Introduction
Implementing the National Disability Insurance Scheme (NDIS) in Australia was expected to become the foundation of a person-centered, responsive, and flexible approach to providing disability care. However, disability organizations, including those that work with the NDIS system, often face the notorious challenge of qualified staff shortage. One such organization is Australian Unity, which has combated the same issue for a long time. This report aims to investigate the staffing issues that Australian Unity faces, what impact that has on the service quality, and what methods may be implemented to address these challenges.
Problem Scope
Numbers and Services Overlap
The first aspect of the problem that disability organizations in Australia face is the numbers and the overlap of demand for the services. Disability, aged, and veterans care initiatives are intimately linked: about a third of providers in one of the domains also operate in others (Commonwealth of Australia, 2021b). Australian Unity (AU), one of the largest home care providers in Australia, is a fitting example of this overlap, offering a broad range of home care and resources for people with disabilities and the elderly (Our Story, n.d.). Presently, over 7,000 employees, out of which 4,000 are care workers, oversee more than 70,000 clients (Our People, n.d.; Our Story, n.d.). The difference in numbers indicates that the extant staff has to meet the needs of many clients, posing the question of whether they successfully cope.
Disproportional Growth
To meet the rising demand, the number of disability care workers should increase proportionally – however, it does not. In 2018, 3,800 care workers cared for 52,00 clients with disability- or age-related issues (Annual Report 2018, 2018). In 2019, 3,700 care workers worked with over 54,000 home care customers (Australian Unity Annual Review 2019, n.d.). A decrease in caretakers’ numbers only continued throughout the years, putting an additional strain on those that remain or enter the field. For instance, in 2020, 3,451 healthcare workers delivered 2.9 million hours of home care to 46,000 people; a year later, the number of workers dropped down to 3,021, and the number of patients decreased to 38,000, but the number of care hours provided remained the same (Annual Report 2020, 2020; Annual Report 2021, 2021). Effectively, the number of customers and required hours increases, while the number of caretakers hardly does, which presents a significant challenge to the company and its leadership.
Recruitment and Retainment
As evidenced by the patient-provider ratios, AU’s struggle represents a nationwide problem. The lack of sufficient staffing has been a recurrent problem in nursing, especially in Australia (Wilson et al., 2020). As the aging Australian population continues to grow, the demand for healthcare workers who can care for the elderly and people with disabilities also expands (Wilson et al., 2020). According to the Commonwealth of Australia (2021a, 2021b), the National Disability Insurance Scheme (NDIS) workforce needs to increase by roughly 353,000 workers, with 83,000 full-time staff, to support the needs of the Australian population with disabilities. In a media statement, the AU representative confirmed the challenges AU leadership faced “in recruiting and retaining suitably skilled and experienced staff,”, especially in rural and remote areas, where the pool of suitable workers is already limited (A statement from Australian Unity, 2022). Hence, the problem that AU faces is not unique to this organization – it is a phenomenon that manifests itself throughout the nation and has a broad range of implications for operation and management quality.
Workforce Shortages in Disability Sector
Causes
Intrinsic versus Extrinsic Motivation
Providing a sufficient workforce to meet the Australian population’s needs has a range of challenges. Attracting new workers is essential since the retention of disability carers was a critical predictor of patient outcomes and life quality (Bailey, 2020). As Hodgkin et al. (2017) argue, one of the significant downsides of the present system of disability care services is the “government rhetoric that promotes intrinsic rewards (altruism, moral fulfillment) over extrinsic rewards (excessive workload, pay, conditions, and management support)” (p. 102). In discussing the perspectives of older disability care workers, Hodgkin et al. (2017) contend that the government justified lower salaries in the field based on carers’ altruism and vocation. Given the increasingly more challenging economic conditions that the younger generation finds itself in, it is unlikely that intrinsic rewards alone will suffice to attract and retain enough staff now or in the future.
Sector’s Reputation
The next cause is related to the sector’s perception and entry and has several facets. Regarding the perception, disability work is frequently misinterpreted, with 42% of Australians being unaware of what disability care entails; it is deemed as a low-prestige occupation; lastly, there are difficulties with recruiting and retaining diverse ethnicities due to the lack of culturally adapted information (Commonwealth of Australia, 2021b). Moreover, the employment nature of over a third of workers is casual, meaning that their hours may vary drastically and thus affect their pay; given that many people are looking for a full-time job, this aspect of employment is disadvantageous (Commonwealth of Australia, 2021b). Overall, working in the disability sector is perceived as employment with low prestige, low compensation, and a lack of clear career pathways (Commonwealth of Australia, 2021b). Those who already work in the field agree with this assessment, naming the lack of career development, education, training, guidelines, and negative attitudes among the significant barriers (Weise et al., 2020). Hence, disability care is increasingly perceived as a career path that is not worth going in.
