Interview with Amanda Stoker
26 March 2023
Subjects: Aged Care Challenges in Rural and Regional Australia, Workforce Shortages, Aged Care Regulation
STOKER: I have on the panel with me Anne Ruston, Liberal Senator for South Australia and Kerri-Anne Dooley, a professional working in this space with experience in the home care, residential care, and importantly, palliative care fields. Anne and Kerri-Anne, welcome so much to this panel. Anne, how are staffing arrangements going for the aged care sector in rural and regional Australia?
RUSTON: Well Amanda, not surprisingly but very disappointingly, we often see rural, regional and remote Australia as sort of like the canary in the coal mine when it comes to the care sector. And it's no different for aged care, because we are right now facing probably one of the worst workforce crises and shortages that we've probably seen in the care sector right across Australia, but it's being felt most acutely in rural, regional and remote Australia. So there's some massive, massive challenges and it's been hugely exacerbated by the bringing forward of requirements for 24/7 registered nurses on-site in aged care facilities no matter where they are - with a very, very small exemption - that's been brought forward by this Government. Last week, we saw the Minister for Aged Care actually having to backflip on her decision and break a really core promise that they took to the election around this 24/7 requirement because there's simply not the registered nurses to be able to fill these spaces. So, whilst we know that there are challenges right across the country and in metropolitan areas as well, and I'm sure Kerri-Anne has got some examples where she has experienced that, but in rural, regional and remote Australia it is really, really critical. We're already seeing nursing homes closing down because they just don't believe they're going to be able to meet these requirements. It is absolutely devastating. And I think we do need to actually look at a bit more flexibility than we're seeing at the moment to address these issues, because as you rightly point out, the worst possible outcome is for somebody who's lived in a community all their life being uprooted and moved hundreds of miles away simply because their aged care home has closed down.
STOKER: Sounds like a bit of an own goal, even if it started out with good intentions. Kerri-Anne, how does this compare with your experience in the more urbanised area of Brisbane?
DOOLEY: Thanks, Amanda. Thank you for highlighting this very important issue. We are seeing workforce shortages even in Brisbane where I live, but certainly that's the experience I'm hearing right across the nation where some of our largest aged care providers are struggling just to get registered, enrolled nurses, AIN support workers to staff their residential aged care facilities.
STOKER: Anne, more and more regulation is piled on this sector each time a problem arises. Could it be that this ever-increasing load of administration and regulation and box ticking is itself part of the problem?
RUSTON: Well, we all know that regulation is a great thing when it's actually designed to deliver a positive outcome. But regulation that actually causes a problem, obviously, is a very, very bad thing. And I think that what we're seeing at the moment is that in the pursuit of the delivery of all of the recommendations of the Royal Commission - in a timeline I might say that wasn't what the Royal Commission recommended - we are seeing a huge burden placed on particularly those nursing homes that are single nursing homes like small community-controlled ones. You made mention about the Rotary Club that was running one in one of the areas in Queensland. There are a lot of, particularly in rural and regional Australia, nursing homes that are run by community groups and the extraordinary new burdens that have been placed on them in relation to their board's requirements to meet their fiduciary responsibilities and their board responsibilities are meaning these people who are volunteers in the community are just throwing their hands in the air and saying, this is too hard. They're going and leaving nursing homes without anybody in control of the board. So, I think we do need to actually have a look at this and say, let's make sure that we have regulation that's fit-for-purpose, lightest touch as possibly it can be, to ensure that we've got the best possible care for older Australians who rely on that care. But right now, I think that we've definitely got the scales in the balance towards overregulation, without really focusing on: is this really delivering a better outcome for people who live in aged care homes?
STOKER: Kerri-Anne, you've got experience in different parts of this profession. How important is facilitating a genuine choice for people who need assistance?
DOOLEY: We're seeing most older Australians want to stay in their own homes. So, we talk about ageing in place and the majority of Australians would choose to be at home. So when we talk about aged care reform, we do need to also look at reform in the home care sector. So we would love to see more choices for people to be able to stay at home and looking at the funding instruments and the funding models to support that choice.
STOKER: Finally, Anne, there is a real challenge for people in what's known as the sandwich generation, caring for older relatives as well as for children, and probably working too. This is disproportionately the experience of women, though not exclusively. Very quickly, how can we make sure that we address those policy challenges without jumping to a big government solution?
RUSTON: We just have to build flexibility. We need to make sure we've got a flexible framework and then allow the individual to make the choices that actually suit their particular circumstances, their family circumstances, because I think we have taken a very much one-size-fits-all approach and it's simply not working. So, I would say just let's build some flexibility, let's get some sense and some pragmatism in this and maximise the use of the resources that are available in communities and give people choice about how they want to interact with the system.
STOKER: Thank you so much, Anne Ruston and Kerri-Anne Dooley. I really appreciate your insights tonight.