The clinical issues were referred to previously in Part 2, and included the fact that 40% of residents are depressed. This means that almost half of residents living in residential care facilities are in a state of human anguish. Additionally, Part 2 reported the high incidence of challenging behaviours in the context of both dementia and depression.
How are the current residential aged care facility care staff equipped to deal with this? In this Part 3 I will explore the limitations in the education and training of these workers; their pay conditions given the cost of living in capital cities; and their own mental health.
The people who provide the hands on care in residential care facilities are known as Personal Care Workers (PCWs), Personal Care Assistants (PCAs) or Care Staff Employees (CSEs). These carers are responsible for showering, and attending to all the personal care needs of the residents.
They are frequently from another culture with English as a second language. In fact, the 2016 Aged Care Workforce survey of residential aged care workers reported that around a third of respondents were born overseas. (Mavromaras et al. 2017). There is no mandated minimal education or qualifications for these care workers.
Employers often request that carers have a Certificate III in Individual Support (Ageing), (National Course Code: CHC33015), around two-thirds of care workers have this qualification. This course is made up of 7 core units and 3 specific aged care elective units, to specialise in elderly or senior care. The core units below are similar across all specialisations of this course, including Aged Care, Disability, and Home Care.
List of core units and aged care electives in the Certificate III.
- Support independence and well being
- Recognise healthy body systems
- Communicate and work in health or community services
- Work with diverse people
- Work legally and ethically
- Follow safe work practices for direct client care
- Provide individualised support
Aged Care Electives:-
- Meet personal support needs
- Facilitate the empowerment of older people
- Provide support to people living with dementia
Surprisingly, there are no formal entry requirements or prerequisites for this course. There is also no information about who teaches this course ie. for example – What are their qualifications and experience? Notable by their absence are the following topics:
- Understanding and identifying mental illness and promoting mental health in residential aged care; and
- Understanding and managing challenging behaviours in multiple contexts (ie. mental illness and dementia).
- Recognising and meeting the psycho-social needs for residents in aged care facilities.
This could explain why 33% of PCAs identified “Mental Health Training” as “most needed” in the next 12 months (Mavromaras et al, 2017). The training and qualification cost varies, but can be up to $1750, through private operators and/or is government subsidised through the TAFE system. It is usually offered 20 hours per week for 18 weeks (approximately 9 weeks full-time equivalent). It can also be done on line.
Once qualified, these carers can expect to earn a median of $21.16 per hour. (https://www.payscale.com/research/AU/Job=Aged_Care_Worker/Hourly_Rate)
The current minimum wage in Australia is $18.29 an hour.
According to the 2016 Aged Care Workforce survey, 57% of residential PCAs worked 16–34 hours per week and they received a median weekly wage of $689. Many of the respondent carers are trying to live in capital cities where the current cost of living is high. For example, Sydney’s cost of living index is 193, meaning that it is 93% more expensive than living in Prague.
It is not surprising that these carers sometimes need second and third jobs. The 2016 survey found that 10% of these carers have other jobs, 30% of carers wanted more hours than they currently had; and 10% were looking for alternative employment outside residential care. Eighty six per cent of personal care workers were female, and 14% were male (Mavromaras et al 2017).
Of the direct care workers in the aged are sector who reported a workplace injury or illness in the preceding 12 month, 20% reported suffering stress or other mental condition. The workforce survey sates that “working conditions are impacted upon by unusual job demands that an employee may perceive to be stressful” (ie challenging behaviours).
In a current case of a carer convicted for physical assault of an elderly resident, who had been sentenced to 8 months imprisonment, Judge Symes accepted the appeal argument by QC Malcolm Ramage that the carer was genuinely “scared” prior to the assault. Judge Symes commuted the sentence to an 8 month intensive correction order which included community service. Mr Ramage QC argued that the carer was a “victim of the system”, and told the court that “one of the great problems is lack of training and lack of staff”. Additionally he told the court that the carer “was never given any training on how to handle dementia patients, in particular those who have aspects of violence or irrational reactions” (ie. challenging behaviours).
Carers are struggling to provide appropriate care to our most vulnerable elderly population with highly complex needs. In the Four Corners programme Who Cares Part 1, we hear from the personal care worker, Tanya Bosch who stated “it is very confronting and distressing work”. She elaborated “it is really frustrating to know that on a daily basis you are failing to meet the needs of some of the most vulnerable people in society”. These carers are overworked, task focused, poorly trained, and poorly paid. Carers do not have time to develop relationships with their residents, nor time to address the resident’s psychosocial needs. This was highlighted by the personal care worker Rebecca de Haan (Who Cares: Part 1) discussing the quality of staff, “we need people who are educated in a way so that they know how to deal personally with the residents”.
In conclusion, our older population living in residential aged care facilities have complex clinical presentations, and many are vulnerable, depressed and lonely; and 28% of facilities say that dealing with aggressive residents is a normal part of the carer’s job. When we look at the care staff, we see a group that are struggling to deliver high quality care, due to minimal education and workplace training, who are often stressed, working 2 jobs, have huge workloads, and are poorly equipped to meet the psychosocial needs of the residents. How does the “industry” contribute to this? Part 4 will investigate the systemic issues (ie. the interaction between government and industry) that forms the context in which care is delivered.
Stay tuned for Part 4.
Senior Clinical Psychologist
Amazing Ageing Psychology
ABC Four Corners Programme “Who Cares”? (2018)
Cost of Living
Mavromaris, K. et al (2017). The Aged Care Workforce, 2016. Aust. Govt. Dept of Health.