Working Conditions
Another reason for the low number of disability carers is the isolated and inconsistent environment in which they operate. Due to the nature of disability care, many professionals work individually, an example being in-home care rather than in teams (Commonwealth of Australia, 2021b). As a result, they might feel isolated from their colleagues, which, in turn, may affect their engagement. Furthermore, the lack of time and resources to provide appropriate training and supervision results in staff developing inadequate skills (Commonwealth of Australia, 2021b). Most people with disabilities who participate in the NDIS programs express interest in qualifications tailored to their needs rather than general skills (Commonwealth of Australia, 2021b). Additionally, no minimum qualifications are required to work in the NDIS, with only 50% of providers requiring a certificate about the completed training (Commonwealth of Australia, 2021b). Most of the time, the workers are trained on the job – however, due to the aforementioned lack of resources, the results are often sporadic. As a result, the high-stake specific requirements that patients may is not met with corresponding training, which places much stress on the providers, causing a drop in numbers.
Bureaucracy
Lastly, the issue of dealing with the burden of administrative ‘red tape’ is pervasive. According to the Commonwealth of Australia (2021), 58% of disability care providers agree that there is an excess of redundant rules and regulations in the NDIS, especially critical in limiting the full functionality of small companies that comprise over 40% of all the NDIS providers. Commonwealth of Australia (2021) concludes that there is a need for more market research on entering and staying in the disability care sector to foster growth. For many organizations that operate with the NDIS system, it is difficult to empower their carers to navigate the regulations comfortably.
Compounding Factors
Many of these obstacles are especially pronounced in rural and aboriginal communities. Employing disability carers is particularly tough in rural areas, with the vacancies attracting 55% less suitable candidates (Commonwealth of Australia, 2021b). Like many Australian organizations, AU struggles with the so-called ‘thin markets’ – areas like Mullumbimby, where there are fewer people and vast spaces to cover (A statement from Australian Unity, 2022). People from diverse backgrounds, including aboriginal and foreign workers may face a lack of accommodation for their cultural and linguistic needs. The experiences of Aboriginal staff are negatively affected by culturally insensitive interactions with colleagues and supervisors, education, and training – these factors result in decreased staff retention rates and much higher turnover (Gilroy et al., 2021). Simultaneously, the non-aboriginal workers who provide care for aboriginal people with disabilities may exhibit a higher degree of cultural incompetence, affecting the quality of provided care (Gilroy et al., 2021). Hence, given the treatment and limited resources available to workers, many relocate to bigger cities or different fields altogether, where they can find better opportunities.
Current State
As a result of the forenamed aspects, the workforce has been declining instead of the much-needed growth in staffing numbers. The growth in demand has been outpacing the growth in supply for disability healthcare providers (Bailey, 2020). Low wages, a lack of comprehensive career structure with limited upward mobility, and “casualization” of labor impacted the numbers and growth rates of disability care professionals (Callaway, 2022). Thus, NDIS has witnessed a comparatively higher rate of staff turnover: 17-25% in disability care compared to 7% in the health care and general assistance sector (Commonwealth of Australia, 2021b). The number of disability care providers who want to leave is alarming. 31% of workers indicated their desire to find other employment in one year, either due to the “negative workplace culture” or insufficient compensation (Cruse, 2022, para. 2). There is a need to have a more extensive supply of healthcare staff and retain more workers (Callaway, 2022). Retaining staff is vital for the service’s long-term stability and cost reduction in the areas of recruitment and training (Commonwealth of Australia, 2021b). Therefore, the future of disability care in the country is precarious.
Impact on Services
There are manifestations of staff shortages that can be seen on the organizational level. Being adequately staffed is vital for providing quality care – therefore, having workers scarcity directly threatens disability services’ quality across the board (Bailey, 2020). According to the AU, inadequate staffing “restricts our ability to sustain current service provision for our existing customers and inhibits our capacity to offer services to potential customers who may have just been approved for home care package funding” (A statement from Australian Unity, 2022). For instance, increased frequencies of shift cancellations, customers not being able to fully enjoy specific care packages due to the absence of the staff trained for certain services, or limited access to the service rosters (A statement from Australian Unity, 2022). Essentially, the organization is overwhelmed, and the patients may suffer. For instance, there are reports of people with disabilities who cannot get out of bed for multiple hours each day since there are not enough healthcare providers to assist everyone (Callaway, 2022). Hence, AU experiences changes in current and future disability care quality due to the lack of workers.
The funding context is necessary to understand the dynamics in the disability care sector. As Miller and Hayward (2017) argue that the approach that the NDIS proposes hinges on the intent to have the majority of disability care providers private and not “government-run” (p.4). In its essence, the NDIS supports the issuance of “individual funding packages” for standard services, coordinates with particular medical establishments for special services, and allocates Information Linkages and Capacity Building (ILC) grants to increase patient access to these services (Laragy & Fisher, 2020, p. 145). The change from funding allocated in blocks to self-directed package determination provided more choice and control over the care that patients may request – however, there are challenges to this scheme (Laragy & Fisher, 2020). Laragy and Fisher (2020) note the reported underutilization of the allocated funds, especially in the program’s first year, since new participants may take a while to align their needs with the best services and providers. As a result, even if the services are available, some people may not be able to access them entirely due to misunderstandings.
