Crawford School of Public Policy

The pandemic has shone a spotlight on existing systemic issues in Australia’s disability support and aged care sectors – particularly on the need for a robust workforce investment strategy, Laura Davy writes.

The aged care and disability support sectors in Australia are under pressure, and the pandemic has exposed the fragility of these systems to the public eye.

People with disability and older people are more vulnerable to COVID-19 for a variety of reasons including underlying health conditions, social inequity, and barriers within the health system.

Care and support workers also face a higher risk from the virus due to the nature of their work, which often involves close physical contact with sometimes numerous people who are themselves at high risk.

But many of the increased vulnerabilities and harms experienced by these groups were a result of structural features of the care and support sector, exacerbated by the pandemic.

For example, pre-existing social isolation was intensified for many older people and people with disability due to social distancing, visitation restrictions, and lockdown policies.

The physical space in which care and support services are provided played a significant role in amplifying risk. Congregate care facilities involve numerous persons with heightened vulnerabilities to the virus living in close proximity. Combined with a highly mobile workforce working between different facilities, this made them ideal settings for rapid spread of the virus.

The pandemic also shone a light on the employment conditions of aged care and disability support workers. Care work is lowly paid and lowly valued in our society. Disability and aged care workers are overwhelmingly female, and most are insecurely employed under part-time or casual contracts. The introduction of individualised support packages through the National Disability Insurance Scheme (NDIS) has only intensified these trends, leading to the creation of a gig economy in the sector.

One recent survey of disability support workers showed that only 47 per cent of those who took time off due to illness were paid sick leave, which reflects the casualised nature of the workforce – and may even incentivise risky behaviours such as working while ill during a pandemic.

Finally, the need for back-up care staff and support workers to step in during emergencies also became painfully clear.

Staff shortages at the height of the Melbourne outbreak led to chaos and neglect in some aged care facilities: in one facility, only six staff showed up one morning to care for the facility’s 115 residents. People with disability missed out on essential support services when workers cancelled shifts because they had to self-isolate while waiting for test results.

It’s clear now that pre-existing structural problems in aged care and disability support exacerbated the effects of COVID-19 for both staff and clients. But because the pandemic shone a light on these issues, we have a window of opportunity now to address the problems through broad social and economic reform of the sector. Quality care is no longer only a social justice and inclusion issue, it is also a public health issue.

For example, the vulnerability of congregate care settings to becoming sites of rapid viral transmission could create a real impetus for change in a pandemic-conscious world. There is also increasing recognition that care and support service staff are frontline workers in the context of COVID-19, providing critical services to people whose very lives depend on the continuation of this support.

There is, however, an urgent need for robust workforce investment strategies to address the labour shortage, quality and equity issues that plague the disability and aged care sectors. Skill and staffing shortages are exacerbated by low wages, and are responsible for rushed and sub-par care provision, as well as preventable deaths due to neglect.

Care and support work will be a growing area of employment into the future due to the ageing population and the expanding NDIS market. So, we also need better career pathways and professional development opportunities to attract people to the sector.

The Royal Commissions into Aged Care Quality and Safety and Violence, Abuse, Neglect and Exploitation of People with Disability have shown that abuse and neglect flourish in invisible, segregated spaces. For example, the interim report from the disability royal commission describes people with disability experiencing violence and neglect in supported accommodation services. The final report from the aged care royal commission states that physical and sexual abuse of older people in residential care is “far from uncommon”.

As such, policymakers need to continue to shed light on the care settings, employment conditions, practices, and attitudes that comprise good care and support, and learn to value the critical role that care and support work plays in the maintenance and flourishing of our society.

With The New Normal: In Focus section, Policy Forum is rebooting our coronavirus pandemic coverage to address the changing situation. We hope you find the discussion valuable, and invite you to join in the conversation.