4.1
By 29 August 2021, Australia had lost 999 people to COVID-19. Just over 70 per cent (702) of these deaths—were linked to aged care services and the vast majority occurred in Victoria during Melbourne's 'second wave' of COVID-19 infections.
4.2
Experts believe that the way the aged care workforce is structured and managed, including the fact that a significant percentage of staff work across multiple sites, contributed to the spread of COVID-19 in aged care.
4.3
This chapter considers the relationship between insecure and precarious work in aged care, and the spread of COVID-19 and its impacts on residents and staff. It looks at the health and safety implications of employment arrangements in aged care, specifically:
how casual, agency and labour hire, and low-hours part-time employment models contributed to COVID-19 outbreaks during Melbourne's second wave;
the issue of staff working across multiple sites; and
the relationship between job security and staff vaccination in aged care.
4.4
The chapter concludes with the committee's views and recommendations.
COVID-19 in aged care―cases and fatalities
4.5
According to Professor Kathy Eagar from the Australian Health Services Research Institute:
Aged care was a crisis just waiting to happen, with COVID. It was already on the cusp of a disaster before COVID struck, and COVID really consolidated what a mess it was. It was the most vulnerable place to be in Australia. Older people in Australia were more at risk in aged care than in any other part of the country.
4.6
Of the 702 people who tragically lost their lives due to COVID-19 acquired in or around an aged care service (as at 29 August 2021), 693—almost 99 per cent—were linked to residential aged care facilities, with just nine linked to home care services.
4.7
Fatalities due to influenza among elderly people in accommodation settings provide a useful comparison. The numbers vary year‑by-year depending on the dominant strain of the virus:
The 2017 influenza calendar year data recorded the highest levels of influenza activity since 2009 swine flu pandemic with over 1,064 older Australians dying from influenza.
In 2018, 115 older Australians died from influenza.
In 2019, 839 older Australians died from influenza.
In 2020, 28 older Australians died from influenza.
4.8
As at 27 August 2021, there had been 2152 aged care residents and 2328 staff infected with COVID-19. (See Figure 4.1.)
4.9
Most of the fatalities in aged care in Australia occurred in Victoria between July and September 2020, during Melbourne's second wave of infections, where around 655 deaths occurred as a result of outbreaks in residential care homes.
4.10
The Department of Health emphasised that COVID-19 has impacted aged care in every country, and that Australia has fared better than many countries:
The Australian death rate is 0.38 per cent (3.8 in 1,000) against the total number of residential aged care beds across the country.
By comparison, Canada has experienced more than 22 times the number of deaths in care homes than Australia as at 23 August 2021.
As at 23 August 2021, Canada had experienced 26,747 deaths. This includes 15,240 deaths at residential in care homes (or 57 per cent).
47 per cent of all aged care homes in Canada have had reported cases of COVID-19 in residents or staff (compared to 10.2 per cent in Australia).
4.11
While Australia may have done better than some countries, its performance was far behind countries like Hong Kong, Singapore, South Korea and Taiwan. These countries benefitted from 'previous pandemic experiences', had 'emergency plans' which incorporated detailed plans for aged care facilities, and had immediate access to personal protective equipment [PPE].
4.12
It is arguable that many of the deaths in Australian aged care facilities could have been avoided, and that insecure work played a significant role in spreading the virus. This chapter considers evidence from: epidemiologists; academics who are experts in quality of care, safety, and the aged care workforce; workers and their representatives; peak bodies; and aged care providers.
Outbreaks in residential care
4.13
Evidence indicates that the proliferation of casual and insecure work in the aged care sector was a major contributor to the outbreaks that led to the majority of aged care-related COVID fatalities, which occurred during Melbourne's second wave.
4.14
According to the Australian Nursing and Midwifery Federation (ANMF), which has over 43 000 members working in aged care, workers in aged care―especially nursing assistants and personal care workers―are 'more likely to be casually employed or working in multiple jobs' than other health care workers. The 'extent' of insecure work in aged care only became 'fully apparent' when it was revealed during Melbourne's second wave of COVID-19 infections. According to the ANMF:
… aged-care workers, forced to have more than one job just to put food on the table, became unwitting transmitters of the virus, with devastating outcomes.
4.15
Ms Patricia Sparrow, Chief Executive Officer (CEO) of Aged & Community Services Australia (ACSA) said that 'casual arrangements' in aged care 'certainly increased the risk of spread', which had 'a terrible outcome in Victoria'. Ms Sparrow explained that the sector 'was on to' this 'quickly', moving to create 'single-site arrangements' to prevent further spread. However, it was 'a very difficult time for … workers', residents and all people affected.
Melbourne's second wave
4.16
According to Deakin University epidemiologist, Professor Catherine Bennett, infection through workplaces drove the second wave of COVID-19 infections in Victoria. Professor Bennett told the committee that two thirds of the total cases were associated with health care, and 'in health care alone, which includes aged care … a third of cases were in workers or directly in residents and another third were the direct household contacts of workers'. See Figure 4.2―aged care outbreaks are represented by the upper blue sections.
4.17
Casual workers in every sector were more at risk of contracting and spreading COVID-19 than those with more secure jobs, and those who worked multiple jobs, and/or could not work from home, were especially at risk. Casual workers were also less likely to be tested. Professor Bennett said:
In terms of case identification, if people couldn't afford to take time off work, they weren't tested; they weren't identified. That put themselves and their immediate contacts at risk but also their workplaces, and of course that impacts the ability to contain the outbreaks. So, linked workplaces was a critical and recognised challenge.
4.18
The impact of financial disadvantage on COVID-19 infection rates is captured in Figure 4.3.
4.19
One feature of Victoria's outbreaks in aged care was that they were long‑lasting. According to Professor Bennett some facilities had 'a continual outbreak, in effect, for three months'. This situation was exacerbated by a number of workforce management practices, 'including the casualisation of the workforce and the potential risk across workplaces, particularly if people weren't being tested and identified'.