The last aspect is the involvement of the Aboriginal people in the disability service industry. Aboriginal communities experience higher rates of disability than non-aboriginal communities (Gilroy et al., 2021). Nevertheless, the difficulties of entry for Aboriginal workers may result in insufficient carers for Aboriginal individuals with disabilities; while not every Aboriginal individual will require a carer from the same culture, their alignment may facilitate communication and care. AU takes action to count and acknowledge the Aboriginal involvement, but it may not be enough to counteract these potentially detrimental effects.
Recommendations
Implemented Strategies
In correspondence to the causes of staff shortage, the AU identifies several ways to address those issues. These points correspond closely with the concerns that AU representatives expressed, such as having the care sector “generally seen as undesirable with high levels of casualization, job insecurity, irregular hours, minimal support and low wages” (A statement from Australian Unity, 2022). AU’s already (at least partially) implemented strategies include prioritizing permanent employment, regular and reliable service rosters, flexible working conditions, mentorship, training, support programs, and career mobility (A statement from Australian Unity, 2022). However, AU highlights that while it already employs internal strategies for overcoming the issue, the actions from the Commonwealth are key for instigating the systemic change required for improvement (A statement from Australian Unity, 2022). Some of the fundamental changes are discussed in more detail through the lens of the nationwide experience.
Background Research and Education
The first step toward solving the issue of workforce deficiency should be addressing the knowledge gap. Data such as total worker numbers, distribution, and specific patient needs are currently lacking (Commonwealth of Australia, 2021a). AU may benefit from identifying the areas that need particular attention. Additionally, Callaway (2022) suggests investing in NDIS-focused healthcare education at the university level, encouraging paid internships in the field, and investing in appropriate funds such as the Innovative Workforce Fund or NDIS Jobs and Market Fund. This approach would help educate a new generation of providers and inform the organizations about specific needs.
Communication of Benefits and Expectations
By communicating the value of disability care, it is possible to emphasize the benefits of working in the field and open opportunities for future workers. Hence, the first recommendation is to communicate the benefits of working in the disability care sector in the community and strengthen entry support and filtering for suitable employees (Commonwealth of Australia, 2021b). Moreover, selecting workers with appropriate values and attributes and improving the accessibility of application boards would result in better workers selection (Commonwealth of Australia, 2021b). Hence, conveying the advantages of working with AU and stating professional expectations for potential employees is recommended.
Cultural and International Orientation
For the workers to persist in the system, culturally appropriate support, training, and mentorship are pivotal. Therefore, the following recommendation is to provide a relevant learning system and workplace culture for the carers to meet their needs and retain a larger percentage of people (Commonwealth of Australia, 2021b). For instance, Callaway (2022) argues for the expanded strategic recruitment of skilled immigrant labor to the disability sector if the organizations want to attract more providers. AU should continue with its efforts to include and keep track of Aboriginal and Torres Strait Islander employees, which it already does to some extent.
Working Conditions
The last and most crucial aspect that AU should focus on is improving working conditions in the field. First, providing healthcare for disabled persons must be treated as a complete career, having “secure employment benefits and competitive conditions against other labor markets” (Callaway, 2022, para. 28). The wages that the workers currently receive should be increased as one of the most prominent reasons behind the staff shortages was listed as insufficient compensation. They should correspond to the extent of hard work, training, and education that went into becoming a disability care professional and access to a safe and supportive work environment (Callaway, 2022). Moreover, creating a diverse array of potential career pathways within the disability care sector to have a broader appeal to the potential hires since upward mobility is essential. An important aspect is establishing ways in which people with disability may train their assistants according to patient-specific needs in a professional environment (Callaway, 2022). Lastly, reducing unnecessary administrative regulations is critical for helping the staff be most effective (Commonwealth of Australia, 2021b). While many of these were mentioned in AU’s statements, more explicit and consistent incorporation is required.
Conclusion
In conclusion, like most organizations in Australia, Australian Unity is struggling to provide enough workers to meet the demand for disability services. Several significant reasons for the workforce shortage were identified: lack of suitable candidates due to unsupported entry and poor sector reputation, a generational shift in mentality, isolated and highly variable working environments with limited training, and excessive bureaucracy. The resulting issues with continuity, reliability, and quality of disability care services may severely affect the patients; these issues are particularly severe in rural and aboriginal communities. Better working conditions are required more than anything to address the problem – higher wages, better training, more support, and less bureaucracy. Additionally, education in the field, communication of professional benefits and expectations, and cultural sensitivity are essential as well. The workload will only grow in the future, and so will the percentage of people needing care in the population; hence, the crisis will exacerbate if not addressed urgently.
References
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