Government’s aged-care payments create Covid-19 risk
The federal government may be undermining its own efforts to reduce the risk of Covid-19 spreading in aged-care homes by only paying some workers in the sector to relinquish second jobs, while others can claim bonuses from multiple employers. A third group is receiving no extra support at all.
There is concern among providers and unions alike that the payments are causing damaging divisions in the aged-care workforce at a time of high stress and risk, because of who is included and who is not.
There is also alarm that the instructions and planning in aged care, particularly at the federal level, still do not reflect the reality of a pandemic emergency and that the sector remains significantly unprepared for Victorian-style outbreaks in other states.
The government has two key coronavirus-related income subsidy schemes for the aged-care workforce, which is low-paid and highly casualised.
When the second wave of infection exploded across Melbourne, devastating the aged-care sector in particular, the government created a support payment as part of a drive for Victorian workers to restrict themselves to a single employer and reduce the risk of cross-infection.
The single-worksite payment underpins a set of “guiding principles” on Victorian aged-care workplace safety forged in negotiations between providers and unions.
Under the principles, workers with multiple jobs are urged to choose one primary employer and stick with them, hopefully able to make up the hours lost from the forfeited jobs, from which they are required to take unpaid leave of up to eight weeks.
The federal subsidy, which is paid to employers and passed on, is supposed to cover any shortfall in paid hours the new arrangement creates.
But the single-worksite arrangements don’t cover casuals who are employed through an agency, not directly by providers. These agency workers are heavily relied on to fill gaps and play a central role in the government’s aged-care strategy as a “surge workforce” when outbreaks occur.
The other government subsidy, a retention bonus for aged-care workers, predated the single-worksite payment and was unveiled in March. It was designed to stop workers abandoning their jobs out of fear for their health and leaving the sector short-staffed in a crisis.
This payment arguably works against the single-worksite payment, offering an incentive – albeit modest – for aged-care staff to supplement their low wages and keep working multiple jobs.
The federal Health Department has confirmed to The Saturday Paper that unlike JobKeeper recipients, staff are entitled to claim the quarterly retention bonus payments from each of their eligible employers. It is calculated on a sliding scale based on time worked, between three and 30 hours weekly.
The payments in residential care range from $160 a quarter for those usually working between three and 7.5 hours in a week, as averaged over a month, up to $800 for more than 30 hours in a week. For in-home care, they range from $120 to $600 a quarter.
The bonuses are available to all “direct care” workers in residential and home-care settings, whether employed directly by providers or through an agency.
Both payments were extended this week as part of a $563 million injection of new funds into aged care announced by Health Minister Greg Hunt and Aged Care Minister Richard Colbeck – the retention bonus until December and the single-workforce payment until June next year.
The single-workforce payment, which was the result of negotiations between providers and unions, will also now cover 12 weeks’ leave from second and subsequent jobs, instead of eight.
But both payments exclude workers not deemed “direct care”, such as cooks and cleaners, even though many are also working multiple jobs and are in close contact with residents. Many have also been forced into isolation when infections have struck their workplaces.
These workers continue to work multiple jobs in aged-care facilities without extra financial support – something about which both the unions and providers are concerned.
“A group of workers get [the bonus payment] but another group, who still turn up and do a great job and are equally at risk of infection, don’t,” says Sean Rooney, chief executive of Leading Age Services Australia, representing commercial providers. “It has been difficult to be able to implement it and it has been seen to be divisive.”
Rooney has written twice to the national cabinet, offering lessons learnt in the coronavirus fight and urging all necessary support to be provided. “We need everybody – all the national leaders, state leaders, everybody involved – to agree that it’s a national priority for us to do all we can to protect older Australians receiving care and service in the aged-care system from the coronavirus because they are clearly the most vulnerable,” he said.
Federal secretary of the Australian Nursing and Midwifery Federation Annie Butler told The Saturday Paper that the payment anomalies and confusion were typical of a sector in “disarray”. “This is, to us, just another example of the lack of genuine preparedness and planning for the sector and … policy on the run,” she said.
Butler said she had written to Aged Care Minister Richard Colbeck 10 times since April seeking clarification on how the bonus payment worked. It was unclear how many employers were claiming it, or whether the government was checking either the veracity of providers’ claims or whether those who were claiming it were actually passing it on to staff.
The Health Department also does not know who is being paid what in terms of the retention bonuses: the employers who claim them on behalf of their staff are only required to provide numbers and hours, not their individual details, making centralised cross-matching impossible.
Health Services Union secretary Lloyd Williams says he has some concerns about the bonus payment. “We are hearing from our members about employers and providers refusing to enter the scheme, arbitrarily striking potentially eligible workers out of it, or the bonus having unfounded deductions being made by the employer and provider before it reaches the worker,” he says.
