combining work and care responsibilities, many carers of those with disability or the aged are forced to reduce their working hours significantly or quit work altogether. In fact, a 2020 national survey of carers revealed that 44 per cent of respondents had to quit paid work and of them, 35 per cent took early retirement.
5.68
The experience of working carers and the lack of support available to them was expressed by the NSW Nurses and Midwives' Association as follows:
Sadly many of us are left disillusioned about the support available, no respite, no financial support and no emotional support, giving up all social activities, leaving us absolutely exhausted and for many of us forgoing the ability to earn a wage or resuming our place in our previous work force and continuing to contribute to our superannuation.
5.69
The committee was also informed that 37.4 per cent of carers are disabled and many of them face significant challenges when seeking and in securing paid employment. Once in the workforce, however, disabled carers may face additional challenges in accessing support. Where such support is not provided and workplace adjustments are not made, many such employees have no alternative but to resign, move to casual employment or redeploy into positions that don't fully utilise their professional skills.
5.70
As Carers Australia and others noted, the economic costs of having to reduce hours or not work at all to meet caring obligations, has significant long-term consequences on the financial security, health and wellbeing of unpaid carers. Yet, this doesn't have to be the case. As discussed throughout this report, alternative workplace arrangements—including improved access to paid leave, flexible workplace arrangements including staggered hours and days off work, job share and working from home arrangements—could be provided to enable working carers to remain in paid employment.
Carer wellbeing and the impact of providing informal care for the aged and disabled persons
5.71
Alongside the economic impacts of providing informal aged and disability care, are the individual and adverse health and mental wellbeing impacts on the individuals of providing that care—especially in the long-term.
5.72
For example, the degree of conflict between work and family-life faced by informal carers was raised by the Australian Federation of Disability Organisations (AFDO), which pointed to research suggesting that:
… informal carers experience conflict between work and family, particularly for those carers who worked more hours; spillover between roles, where emotions and behaviours expressed in one role carry over to the other role; and negative effects upon health and wellbeing including physical and mental health issues, lower self esteem, and reduced life satisfaction.
5.73
The point was also made that the higher the number of risk factors experienced by a carer, the greater the impacts on the health and wellbeing of the carer:
The inference that can be taken is that the more risk factors a person with caring responsibilities is exposed to – whether through work and/or dealing with support systems – the greater the impact on the person's health and wellbeing and the likelihood that they will not be able to sustain work participation in addition to caring duties.
5.74
While valuing their work and caring roles, a number of working carers revealed to the committee the impact that combining the two has on their own personal wellbeing:
Work definitely adds to my wellbeing—I enjoy it, and the staff provide socialisation. I have a supportive manager. I go at a defined time, and I am home at a defined time … I think that individual situations depend very much on the attitude of the employer. I consider that I am in a very fortunate arrangement. I well recognise that the amount of caregiving depends on the condition of the person being cared for, and I feel that a carer supporting a profoundly disabled person needs more support than is currently available.
The biggest impact has been very little or no time to myself, including social interaction with work colleagues, time for medical or dental appointments for myself, other outside interests or activities, etc. This has affected my wellbeing emotionally, physically, and mentally, particularly when the paid work was not very engaging. It has also impacted my daughter at times when she is getting an exhausted carer with little capacity to think or problem solve creatively, or at all.
5.75
Other submitters also highlighted the personal and emotional costs of caring. Ms Alison Brook of Carers Australia explained:
If you replace the cost of providing this care across the country, by all these people who are unpaid, who do it out of a sense of love—but there are such other costs to them: the emotional cost, the drudgery, the thanklessness, the embarrassment, whether you're the carer or the person receiving the care. It's hard to maintain that purity of good spiritedness in the everyday drudgery of providing the care—and doing it from a position of poor mental health yourself, social isolation, financial disadvantage. We're really asking a lot. I think that removing some barriers to employment and having a nuanced discussion about what that could look like is an important conversation to have right now.
5.76
AFDO also highlighted the adverse flow on effects for employers who manage those combining work and care responsibilities. AFDO advised that 'caring responsibilities were linked to reduced focus and commitment to work, higher levels of absenteeism and presenteeism, and engaging in time theft'.
5.77
The ANMF highlighted the findings of the Royal Commission into Aged Care which 'reported that many informal carers experience adverse health, wellbeing and financial outcomes and struggle to balance the need to care for the elderly with their work and other personal commitments due to a lack of formal supports'.
5.78
The point was made throughout the inquiry, that in addition to better formal care services, improved income support and more flexible workplaces, carers also need mental health programs 'to address the economic challenges and abuse experienced by care givers more broadly so as to be inclusive of those who are caring for more than one person or for persons in complex situations'.
Recognising and supporting unpaid carers
5.79
Over the course of the inquiry the committee heard that despite an overreliance on informal care in our society 'without adequate complementary formal care arrangements', the support available to informal carers is inadequate.