4.20
Professor Eagar also highlighted the unfortunate role played by the aged care sector in spreading COVID throughout the community:
Although most of the media coverage was about the amount of COVID that went into homes, what I think didn't come out very well in the media was the amount of COVID that left homes. In Victoria there were something like over a thousand cases where aged-care workers, visitors and family members also got COVID.
Outbreaks largely limited to private aged care facilities
4.21
Health Workers Union (HWU) Victoria Industrial Organiser, Mr Ray Collins, said despite there being a significant state-owned aged care sector in Victoria, with over 5000 beds, all the outbreaks in Victoria during the second wave were in private and not-for-profit aged care, rather than in state-owned homes. Mr Collins attributed this, in part, to lower staffing levels in private facilities, and in part to a greater reliance on casual and agency workers:
… if you work a business model that relies on casuals and they don't turn up to work, you've got a problem on the day. At seven o'clock in the morning, you've got a problem if you don't have enough personal care workers because the casuals didn't turn up and forgot to ring in. The agency staff can't supply people for the first morning shift of an aged-care facility. Whilst you roust in more staff, you've got a problem.
4.22
Professor Eagar said that a workforce with more casuals and agency staff is at a disadvantage in infection control, because:
[T]here are different work routines, equipment, IT, et cetera, in every facility, so the more facilities that workers are going to and the more casuals and part-timers you've got coming in, the less likely they are to be familiar with those work routines, equipment, IT, et cetera.
4.23
Executive Director of Per Capita, Ms Emma Dawson also observed that residential aged care homes 'in the private for-profit and not-for-profit space' were the ones 'most vulnerable to the virus', while 'state-run homes in Victoria actually did very well at keeping the virus at bay'.
4.24
Professor Eagar confirmed that the reason state-run facilities avoided outbreaks is because they have 'a higher level of staffing, a better-balanced skill mix, less reliance on casuals and better govern[ance] systems'.
4.25
The HWU argued that COVID-19 'exposed the profiteering nature of the private aged-care sector and its treatment of the workforce'. Mr Collins, pointed to the outbreaks at Epping Gardens and St Basils, where he claimed:
[A]t Epping Gardens … our members informed us that only two carers were rostered for 150 residents—that is, there were two carers for 150 residents on the eve of the outbreak. [And at] St Basil's aged care in Victoria, where the federal government supplied PPE was not made available. These two facilities had the highest recorded outbreaks during the second Victorian wave. Their business model is based on a casualised workforce.
4.26
The awareness generated by the tragic deaths in aged care during Melbourne's second wave represented a 'tipping point' for many Australians, and a further 'loss of faith' in the aged care system, Ms Dawson said:
[A] lot of Australians went, 'I'm not putting my parents in that situation.' There was a great loss of faith in our aged-care system and its ability to do the most basic job, which is to protect the health of its residents.
Inadequate oversight, preparation and supplies
4.27
Expert witnesses provided evidence suggesting many aged care facilities in Victoria—and other states that experienced outbreaks—were under-prepared and under-resourced to deal with an outbreak of COVID-19.
4.28
Professor Eagar said many homes had 'little or no training in infection control and [inadequate] access to PPE'. Professor Sara Charlesworth from RMIT University provided similar evidence, saying it was a 'failure of the federal government to provide adequate PPE' in both residential aged care and home care, where it was 'almost impossible … to get hold of PPE', and workers 'had to buy their own'.
4.29
Ms Dawson described inadequate hygiene standards 'at some private homes'; unsuitable PPE, and infection control that was 'slow to get off the mark'. However, it was Per Capita's view that holding multiple jobs across multiple sites due to insecure casual work was the key factor in the spread of the virus:
[workers] were spreading the virus as they moved between those jobs and were unable to take time off because they were not covered by sick leave or adequate compensation to be able to isolate at home. It exposed not only a crisis in the quality of care provided in many of those privatised care facilities but also a crisis in the workforce that showed that their precarity was actually a public health threat to the community.
4.30
There were similar problems in other jurisdictions. HSU NSW/ACT/QLD surveyed 500 aged care workers during the pandemic—a number of whom indicated they did not 'feel safe at work'. When asked 'what best describes how you feel about working in aged care right now', the highest-scoring response was 'overworked', at over 35 per cent of workers, followed by 'stressed', at over 20 per cent, with 'unsafe' coming in at around 6 per cent of workers.
4.31
Workers were asked 'what would make their jobs safer'. They replied:
Greater access to PPE (masks, gloves, hand sanitisers)
Compulsory testing of staff and residents
More supportive management
Maintaining the restrictions to visitations.
4.32
Professor Charlesworth maintained that, while job insecurity 'helped create the conditions' for the outbreak, it did not cause the problems on its own. In addition to insecure work, the professor argued a 'lack of oversight from the [Aged Care Quality and Safety Commission] was a huge issue'.
4.33
In November 2020, The Age reported that 184 (28 per cent) of the Aged Care Quality and Safety Commission's 665 staff were casuals, contractors or employed via labour hire firms, including labour hire company Adecco:
Casual and labour-hire staff at the Aged Care Quality and Safety Commission are concentrated in the division charged with visiting homes to assess their performance. Recent job ads for aged care homes assessors show one-year casual employment is typical at the commission.
Lack of access to paid leave
4.34
Mr Collins said that initially during Melbourne's second wave outbreak, there was a lack of access to paid leave for those casual aged care workers who were potentially at risk of contracting COVID or required to isolate:
Casuals had nothing. If you came to work and you had a sniffle, you would go home. If you mentioned that maybe someone in the family had the flu or whatever, you were told to just go home. As a casual, you're there for the period of time that your employer chooses. ... People work when they shouldn't work when they're casual, and they went to work and they went across sites. They went from sites that had COVID to sites that did not have COVID. Some of these people were doing 100 hours a week.