“The HSU has expressed its views to the minister on multiple occasions that the retention bonus scheme, as with any other funding or program for workforce continuity during Covid, must come with more stringent and mandatory regulatory measures for providers and employers, to ensure it functions in the way it is intended.”
The department has also conceded it has no idea how many or which aged-care staff are moving between facilities and which facilities are sharing staff.
It seems nobody – not governments, unions or aged-care providers – has such an overall map or can readily develop one because no one has collated or even collected all the information.
Victorian providers are required under a state government health directive to collect details of where else their staff are working.
Unions say some workers who try to restrict themselves to a single site and claim the one-worksite payment are being sacked from other jobs – leaving them without part of their income and without either of the two payments to which those jobs entitled them.
Rooney says he has not received any such reports and that concerned unions should bring them forward.
The Saturday Paper understands the federal government did not support Victorian moves to issue a formal directive enforcing the one worksite principle. But it agreed to assist with funding and urged providers and unions to negotiate an agreement.
The South Australian and Queensland governments have since issued their own one-worksite directives for aged care, in SA for the whole state and in Queensland for designated south-east hotspots. The Queensland edict is not compulsory.
The federal government is now refusing to extend its one-worksite subsidy to either of those states in protest at the directives. This has left South Australian workers, who are banned from working multiple jobs, and Queenslanders, who are discouraged from the same, without any compensation.
Frustration with the payment anomalies reflects a broader sentiment that the Covid-19 advice coming from governments is often conflicting and impractical. There is also concern about a lack of preparedness for managing the coronavirus, even six months into the pandemic.
During a hearing of the senate’s Covid-19 committee last month, Greens senator Rachel Siewert asked how many staff were still working in multiple facilities.
“The Department of Health does not capture this data,” it said in a written reply.
The bonus payment scheme is not the only aspect of the government’s pandemic response that may be hindering, rather than helping, the battle to keep the virus from ravaging aged care. The sector has been bombarded with documents – multiple versions of guidelines, fact sheets, principles, strategies, letters and codes.
Despite the single-workplace developments, the federal government’s own guidelines for managing outbreaks in residential facilities still say workers are only required to restrict themselves to a single facility in the event of an outbreak at their workplace, not as a preventive measure in advance of infection.
The guidelines also give aged-care providers and public health units discretion to decide whether or not to formally declare an outbreak – which triggers reporting obligations and more stringent infection control measures and restrictions on staff movements – depending on who is infected.
Under the guidelines for managing Covid-19 in residential aged care, an outbreak is defined as a single confirmed infection involving a staff member, resident or frequent visitor. “This definition does not include a single case in an infrequent visitor of the facility,” the guidelines say. It continues that to determine if someone is a frequent or infrequent visitor, facilities should “consider the frequency of visits” – these are written instructions – as well as “time spent in the setting and number of contacts within the setting”.
If the provider or a public health unit decides the person is infrequent, there is no obligation to follow the rest of the outbreak-related steps. But many providers prefer caution.
“The experience is the other way,” says Councils on the Ageing (COTA) chief executive Ian Yates. “The providers are declaring an outbreak at the first instance and closing the place down.”
During the senate hearing, former chief medical officer and now Health Department secretary Dr Brendan Murphy revealed the department had refused providers’ requests to tell them where infections had been identified, so they could crosscheck staff lists and reduce the risk from mobility.
“Why won’t you give it to these providers at least on a confidential basis, so that they can do everything they need to do to ensure that Covid does not get into their facilities?” Siewert asked.
Murphy said the government did not want the information becoming public because it caused a media frenzy whenever the site of a cluster was revealed, and staff had been “harassed”.
He also insisted that wider community transmission meant it was inevitable that infection would spread to aged-care facilities.
That attitude has angered some in the sector who say the lack of focus on prevention implies the aged are expendable.
Murphy told the committee he did not believe a single case in an aged-care facility should be considered an outbreak at all.
“We feel particularly those facilities where there has been a single case – which may just be one worker who has contracted the virus in the community, turned up to the facility or been associated with the facility and because they work there, it’s listed as an aged-care outbreak even though there has been no transmission whatsoever in that facility – … that facility has not had an outbreak,” Murphy said.
But that directly contradicts the guidelines’ instructions.
Ian Yates says the pandemic has exposed serious issues in aged care that must be addressed – including its casualised workforce.
“It’s not a transparent industry. And it needs to be.”
Correction: an earlier version of this article incorrectly stated there was no directive making the one worksite arrangement compulsory in Victoria. There is now a directive in place.
This article was first published in the print edition of The Saturday Paper on Sep 5, 2020 as "Government’s aged-care payments create Covid-19 risk".
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