Implications of aged care worker regulation

Written by Ilsa Bird, Sector Support Coordinator

I have proceeded with pressing an assault charge against the carer. Not because I’m vindictive but because I don’t want her to work again in the aged care sector and this is my only choice. There is no regulation for care workers in Australia. No national register to guard against this type of behaviour.

– Witness Testimony, Royal Commission into Aged Care Quality and Safety

The coming years will see some very significant changes in aged care including numerous changes that will impact our workforce as the Royal Commission into Aged Care Quality and Safety produce their final report this year. Although the recommendations will not be released until April 2021, we can speculate based on the final submissions by Counsel Assisting that there may be some sort of mandatory screening or national registration that is introduced for aged care workers. In this article we will look at the implications of such changes and how providers can plan for several scenarios to adopt these potential changes.

What might this look like?

We can not definitively determine what employee screening or a national register will look like however recommendations from Counsel Assisting during the Royal Commission[1] include:

• mandatory minimum qualifications
• scope to require that qualifications be obtained from certain approved training providers
• ongoing training and continuing professional development requirements
• minimum levels of English language proficiency
• criminal history screening requirements
• a Code of Conduct and power for the registering body to investigate complaints into breaches of the Code of Conduct.

We can however assume that aged care worker regulation may mirror similar systems already in place as discussed in several Royal Commission Hearings and published papers. For example, we have already seen employee screening introduced in NDIS and national registration of primary and allied health staff via the Australian Health Practitioner Regulation Agency (AHPRA). Regulation may include either additional screening, national registration or a hybrid model. Below we have included a summary of both the NDIS Worker Screening Check and AHPRA national registration.

NDIS Worker Screening Check

As of 1 Feb 2021, any person working with people with disabilities will be screened by a Worker Screening Unit in their state to assess if they are cleared or excluded for work in the sector. In NSW, this is conducted by Service NSW. Workers are required to pay a one-off fee for the screening and provide identification to obtain clearance which is then documented on a national database. Clearance is valid for 5 years and the national database is accessible to registered NDIS providers. It is a condition of registration that providers ensure that staff have an NDIS Worker Screening Check.

National registration through AHPRA

In Australia, primary and allied health professionals must be registered with AHPRA in order to practice within their qualifications. The application for registration includes proof of identity, proof of approved study qualifications, a CV, criminal history check, demonstration of English language competency and a declaration of previous disqualification. Once a practitioner is registered with AHPRA their name is added to the Register of practitioners. This register can be accessed by any member of the public via the AHPRA website. Registered practitioners are required to pay a yearly registration fee to AHPRA who provide insurance for practitioners. Registered practitioners are also required to complete Continuing Professional Development to gain CPD points to maintain registration. The number of CPD points required are set by the associated board e.g. Pharmacy Board of Australia.

Although Counsel Assisting have made submissions to the Commissioners to mimic similar models as above, it is currently unclear who will be responsible for it, whether it will be outsourced or who will pay. In the consultation paper published by the Department of Health in 2020, it was suggested that regulation may reside with AHPRA, the ACQS Commission, Service NSW, a newly formed government body or a non-government body.

Processes need to be put into place to screen out those unsuitable for the work. Aged care workers need to be registered and highly trained, with a clear set of qualifications required for registration…if an aged care worker does something wrong, this should be documented in a national database. Future employers should be able to see that there is a mark against their name in the system.  – Witness Testimony, Royal Commission into Aged Care Quality and Safety

Benefits and challenges for staff and providers

The primary benefits of employee screening and/or a national registration of aged care workers are improved quality and safety of care and protection for our older Australians. There is research in support for background checks including a recent, large American study that found that the National Background Check Program was associated with fewer quality deficiencies and higher star ratings for participating residential facilities.[2]

There are also some challenges that may arise for aged care providers and their staff. Firstly, the cost associated. If the cost lies with an already underpaid workforce, this may create a barrier regarding entry into or retention of workforce. If the cost lies with providers, will there be additional funding for providers or is it expected that providers will need to price this into services and therefore increase cost of care for consumers. The second challenge is whether volunteers will be included in mandatory screening and how this will impact attraction and retention of volunteers.

What can you do now?

Although we don’t know exactly what aged care regulation will look like, it is still possible to plan and prepare for potential changes. Before any regulations are introduced, review your recruitment, employee review, incidents register and risk assessment management procedures to determine how screening and a national register might impact your current organizational processes.

As there are potential models for screening and a national register, it would be advantageous to undertake scenario planning to determine how to adapt to different models and scenarios. Consider how you would manage the following:

• Registered providers are responsible to pay for employee and volunteer screening with no additional funding. How will this cost be absorbed by your organisation? What if screening is outsourced and pricing for screening is not regulated?
• The government requires all paid aged care employees to be registered by a governing body by 1 July 2021. How can your organisation support your employees to do this in a timely manner? Can your staff contingency plan cope with a situation where staff are not registered in time and therefore can not work?
• New legislation is introduced that all employees require mandatory minimum qualifications by 2024. How will your staffing levels be impacted if 20 or 30% of staff choose not to complete these qualifications?
• A National Aged Care Worker Board is established to govern the clearance or exclusion of aged care workers via AHPRA and several of your staff are not cleared. How will you manage staff levels, internal and external communications or other challenges surrounding this issue?

Although the Department of Health have undertaken consultation regarding an Aged Care Worker Regulation Scheme, it is likely that any announcements regarding screening or national registration will be made following the release of the Aged Care Royal Commission final report on 26 February 2021.

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References

[1] Royal Commission into Aged Care Quality and Safety: Counsel Assisting’s Submissions on Workforce. (2020). Retrieved from https://agedcare.royalcommission.gov.au/publications/counsel-assistings-submissions-workforce

[2] Roberts, F., Davis, J., Meier, K. J. and Amirkhanyan, A. (2020) Limiting managerial discretion in a New Public Management World: Nursing homes and the National Background Check Program, American University School of Public Affairs Research Paper Forthcoming. http://dx.doi.org/10.2139/ssrn.3604523.