4.35
Professor Bennett confirmed that lack of access to leave—and also fear of reputational damage for dropping or refusing shifts—contributed to 'presenteeism' among aged care workers in Victoria, and hardship payments provided government were not sufficient to cover the losses many workers endured, or feared.
4.36
Professor Bennett said her observations and anecdotal evidence was strongly suggestive that lack of access to paid leave impacted people's behaviour in relation to testing and staying home from work. However, she said there was not yet data 'at a level' to show definitively 'whether people did undertest if they were in casual work'.
4.37
Mr Ryan Batchelor from the McKell Institute Victoria said 'international research [demonstrates that] access to sick leave reduces contagion and helps stop the spread of disease'.
4.38
Mr Batchelor described a peer-reviewed study from the United States on a 'rollout of emergency sick leave provisions', which showed 'a statistically significant variation in infection rates between those states that had access to emergency sick leave provisions and those that didn't'.
Box 4.1: Case study—outbreak at Epping Gardens
Heritage Care is a medium-sized private residential aged care provider with 10 facilities in:
Victoria—four homes with 443 beds; and
NSW—six homes with 467 beds.
Heritage Care owns and operates Epping Gardens—the aged care home at the centre of one of Melbourne's worst COVID-19 outbreaks.
By the conclusion of the outbreak, 103 residents and 86 staff had tested positive to COVID-19. A total of 38 people died as a result of the Epping Gardens outbreak.
The following information is from the Department of Health's Independent review of COVID-19 outbreaks at St Basil’s and Epping Gardens aged care facilities (December 2020):
Epping Gardens has 148 beds—132 allocated to residential care and the transition care program, and 16 leased to the Northern Health Palliative Care service;
at the time of the outbreak there were 119 residents;
the outbreak at Epping Gardens was formally notified to the Department of Health at 12:28pm on 20 July 2020;
the General Manager and the Director of Nursing immediately isolated residents, enacted the facility’s outbreak management plan, implemented full PPE, commenced contact tracing and notified the Heritage Care Clinical Services Manager;
one staff member was positive and isolating at home;
one resident died in hospital from COVID-19 on 23 July 2020;
delays in on-site testing resulted in many staff choosing to get tested in the community and being forced to isolate, leading to critical staff shortages;
concerns were raised about the lack of preparation and a lack of clear and present leadership on site;
even when 'surge workforce staff were scheduled to work, in some cases, they failed to attend';
some casual and agency workers booked to work at the site refused, and some arrived not knowing there was an active outbreak, and left as soon as they found out;
twelve-hour shifts were implemented 'to conserve available staffing resources'; and
on Monday 27 July, there were only two regular staff and two agency staff—'one quarter of the regular staffing roster for a morning shift'—to care for more than 100 residents.
According to the CEO of Heritage Care, Mr Gregory Reeve:
Epping Gardens' outbreak management plan in place at the time was 'nowhere near as advanced as they are now, given the lessons learnt';
the primary concern was securing the required staff to provide adequate care;
while many of the home's staff were furloughed, Heritage Care:
attempted to 'engage [staff] from other nursing homes within Victoria and even New South Wales, offering to pay for accommodation and transfer costs like flights and travelling expenses'—only one person volunteered;
accessed 'a casual pool', which Mr Reeve described as 'not very great for a casual pool';
rejected two staff that had been sent to work at Epping Gardens because they 'were already working at another home within that outbreak', and the risk of cross-infection was too great; and
attempted to access staff from nursing agencies, but could not secure any.
Mr Reeve advised the Department of Health and the Aged Care Quality and Safety Commission, who 'provided support' but were also unable to provide staff, 'because there was a massive outbreak and there just wasn't supply available'. Ultimately, Mr Reeve and the 'executive team went in and supported the home … until such time as we did get support from Austin Health, the [Australian Defence Force] and others'.
Mr Reeve was asked if the situation on 27 July—when there were only two regular staff and two agency staff to care for 100 residents—demonstrates 'the pitfalls of switching to an overstretched and insecure workforce, which leaves you with no margin for error if someone calls in sick or can't cover a shift'. Mr Reeve replied:
Yes, I concur with you in that regard. … I would agree with you and absolutely welcome working with the unions in this regard and, of course, with anyone at the government level or another level. That is exactly what I would like to achieve.
Working across multiple sites
4.39
Professor Eagar said that Melbourne had 'this particular problem where COVID went from home to home':
When you dug through into that it was because of the number of aged-care workers in Melbourne who were working in five homes, each for one day a week. That was really led by employers wanting a highly casualised workforce, where they could vary the number, from time to time, not give people security, because it was cheaper to do so. None of the employers were then responsible for annual leave, sick leave, professional development and training et cetera. For the workers, getting a casual loading was more money in their hand to live on, on a day-to-day basis.
4.40
Professor Bennett confirmed that working across multiple sites was a key factor in spreading COVID-19 through healthcare settings broadly, but most particularly, through aged care. The professor agreed that 'an earlier and more widespread requirement' to work exclusively at one facility during the outbreak would have been a 'reasonable measure to assist in infection control'.
4.41
Professor Charlesworth, who conducted research on the Victorian outbreaks, found evidence that staff working across multiple sites in residential aged care 'were carriers of the virus'. She said: 'I think job insecurity was a factor'.
4.42
At a Senate Estimates hearing on 27 October 2020, representatives from the Department of Health confirmed that the department does not hold data on aged care staff working across multiple sites. However, due to COVID-19, the department has 'done some work' to identify multiple-site workers, particularly in Victoria where the 'one-worker one-site rule' was operating for part of 2020:
Peak bodies conducted a survey of their members in Victoria, where these arrangements apply. They had 261 facilities out of around 430 … respond to that survey. Each of those facilities reported 100 per cent adherence to single-site guidance.
