In the face of disparity, do we need a ‘NDIS for aged care’?

It’s generally accepted that the work of care is underfunded, undervalued, under… you name it. And, as has become painfully clear over the past few years, not even a global pandemic has managed a real shift.

While we’ve seen impromptu virtue signalling (clapping for essential workers at the height of the pandemic), substantial and systematic change towards a world in which all are adequately included in what scholars have called the “species activity” of caring, is far from our reality.

Caring, in Fisher and Tronto’s words, “includes everything that we do to maintain, continue, and repair our ‘world’ so that we can live in it as well as possible”.

In our ARC-funded project, Addressing the Deficit in Men’s Participation in Paid Care Work, we’re interested in both the question of how all of us can receive the care we require, and also, how everyone, regardless of gender, can participate in the work of caring.

A shortage of care workers

The Australian Health Care and Social Assistance (HCSA) sector is facing significant attraction and retention challenges, especially in jobs in personal care work and nursing. Reflecting this, the Royal Commission into Aged Care Quality and Safety was told by lead Queen’s Counsel Peter Rozen in October 2019 that “the workforce is too small. The bare minimum has become the norm.”

This was pre-pandemic. The HCSA sector is predicted to make the largest contribution to Australian employment growth of all industry sectors in the coming years, needing a million workers by 2050.

Currently, men comprise just about 20% of the overall HCSA workforce. While calls to increase men’s participation in the sector are getting louder, stereotypes that paint men as unfit to care persist.

The men we interviewed for our project all work in the Australian HCSA sector in support roles that don’t require tertiary education – in jobs such as personal carers and assistants, or aged and disability carers.

A high proportion of these men are marginalised in some way because of their ethnicity, race, class status, their migration background, their ability status, or sexual orientation.

The pictures our respondents are painting of work in disability care versus work in aged care are astonishingly different.

Not all care is equal

Working conditions in the disability sector are far from rosy. Still, as many of the men we interviewed reported, they’re worse in aged care.

This corresponds with the percentage of men who work in the field. The Australian Disability Support Workforce Report finds that some 30% of disability support workers are men, compared with only 10-11% of direct care workers in aged care.

The low value of aged care and rampant ageism might also be connected to the fact that care for the elderly is not, generally, reproducing the care receiver in order to be a “productive” part of society.

This is unlike the early childcare and education sectors, which certainly have this function of making future workers (and, to a certain degree, this case can be made for disability care that also aims to include people with disabilities into the labour market).

Read more: Aged care staff urgently need training to report and prevent sexual assault

Productivist thinking, a key function of capitalism, paints aged care as less valuable even than other forms of care because its recipients have already stepped out of their working lives. Cynically put – the “return on investment” doesn’t stack up.

Our respondents discuss how ageism affects the very sector that supposedly should care for the elderly, with several men (across different focus groups) connecting the fact that pay in the aged care sector is worse than in the disability sector with ageism itself.

What we also hear in the focus groups and interviews are critiques of the “economic model of care”, as some respondents called it – aged care homes and other institutions that treat care as a money-making machine, and in which most of the money paid by clients doesn’t go to the workers.

Pay: It’s complicated

While most agree pay needs to be higher, the results from our study are in line with research that finds that pay is but one step to ensuring quality care.

We find that pay is not the only, and often not the most important, aspect about their jobs that care workers are dissatisfied with.

Workers ask for more job security and for ratios that truly allow workers to do their jobs well. As Bradley, a 30-year-old respondent from regional Australia who’s worked in the HCSA sector for eight years, puts it:

“Aged care needs a complete overhaul. One word – ratios, which is what all staff have been saying for ages, but no one up in high upper management seems to actually acknowledge that, or even seem to care. So they just need safe staffing levels. Sure, that’s ultimately what’s needed. They need a lot more staff.

“We need an NDIS for elderly people. That’s what we need. And the moment that a government is willing to tax the richest people in this country properly to pay for it, then perhaps one day we’ll get that. Otherwise, if you’re putting one care worker on to look after 17 residents, you’re going to get substandard care.”

Read more: Workforce shortages are putting NDIS participants at risk. Here are three ways to attract more disability sector workers

Bradley moved into the disability sector, after being burnt out in the aged care sector to the degree that he was no longer able to work. From what we learn from other respondents, unfortunately, his case isn’t unique.

Four years on from the Royal Commission into Aged Care Quality and Safety, and “post”-pandemic, the challenges in the sector, but also the significance of the aged care sector, remain clear.

If we’re serious about addressing the challenges, then aged care must not continue to be the “Cinderella” of the HCSA sector in the way it’s so vividly painted to be by our participants.

Improving the conditions and attracting more men into the sector will be a reciprocal process.