5.80
The committee's Interim Report outlined a range of income support payments which may be available to carers of older Australians and disabled people. The Interim Report also considered the adequacy of these income supports, noting that on occasion accessing these supports force carers to 'work on top of highly intensive caring roles and often puts them under immeasurable financial strain', and that some of these systems can be 'prohibitive to workforce participation for carers'.
5.81
The committee received evidence that income payments for carers of disabled people and older people are:
insufficient to meet living and care costs;
inaccessible to some carers due to eligibility requirements, particularly regarding:
carers looking after someone with 'episodic or fluctuating conditions, and psychological and cognitive conditions';
low-income thresholds and time limitations on hours of work, study or volunteering per week; and
inconsistent definitions of carers, affecting how and when carers can obtain support, including financial support;
difficult to access due to associated mutual obligations which adversely affect carer's ability to provide support to others; and
difficult to access due to carers' 'admin load' and 'bureaucratic obstacles'.
5.82
Additionally, the committee was told that:
… carers are more likely to be from marginalised populations, and the burden of caring further compounds their marginalisation by reducing employment opportunities and confining them to a position of lower economic status.
5.83
The Centre for Disability Research and Policy suggested that carers of disabled people were missing out on funded support from the NDIS, with dramatic impacts on carers and the people they support.
5.84
Even for those who have access to an NDIS care package, the challenges are considerable, with one mother of a disabled child advising that the time she spent obtaining health and care services, making claims and answering questions 'was greater than the time spent receiving care'. She observed that navigating the systems is 'harder than navigating the disability of my child'.
5.85
In recognition of the complexity of the carer support system, the Australian Government is developing a Carer Inclusive Workplace Framework and a new National Carer Strategy. For this purpose, it has committed more than $770 million to 2023–24 to support informal carers through the Carer Gateway, designed to connect carers with a nationwide network of service providers. Despite a national advertising campaign to explain the Carer Gateway, the committee was told that since 2020, only four per cent of carers have registered through the gateway with local service providers.
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Notwithstanding the slow take-up of the Carer Gateway, the holistic approach to information and services was supported by submitters to the inquiry. The point was made by numerous submitters that improved investment in care supports (including support packages) and improved performance by service providers will require 'a coordinated, whole of government approach'.
Access to respite or substitute care
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The committee heard that the introduction of the Carers Gateway had brought attention to respite care from the perspective of carers and their needs. While this shift in focus was appreciated, many witnesses explained that respite care remained complicated and difficult to access.
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Associate Professor Myra Hamilton argued that the shift towards a model of consumer-directed care through the NDIS, and home-care packages with a focus on the older person or disabled person, mean that carers' needs for respite care have been sidelined. She continued:
I think a big part of the problem as well is that in our shift towards a model of consumer directed care through the NDIS and the home-care packages, the focus is very heavily on the older person or the person with the disability and so the carer's needs are lost in those systems … Carers also used to access respite through state based ageing, disability and care programs. But with the introduction of the NDIS, the state based funding went into the NDIS and those carer programs were lost … All of a sudden, respite that met the needs of the carer was lost.
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For those who managed to access the Carers Gateway, Professor Marian Baird AO explained that the services were focused on facilitating short breaks for carers, to focus on their health and wellbeing. The Professor made the point that it was not designed to provide the time that carers needed to participate in paid work.
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Drawing from her own experience, Professor Baird explained the complexities involved in trying to secure respite care including lack of respite care beds or a respite bed being conditional on the person being moved into the facility permanently. She also noted that the work involved in admitting a person for a period of respite for the administrators of an aged-care facility was very demanding. Professor Baird continued:
This try-before-you-buy approach prevents us from making use of the respite services. It's also contradictory that the government wants older Australians to age at home but cannot provide any access to respite unless they move permanently into an aged-care facility. This really contradicts the policy.
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Similarly, National Seniors Australia argued that respite care, with both short‑ and long-term notice, is inadequate, while other submitters argued in favour of more respite hours per year. The committee heard from carers that:
Most help to me would be being able to access respite care and support. I work near full time hours as the sole income earner, I study full-time, have kids and I'm a full-time carer for my husband. I am running on empty.
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Witnesses also spoke of difficulties for carers accessing day programs and respite care during the COVID-19 lockdowns in particular, impacting carers' employment, health and wellbeing, as well as significantly affecting those they care for.
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Several other witnesses drew the committee's attention to the lack of quality, subsidised respite services for carers of disabled people or older people. A Carers NSW survey of carers revealed that 44 per cent of respondents caring for someone in aged care and 30 per cent of respondents caring for someone with disability agreed that respite services enabled them to stay in or return to work. Reflecting on these findings, Carers NSW noted that:
… adequate, appropriate and accessible care service systems are essential in sustaining the balance of work and care for a majority of carers. Therefore, governments must ensure that these systems are adequately resourced and effectively implemented at the level and intensity needed.