4.43
However, the department also looked at 'one-touch payroll' data from the Australian Tax Office and observed:
7.1 per cent of residential aged care workers in Victorian hot-spots had been receiving income from multiple providers prior to the single-site mandate; and
this only dropped to 4.5 per cent after the mandate took effect.
So, while 100 per cent of the 261 providers that responded to the department's survey reported full compliance with the measure, pay-roll data shows that '4.5 per cent of aged care workers [in the relevant hot-spots] still work for multiple aged-care providers' (as at September 2020).
4.44
The aged care minister revealed that the department is working on a national 'worker registration program' to capture information about working across multiple sites.
4.45
Professor Bennett explained that not all aged care sector workers who work across multiple sites are casual workers―as well as part-time workers with multiple jobs, there are aged care facilities that outsource their cleaning to labour hire companies who provide cleaners who work across multiple sites while being employed by one employer:
You might be working for a cleaning company but, if you work across different sites, again you have this issue of people taking the virus potentially from one facility to another. So there were kinds of layers, I think, to the casual work. There were people, particularly in some of the roles, like cleaning, that might have been a key part of the infection control strategy for the institution itself but not necessarily thinking about potentially the risk to the individuals.
4.46
Asked how the proliferation of casual work and the practice of workers being employed across multiple sites helped to facilitate the spread of COVID-19 in aged care, Mr Collins said:
Many workers stopped working. We were getting calls in the early hours of the morning that people were not turning up for shifts. Workers were not going to work. … In Victoria, that's what happened at particular sites: people did not turn up to work. They sometimes took work at other locations because it's a casual arrangement and there was a bidding war. A bidding war took place for workers because they couldn't get enough workers. They would choose to take their casual hours at site A rather than site B. They are on one hour of notice. Sometimes they didn't ring in. Facilities were understaffed and there were deaths directly related to that at two facilities that I could go on record with: St Basil's and Epping Gardens.
4.47
Mr Collins was asked to clarify what he meant by 'one-hour notification'. He said casual employment arrangements mean either an employer or a worker can cancel a shift at one hour's notice.
4.48
As well as the obvious risk of people moving from site to site, carrying the infection, Professor Bennett said, from an epidemiological perspective, secure full-time work is safer because it helps to build a team culture of safety:
[I]t's about having a secure workforce in terms of the training levels and providing that sort of continuity. A lot of infection control is about teamwork and about building a culture. It's building a culture of calling out if there's a breach or supporting each other so that you're checking each other's mask fitting. There are a whole range of things that work at team level, and that's much harder to create if you don't have a stable workforce, if you've got turnover in your staff.
4.49
Professor Eagar concluded by recommending that facilities such as aged care prioritise establishing 'a core workforce', using a casual workforce minimally to handle surge requirements:
I think we just have to really be aware of what you sacrifice when you move away from a permanent workforce. For me, it is about the team approach to infection control and prevention; it's about individual skill; but, as I said earlier, it's about how that skill networks to build a culture, to build your training levels, to build shared responsibility and a cohesive response in an emergency.
4.50
A peer-reviewed academic study comparing international responses to COVID-19 in aged care was 'conducted to support federal policy decision making in Australia at the end of 2020'. The study looked at dozens of strategies employed around the world and found that—in conjunction with other measures—single-site work and paid sick leave are effective in preventing and mitigating infection:
Effective prevention and mitigation of COVID-19 transmission in [long‑term care facilities] LTCFs requires a proactive, coordinated response between relevant stakeholders and multifactorial, hierarchical approaches that marshal available resources. LTCFs should maintain awareness of the clinical risks for residents, prevent introduction of [COVID-19], and initiate [infection prevention and control] IPC and clinical management behaviors to identify and manage residents with COVID-19 infection. Early international experience suggests this should include facility preparation and planning; workforce education; single facility work, sick leave provisions, and distributed deployment for staff; widespread active testing; early adoption of IPC precautions including use of PPE; reconsidering locations for care delivery, including creative approaches to cohorting of residents; and leveraging the capacity and expertise of the acute care sector.
4.51
An international comparative study conducted by the AARP [American Association of Retired Persons] Public Policy Institute concluded that stable work, adequate wages and access to paid leave were key to minimising the impacts of COVID in residential aged care:
Secure sufficient staff and resources for facilities, and restrict staff to working in one facility, if possible, with adequate wages. If not possible to restrict them, provide the incentives they need to work in only one facility so they do not need to seek employment in two or three nursing homes. Staff need a salary sufficient to minimize their movement between facilities and paid sick leave to stay home when they are ill. A literature review showed that increased facility staffing, particularly registered nurses, was consistently associated with reduced risk of COVID-19 infections and mortality. Another measure that proved effective was voluntary staff confinement to facilities, with staff sleeping in unused areas of the facility.
Improve facility jobs by providing a living wage, adequate benefits, and stable employment. Train workers in gerontology to be part of the clinical team, and mentor them.
Ensure the psychosocial well-being of workers by providing assistance, such as a dedicated helpline and offering flexible scheduling.
Single-site 'mandates'
4.52
In response to the tragic outbreaks in aged care, the sector—in conjunction with the Commonwealth Government—developed a single‑site policy to be applied in areas declared COVID-19 'hotspots'. Ms Sparrow explained how the policy came about:
As sector, there are a few key people who developed a process where we would have workers working at a single site, making sure that no individual worker was financially disadvantaged as a result. We only did this in areas that were declared hotspots. When there was a declared hotspot, workers would only work at one site, and providers worked together to try and make sure that workers had as many hours as possible. The Commonwealth government, in particular, stumped up funding to make sure that nobody was then left without an important component of their salary.
