The Royal Commission on aged care is laying the foundations for the fundamental reform and redesign of Australia’s aged care system.

And guess what? Training is part of the solution.

The interim report

The  3-volume Interim Report, entitled Neglect, sets out what has been learned to date, draws some preliminary conclusions and outlines key areas for their work over the next 12 months. It has caused distress in terms of the way Australia’s older citizens are treated when they enter aged care. And rightly so. The Final Report will be handed to the Governor-General on 12 November 2020.

In the foreword to the report, aged care is seen as a ”cruel and harmful system must be changed”, with older people and their families left isolated and powerless in this hidden-from-view and sub-standard system. Not good news! And in regard to training and other issues, they report that:

“The aged care sector suffers from severe difficulties in recruiting and retaining staff. Workloads are heavy. Pay and conditions are poor, signaling that working in aged care is not a valued occupation. Innovation is stymied. Education and training are patchy and there is no defined career path for staff. Leadership is lacking. Major change is necessary to deliver the certainty and working environment that staff need to deliver great quality care.”

OK! This conclusion is not very positive at all, or good.

A focus on training

In examining the three volumes of the interim report and entering the key word ‘training’, this is what the volumes reveal. The word training appears a lot, so we have tried to pick up on key themes. Volume 1 suggests that:

“Much of the evidence to the Royal Commission indicates that, despite their best efforts, aged care workers and professionals too often have limited training and insufficient knowledge to do their jobs as well as they potentially might do. Workers are not trained in how to care for older people with the complex conditions that abound in aged care, such as the myriad forms of dementia or conditions which affect their physical and cognitive functioning.”

At an Adelaide hearing it was stated that an aged care training framework should:

“include nationally consistent training in partnership with the sector and an aged care capability framework to underpin role design and skills acquisition in the aged care sector (covering nursing, allied health, management, care and other support staff). Subsidies for traineeships for aged care workers should be developed across a number of key aged care sector roles and skills (e.g. dementia care).”

Participants at a roundtable “pointed to identified problems with the quality assurance of vocational training providers, suggesting that some deliver training packages as a mere commodity rather than a critical means of supporting labour force capability in the care of vulnerable older people.”

That’s not good news, and points to why providers are in ‘in the game’ in the first place. Is it profit, or is about serving the needs of an industry and the wider community?

The interim report also pointed to a number of other training issues.

First: “The effectiveness of My Aged Care is heavily dependent on the training and attitude of the staff. Any successful assistance occurred usually after several phone calls to find the right person with the right knowledge and the right attitude.”

Second: “Witnesses described cultural and geographical barriers to providing a quality aged care workforce, including limited access to training providers in remote locations. [our emphasis].”

Third: The management of complex needs raises issues of skills and training for the aged care workforce. Some points that seem to require training is in the management of dementia and training associated with the use, or not, of restraint as well as advocacy for their clients, wound care, nutrition and behaviour management, including how best to defuse potentially dangerous situations.

Fourth: Professor Deborah Parker from the Australian College of Nurses told the Commission that “nurses are not provided enough training in dementia care or in mental health, especially in relation to depression and anxiety.”

Fifth: Professor McCallum considers that personal care workers have been ‘underdone in terms of the VET system and its training and we need better access to training for personal care workers’. In addition, it was suggested “that the gaps in training of personal care workers could be improved by training for informal carers, training in care planning, personal advocacy to support consumer-directed care, mandated qualifications (including a compulsory unit on dementia), shorter courses, improved on-the-job training and a skills escalator to boost the labour supply in the workforce.”

Sixth: Mr Mersiades said the answer to workforce issues is not the implementation of minimum staffing ratios but significant upskilling of the workforce. He said that more training was required for palliative and end of life care. He also supported the registration and credentialing of the unregistered portion of the workforce

Seventh: Ms Jackson, one of a panel of four aged care workers, said that, “in her observation, the training available to personal care workers has decreased during her time in the aged care workforce. She referred to a move away from face to face sessions to online based training systems, which she considered more of a ‘tick and a flick’ approach. Ms Hansen, another of this panel, told the Commission “that in-house training is often not recognised by other employers.” The Commission also heard from this panel that “it is largely up to these lowly paid workers to pay for any additional training they undertake.”

And finally, the Commission’s interim report concludes that:

 “The fragmentation of the system and its dependence on other sectors, such as health and vocational education and training, both of which have identified problems, has added to the difficulty of implementing reform, but such factors cannot and should not excuse years of systemic neglect.”

Training, and better training, is part of the solution to the quality of our aged care system. Whatever is done, though, responses to this Royal Commission will need to be wide-ranging.