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Acknowledging these challenges, the ANMF emphasised the significant benefits of access to quality respite care:
Respite care enhances the sustainability of informal care arrangements. Carers gain the opportunity to manage their own wellbeing engage in workforce participation, whilst care recipients are given greater opportunities for rehabilitation, reablement or medication review under the supervision of skilled health professionals.
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Dr Catherine Thomson, from the University of NSW's Social Policy Research Centre, argued in favour of adequate replacement care as an option which has the potential to enable carers with support needs to participate in paid employment. She argued, however, that working carers also needed to access carer-friendly workplaces with appropriate policies and practices.
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The point was also made by Carers Australia that respite or placement care is not only limited or unavailable in some parts of the country, but that when it is available, it doesn't allow for flexibility to manage casual work or roster‑based employment.
A way forward
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Substantial evidence was received from submitters questioning the sustainability of the current aged and disability care sectors, and calling for a broader review of funding models. Evidence to the committee also called for increases to the funding of supports to meet the true costs of service provision, and to address thin markets (including service availability and quality), particularly in rural and regional areas.
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The ANMF was of the view that 'increased focus on informal care arrangements [was] a distraction from the important actions and improvements that are urgently necessary to address the systemic issues with Australia's aged care sector', including addressing funding and investment.
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The ACTU asserted that care in Australia is underfunded, comprising 16.7 percent of gross domestic product (GDP) compared with 20 per cent for other developed nations, with aged care alone underfunded by around $10 billion per year. The Social Policy Research Centre argued that:
… addressing chronic underfunding of Australia's social services industry will contribute to a positive cycle, both bolstering capacity in formal care systems and improving employees' resources to manage work and care. This will also help to reduce labour turnover and further strengthen the quality and sustainability of formal care systems.
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The committee heard that while current policies favour markets and private provision of care and produce inequitable outcomes, which are worse in rural and regional areas, the Australian Government could play a significant role in addressing some of these weaknesses, through greater public provision, which would reduce pressures on carers, especially where health care and social assistance have been privatised.
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The Australian Services Union supported an end to the uncertainty of short‑term funding (by introducing minimum six-year contracts), a price floor on all contracts to cover SCHADS award conditions, and equal pay rates for work performed, as well as requirements for employers to ensure fair and secure employment, account for annual Fair Work Commission wage increases, and the payment of the superannuation guarantee and award amendments.
Profit versus not-for-profit service providers
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Several submitters called for an end to the funding of for‑profit providers in the sector. Dr Yvette Maker commented that devolution of care and support services has shifted responsibility for service provision, as well as risk, 'away from the state and onto individuals and families in relation to financial security, care and support and familial welfare', with providers using 'public funding to buy property and grow their businesses'.
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The Work + Family Policy Roundtable highlighted the challenges for not‑for‑profits competing against for-profit providers, with flow on effects for workers and care recipients, as well as the providers themselves.
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Submitters warned that 'human service quality and sustainability has been undermined by service marketisation and individualised funding models … [and] the end result however, for service users and their loved ones, is lower quality and less reliable services'. People have been commodified while 'filling shareholders' pockets'.
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As suggested by the Western Australian Council of Social Service, for-profit providers cherry‑pick the most profitable clients, leaving less productive or more costly clients to be serviced by not-for-profit providers. As well as creating service quality problems, this makes not-for-profit providers 'more marginal when it comes to their sustainability' and has led to the creation of service 'deserts'.
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Ms Phillips told the committee about her personal experience of moving from being employed by a government care provider to a private provider, saying:
… quite a few of us went across to the private provider. We experienced a drop of between 25 and 35 per cent in pay by going to that private provider for doing exactly the same work with exactly the same clients—from one day at council to the next day with a private provider. There was no paid travel time between clients. There was a drop in mileage allowance to cover the cost of petrol for the cars that we had to provide. There was no personal protective equipment provided, no training, no support and no supervision. All of those things are key to providing a good quality service.
… They were a 'for profit' model. They were just interested in how many clients they could get onto the books.
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Ms Phillips called for more stable funding models, leading to a more stable sector, which is critical to providing quality care. The Centre for Future Work at the Australia Institute, likewise, was clear about areas that it believes need to change to address issues in the care sector:
Mandating minimum staff time, and increasing transparency and accountability for public funding in aged care, are positive changes currently being implemented by the Federal Government. However, bigger reforms are required, including rebuilding public care systems and workforces in some areas. Ensuring that funding for individual consumer‑led care services is used to employ workers in decent jobs is a priority.
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Raising concerns about the impact that profit motives of for-profit providers have on care outcomes, Dr Peter Davidson of the Australian Council of Social Service called for a more fundamental structural change which 'requires preferring community-based and not-for-profit providers over commercial for-profit providers'.
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Finally, as Professor Charlesworth pointed out, because for-profit providers largely operate on government funding, 'the government really has a responsibility to make sure that these funds are spent properly'.