4.53
Mr Collins said the single-site policy was his idea, developed during 'a sit‑down' with aged care employees during which he put it to them that, 'in order to deal with COVID, we needed to have everyone working at one site'. Mr Collins said:
It was very controversial internally at my union because I put it that our members were going to lose work and lose hours. We had no choice. We were supposed to be cooperating together to control COVID in Victoria. What that did to the casualised workforce—the people who were used to working at two or three or sometimes four sites to make ends meet; they are very poorly paid—is suddenly restrict it to a contractual arrangement, because of funding, for 38 hours, at a maximum, at one site.
4.54
The single-site workforce arrangements and Commonwealth grant funding are applied in relation to residential facilities under Commonwealth jurisdiction in areas declared COVID-19 hotspots. For instance, on 4 September 2021, the arrangements applied across aged care homes in all of NSW, all of Victoria, and all of the Australian Capital Territory—areas under lockdown at the time. The purpose of the arrangements is:
… to minimise the financial burden for approved residential aged care and approved [National Aboriginal and Torres Strait Islander Flexible Aged Care Program] NATSIFACP aged care providers as a result of supporting residential and NATSIFACP workers to work at a single site. … An underlying principle is that the worker is not to be disadvantaged as a result of working at a single site.
4.55
The Department of Health asks workers in residential aged care facilities in hotspots to 'limit their work to a single facility to reduce the risk of transmission of COVID-19 and protect workers and residents'. The department also asks providers to 'adjust their rosters as soon as practical and ensure staff are only working at one residential aged care facility'. However, this is guidance only—there is no actual mandate.
4.56
The guidance encourages workers with more than one aged care employer to 'choose a primary employer', who can then apply for funding from a Commonwealth grants program if they lose money by providing additional hours to that employee.
4.57
Critics have noted that the guidelines are not enforceable, and there is no mechanism 'to stop staff from working across multiple sites to supplement their income'. Funding for the grant program has also been triggered late during outbreaks. For instance, funds did not become available during Victoria's May 2021 outbreak until Thursday 27 May, 'well after the first cases began emerging in Melbourne'.
4.58
Once an outbreak is over, it is clearly intended that workers should go back to their usual routines—including working across multiple sites. This is evident from the Department of Health's statement to providers in NSW, which says:
Workers are encouraged to speak with their primary employer and look to work all shifts during this period with the residential aged care provider where they were working the most hours prior to the outbreak. To the greatest extent possible, the employer should seek to match any hours no longer being worked with a secondary employer to ensure the worker is not financially disadvantaged and receives the same average take home pay in their regular pay cycle. It is important workers also retain the security of any secondary employment.
The use of agency staff is permitted but should be limited, while still ensuring an adequate standard of care for residents.
4.59
Despite the well-known risks of staff working across multiple aged care facilities, the practice has continued into 2021, and more cases of COVID-19 have been linked to staff working across multiple aged care homes. For instance, in May 2021, the Victorian health minister reported that a staff member working at an impacted facility—Arcare Maidstone—had also worked at the BlueCross facility in Western Gardens, 'triggering the BlueCross staff and residents to be tested, and uncovering a case at that facility'.
Impacts of the policy on workers
4.60
The Queensland Nurses and Midwives Union (QNMU) said 'staffing shortfalls' have become more common during COVID and have been further exacerbated by single-site policies. This has left some workers without enough hours, and some with too many. Industrial Officer, Mr Kevin Crank, said:
Whilst, the QNMU recognises the importance of infection control measures, this further exemplifies the need for more secure employment arrangements so that workers are not reliant on multiple insecure jobs to earn a livelihood.
4.61
Despite the funding provided by the Commonwealth, Mr Lloyd Williams from the HSU said the single-site policy has meant workers on 'low hours' have been forced to 'give up additional employment … which they have to eke out a living, and they weren't compensated adequately for it'.
4.62
Former aged care worker, Ms Anu Singh said that 'a lot people [nearly 30 per cent] lost their second job' as a result of the single-site mandate, 'and lost the hope of saving money for a happy living or just keeping up with their daily living expenses'.
4.63
Nursing agency worker, Mr Paul Bott explained the impacts on the sector from his perspective:
During the second wave, people could only work at the one site and there were significantly fewer hours to what they were used to. Also, we didn't have enough staff at the facility because staff decided to work at the main facility that they worked at. They decided to work at the one they'd had the most hours at. So that other nursing home lost that staff member. So, during that period, there was significantly fewer staff, and we were told to work longer…
4.64
CEO of the Aged Care Industry Association, Mr Luke Westenberg, maintained that staff in South Australia, where the State government did impose a single‑site mandate, 'were unhappy' because:
… they preferred having the flexibility to work across multiple sites and they were less attracted to the proposition of working, even for the same hours, for a single employer. They actually preferred working across multiple employers. … The feedback, largely anecdotally … was that there were a number of staff who were unhappy at having to restrict themselves to a single facility, and they therefore were advocating fairly strongly for these requirements to be lifted as soon as possible.
4.65
The United Workers Union (UWU) agreed that the imposition of a single-site mandate in South Australia caused 'significant hardship' for workers in that state. Aged care worker, Ms Tracey Colbert said that a lot of people left the sector 'because they didn't have the hours', or, conversely, 'because of the burden from pushing themselves, physically, too hard'.
4.66
Ms Melinda Vaz, an enrolled nurse in Western Australia (WA) talked about her experience:
At the facility that I work at carers were told during the pandemic that they could only work at one site. As a result, we were often short-staffed. Management stated they would put the shifts out on ShiftMatch, but no‑one would arrive. We were told at staff meetings that they were trying to find staff but they just don't exist. We're expected to still provide the care with fewer staff. That does not equate to quality care.
4.67
However, workers who spoke to the committee said they would strongly prefer to work at one site if it did not mean losing income. Mr Bott said that he would 'definitely' prefer it, if he could get sufficient hours:
We're a single income family with three kids and renting. So I need the hours to sustain a good family life and to pay rent, to pay for the food and to pay for entertainment that our children like. My son plays football on Sundays, and I would like to be able to take him to games. But, if I don't get enough shifts during the week, I will have to work on that Sunday.
4.68
Ms Colbert also expressed a preference to be a full‑time employee at one site.
4.69
Mr Collins said that, while the 'employers initially didn't understand' the idea of single-site work, in the end:
… it was the way to go, and it worked. If it worked during COVID, why can't we now have an industry that says, 'We're not going to have people working across three, four or five sites as casuals. We'll give them permanent part-time work'?
Provider perspectives
4.70
This section considers evidence from some of the providers who participated in the inquiry, regarding:
the extent of multiple job holding among their workers;
their data collection; and
their experiences with, and attitudes to, single-site policies.
Bolton Clarke
4.71
Ms Melissa Leahy, Chief People Officer at Bolton Clarke, suggested the current workforce model in aged care is so entrenched that both providers and workers found it difficult to adapt to single-site arrangements. Ms Leahy suggested a more long-term approach is needed:
The COVID-19 pandemic has also accelerated the need for aged care employers to navigate the complexity of stable employment. This has required a focus on sufficient hours according to individual circumstances and ensuring employees are not compelled to work across multiple workplaces.
4.72
Aged care providers who were asked during the inquiry to provide data on how many of their workers were employed across multiple sites indicated that they did generally collect this information. However, some providers had cause to collect the information as a result of COVID lockdowns.
4.73
During a lockdown in Queensland (QLD), Bolton Clarke submitted it was 'notified of 113 residential aged care workers across QLD and NSW that held a second job'. The company also conducted a consultation in 2020, finding that 243 workers in residential care reported 'working multiple jobs'—approximately 10 per cent of its residential staff cohort.
4.74
There were a number of reasons workers held second jobs, including 'that they actually enjoy working the second job', or that they wanted 'weekend work and the penalties that they could get for working on a weekend'.
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Ms Leahy noted that some workers were working in second jobs that were considered high risk, such as 'driving Ubers on the weekends'.
4.76
Bolton Clarke chose to undertake the consultation 'because of the risk'. Then to mitigate the risk, Bolton Clarke asked these workers to work exclusively at Bolton Clarke. The result was that:
43 per cent of those employees took up the offer and 'increased hours up to full time';
41 per cent of those employees 'decide[d] to take a career break with us [and] obtained more hours with their other provider'; and
the remaining 15 percent 'were low risk … working a second job in a support environment, a call centre environment or an environment where they weren't having direct contact with customers'.
TriCare
4.77
For-profit aged care provider, TriCare submitted that it 'collects information on secondary employment at a site level' only. However, at the time of writing TriCare was 'in the process of centralising and systemising this information'.
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CEO, Ms Kerin McMahon said that TriCare's staff are 'no different' to other staff across the aged care sector in that many do work across multiple sites. Based on data from 30 July 2021, TriCare estimated that it had approximately 19 staff working across its facilities 'during any one fortnight'.
4.79
However, Ms McMahon said that 'like all providers', since dealing with COVID over the last 12 to 18 months, TriCare has 'been working hard to reduce that and reduce that risk'.
Heritage Care
4.80
Heritage Care's non-managerial workforce is made up of approximately 10 per cent permanent full-time staff, 60 per cent permanent part-time staff, and 30 per cent casuals. For part-time workers, the standard number of minimum contract hours per week is 12 and the 'largest cohort of part-time workers' are on 12-hour per week contracts.
4.81
As at 30 July 2021, Heritage Care submitted that 20 per cent of its directly‑employed part-time and causal workers held secondary employment. Mr Reeve said he believed single-site employment is something that staff would 'find more attractive', and he supports a move towards more stable employment in the sector. This is further discussed in Chapter 6.
4.82
Mr Reeve was asked if all of the unvaccinated workers across Heritage Care's network would be limited to 'only working at one facility'. He replied that Heritage Care's 'current policy' is that unvaccinated workers 'should be single‑site'. However, while this is the company's 'preference, and what's going to be communicated', Mr Reeve said they cannot 'make it mandatory, per se', and the policy is currently being reviewed from an industrial relations standpoint.
On-demand platforms during COVID-19
4.83
In response to the pressure placed on the aged care system by the COVID-19 pandemic, the Commonwealth government chose to pay millions of dollars to on-demand platforms to provide surge workforce at aged care facilities. Mable alone received $7.8 million for this purpose in 2020.
4.84
Anglicare's Newmarch House in Western Sydney was one of the aged care facilities forced to rely on Mable for surge workforce after losing 87 per cent of its usual staff at the height of the outbreak. Anglicare CEO Grant Millard described the quality of service provided by Mable to the Aged Care Royal Commission:
It quickly became apparent the staff that Mable could provide did not have the skills and qualifications that were needed in the particular circumstances … The types of people who were being provided, I think there were very few people who had any residential aged care experience, some had home care experience. None of them had any practical experience in the use of PPE.
4.85
Professor Charlesworth told the committee that the Royal Commission 'excoriated' Mable, and that the Newmarch House saga was 'an unmitigated disaster'.
4.86
The ANMF added that they had seen problems associated with Mable's usage in aged care settings during the pandemic:
We got a lot of feedback about the problems experienced using Mable through the height of the COVID pandemic, when we saw that the right staff were not supplied at the right time.
Vaccination and job security
4.87
Vaccination is a key issue for workers and providers in the aged care sector. Inquiry participants made a number of observations in relation to:
efforts to get the aged care workforce vaccinated;
mandatory vaccination for workers in the sector;
attitudes to vaccination among aged care workers; and
access to vaccines, and support for achieving mandatory vaccination by the target date.
4.88
A number of inquiry participants commented that the Commonwealth's initial approach to vaccination in the aged care sector appeared to mostly focus on vaccinating residents of aged care facilities, with staff considered as an afterthought.
4.89
Director of Aged Care for the UWU in WA, Ms Carolyn Smith described the problem as one of 'rollout and access'. Ms Smith said the campaign to get workers vaccinated has been 'incredibly badly run'—failing to take into account that workers do shifts 'all over the place', many have English as a second language, many have been unclear on their eligibility, and many have faced additional barriers:
Imagine a worker who lives in an outer metro area and works across two different facilities, sometimes up to 50 hours a week, all at the times when immunisation clinics or GP clinics are open. She was told there was going to be Commonwealth run vaccination in her facility and when she turned up she was told it was only for residents and only if there were any leftovers would she get the vaccination.
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Mr Reeve said, unlike the vaccination of residents, the rollout of vaccinations to staff 'wasn't scheduled in a strategic manner':
… the way it was originally handled, certainly in our homes, was that when the residents were being vaccinated there were sometimes ampoules or doses left over and so some staff had the opportunity to be vaccinated then, but it was never scheduled at that stage. So it was really: 'Would you like to get vaccinated? Here's the consent form. Here's the education. We've got half a dozen places.
4.91
Enrolled nurse, Ms Vaz confirmed that staff in her facility were told they would 'get the leftover' vaccines if they were 'working on the shift that day'. This is not what workers expected, Ms Vaz said: 'People were expecting, like with the flu jab, the facility would provide that vaccination, but it didn't happen. So there was a lot of confusion with staff.'
4.92
TriCare submitted, as at 30 July 2021, 39 per cent of its aged care employees had received at least one dose of vaccine, and 25 per cent had received two doses. In contrast, as at 28 July 2021, Heritage Care had 73 per cent of its 980 direct‑care staff having had one shot, and 55 per cent of staff fully vaccinated.
4.93
Ms McMahon blamed 'access to vaccines' for the relatively low levels of vaccination among TriCare's staff:
That's certainly the feedback that we've been receiving from our staff, who are obviously commenting in regard to wanting to get the vaccine and trying to access the vaccine. People are seeking the Pfizer vaccine, and, in Queensland, it's still only provided through public health networks and those clinics, so actually accessing an appointment has been challenging. We're working really closely with our staff to provide flexibility to ensure that they can take the time they need to be vaccinated, and facilitating that process in every way possible. As an organisation, we intend to complete the [request for tender], which is something that's available for the sector at the moment, to potentially vaccinate our own staff to further facilitate that process. We're certainly working hard at trying to lift that rate.
4.94
Ms Hutchins from the HSU said 'very little in-reach vaccinations' were arranged by the Commonwealth 'early on', which would have put the sector 'so much further down the path of a vaccinated workforce' at this stage.
Mandatory vaccination for aged care workers
4.95
On 28 June 2021, the National Cabinet 'agreed to mandate that at least the first dose of COVID-19 vaccine be administered by mid-September 2021 for all residential aged care workforce'. At the same time, the government announced the Residential Aged Care COVID-19 Employee Vaccination Support Grant, which provides $11 million to enable residential aged care employees 'to attend off-site vaccination centres and GPs':
Under the grant, Residential Aged Care Facilities (RACFs) will be paid for the following three categories of eligible expenditure:
Casual staff going off-site for vaccination—a flat fee of $80 payable per staff member, per dose;
Paid leave for casual staff who become unwell after vaccination and do not have other leave entitlements—one day’s paid leave (at a rate of $185) for up to a quarter of the provider’s total number of casual staff; and
Facilitation of off-site vaccination for employees—up to $500 per site in flexible vaccination facilitation costs per site, which may be used for activities like: transport services, arranging groups of staff to be vaccinated and or any other reasonable expenses that incentivise staff to get vaccinated.
4.96
Ms Smith said the mandate means 'the clock is ticking', but 'there is still no program to vaccinate workers in situ at work', and 'no plan' to paid leave for vaccination to anyone accept casual workers:
To reach the numbers by 17 September, we need 3,000 aged-care workers a day, seven days a week, to be vaccinated around Australia. We're not seeing that. So that's another staffing crisis we're going to see come 17 September, because we are not going to reach 100 per cent vaccinated by then.
4.97
The HSU said access is a big problem for many workers who are 'diligently' trying to get vaccinated, but cannot get access to vaccines, especially in rural and regional areas. Ms Hutchins said:
This has been a stuff-up. The problem is that the announcement, as Gerard has said, has a huge implication for a workforce that is already stretched. This could see an aged-care workforce crisis, come 17 September. We're looking at the possibility of 25 per cent of the workforce not being vaccinated, and where is the government? Where is the planning? We have heard nothing.
4.98
Ms Smith said the UWU supports mandatory vaccination and believes 'hesitancy isn't the key issue'. There may be 'some hesitancy' among aged care workers, just as there is in the broader community. Though, it is likely to be less 'because aged-care workers understand about vaccinations; they are required to have the flu vaccine'. The union supports mandatory vaccination, but it is also 'concerned' that:
There is still no communication. There was an announcement, I think, three weeks ago that vaccinations were going to be mandatory. There's still not communication out in the workplace about what [mandatory vaccination] means.
4.99
Ms Vaz agreed, saying staff have been told; 'If you're not vaccinated, you won't be given a shift', and they are 'struggling just to find somewhere to get vaccinated'.
4.100
Bolton Clarke said 'anecdotal feedback' from its employees is that 'they're very supportive' of the mandate, though the 'cut-off time is going to be challenging':
Currently [as of 28 July 2021], 30 per cent of our employees have had the first vaccination; 17 per cent of our employees have had the second vaccination. They are aware that we are chasing down vaccination dates, particularly in residential aged care, with a September time frame. It is challenging for us and challenging for our employees to get the COVID vaccination. Booking a COVID vaccination has been somewhat challenging. … But we certainly haven't had any feedback or pushback from employees to date.
4.101
The HSU said there are a 'whole range of reasons why it will be difficult to get vaccinated', and warned that mandating vaccination by a certain date could backfire on the government, leading to workers leaving the sector if vaccines are hard to get. National President, Mr Gerard Hayes said the government should use the carrot, not the stick, to get workers vaccinated:
Our members have effectively got until September to get vaccinated or else potentially they don't have a job. … we are clearly getting advice from our members that it's easier to go and work for Bunnings for $27 an hour. ... So over the next 10 weeks we would like to see a concerted effort to encourage people. To incentivise that the government would do very well to consider our attraction and retention issue, and a big part of that is the wages…
Progress on reaching the target
4.102
The Department of Health publishes the residential aged care worker COVID‑19 vaccination rates map, which shows data by facility across Australia. The data is updated each weekday by 5.00pm.
4.103
The interactive map allows you to drill-down into each statistical area and see the percentage of staff that have had their first dose, as reported by providers. On 17 September 2021—the date by which all aged care workers were supposed to have had their first dose—most areas had 90–100 per cent of staff vaccinated. However, there were still a number of Statistical Area 3s (SA3s) with only 70–79 per cent or 80–89 per cent of staff having had their first dose, mainly in regional areas:
Upper Murray exc. Albury;
Meander Valley–West Tamar;
4.104
Media reports on 17 September suggested that around 94.4 per cent of the workforce had received their first dose, leaving 'about 15,000 aged care workers nationally' unvaccinated, and, according to the rules—now unable to work. The Newcastle Herald reported that aged care managers told reporters that the mandate has 'already led to resignations in the lead up to [the vaccination] deadline':
That means an already under-resourced sector is under more pressure at what is a critical time, say managers, as well as the Health Services Union, and the Australian Council of Trade Unions.
4.105
Aged care service managers explained some of the barriers to getting to the 100 per cent target so quickly:
Barriers include logistics, such as child minding, shift work, and transport, and in one case an 'objector' was making a conscious choice … Initially, 85 of [one service manager's] 189 members of staff had been hesitant about getting vaccinated. … Some of the barriers [the service manager reported] hearing about across the aged care network is they want more information.
4.106
Assistant Secretary of the Australian Council of Trade Unions, Mr Liam O'Brien, said the high levels of vaccination among aged care workers 'confirms overwhelmingly' that aged care workers are 'willing' to get vaccinated. However, there are still significant concerns that some areas have not meet the deadline:
In a sector that already suffers from significant labour shortages unions are concerned that any loss of workers could compromise the safety for workers and the residents they care for … The government need[s] to ensure an appropriate transition so that quality and safety [are] not compromised beyond the deadline…
Committee view
4.107
The disastrous outbreaks of COVID-19 in Melbourne's aged care homes during 2020 were unprecedented, but they could have been predicted, and they should have been prevented.
4.108
Hundreds of vulnerable residents were infected, and many died a lonely and traumatic death, isolated from their loved ones.
4.109
The committee is deeply saddened by these events and wishes to convey its heartfelt condolences to all the residents, staff, providers and families involved.
4.110
Hundreds of workers were also infected, along with their families and community members, and—apart from the disease itself—workers and providers were impacted by the trauma of trying to care for residents in impossible and unprecedented circumstances. Our hearts go out to you—and our deepest respect.
Secure work is safer
4.111
The evidence is clear that workers moving from site to site, working at multiple aged care homes, contributed to the spread of COVID-19 infections during Melbourne's second wave.
4.112
The practice is not only bad for workers and a source of anxiety for residents, it is unsafe, as it increases the spread of contagion in a vulnerable population. This is not only true during a pandemic—it is always the case.
4.113
International studies comparing the COVID responses of countries around the world have identified secure, adequately-paid, single-site employment to be a key component of any successful strategy for infection control—it's a 'no brainer'.
4.114
The committee notes the government's introduction of a single-site policy and grant funding to assist providers to offer workers additional hours to work at one site during COVID-19 outbreaks. However, this should not be designed as a temporary measure.
4.115
The committee is concerned to see the rhetoric in Department of Health statements encouraging providers to see single-site measures as temporary. Providers should be encouraged to offer workers increased hours in a way that is ongoing, through the provision of new contracts.
4.116
The Commonwealth must not waste this opportunity to enhance the safety of residents and improve the security of the workforce.
4.117
The committee shares the concern of aged care providers, unions and academics about the performance of gig platforms in aged care facilities during the pandemic, such as Mable at Newmarch House, and supports Recommendation 87 of the Aged Care Royal Commission that this form of indirect engagement is undesirable and should be restricted wherever possible.
4.118
The committee recommends that the Australian Government redesigns the single-site policy and Commonwealth grant to aged care providers so that they incentivise providers to offer ongoing full-time, and higher-hour part‑time, positions to aged care workers—rather than the current temporary support.
Vaccinations
4.119
The committee notes compelling evidence on the importance of ensuring that paid leave is available for workers during a pandemic—both for preventing workers going to work sick, or when they should be isolating, and for encouraging and supporting workers to get vaccinated.
4.120
The committee recommends that the Australian Government commits to fully funding two weeks of paid pandemic leave, and up to three days of vaccination-related leave, for all workers in the aged care sector, regardless of their role or employment contract.
4.121
The committee is concerned that the rollout of vaccinations to aged care workers was treated as an afterthought, when it should have been part of the rollout to residents.
4.122
Overworked, underpaid and precariously-employed aged care staff should not have been faced with having to arrange their own vaccinations by 17 September 2021, or risk losing their jobs.
4.123
With booster shots likely needed in the near future, the Commonwealth must manage this process more effectively next time, or risk losing workers the sector can hardly afford to lose.
4.124
The committee recommends that the Australian Government arranges in‑reach vaccination for all aged care workers who remain unvaccinated, as a priority, and ensure future vaccination programs (such as for booster shots) are conducted via in-reach programs.