COVID-19 has shone a light on the operation of aged care and disability services (but particularly aged care) and the fragility of the workforce model. Those who did not have insight into the operations of human services were surprised at the casualised nature of the workforce that is providing critical services to those with complex care needs. The impact of insecure work, with employees working for multiple employers, with no sick pay, contributed to the risks of employees attending work whilst sick, and potentially spreading infection between facilities and service providers.
Those of us with more direct sector experience were not surprised. The introduction of consumer directed care models with little to no slack in pricing structures leaves no meaningful room for spare resources. In recent years, we’ve developed a number of financial models for NDIS service providers looking to develop or grow their NDIS provision. Every time we work through the NDIS disability support worker model, we question: is there really enough time factored in for training, for supervision, for connection with colleagues – let alone for genuine, caring, high quality services?
Our concerns were echoed late last year by two reports:
- National Disability Services State of the Sector Report 2020
- Joint Standing Committee on the NDIS: NDIS Workforce Interim Report
The NDIS Workforce Interim Report describes the sector as ‘overworked, underpaid, undervalued and poorly trained’. It references the insecurity of casualised work, says pay ‘may not reflect the complex, sensitive nature of disability support work’ and laments the limitations in training, supervision and career development.
The report further discusses issues that resonate with our experience of working with disability service providers – specifically that effective disability support is complex and skilled, requiring a combination of a strong understanding of the impacts of disability with a people-centred values set. Unfortunately, pricing is likely inadequate and, as a result, may be driving poor workforce conditions.
Learning that these factors contribute to a shortage of worker supply is no surprise. The NDS State of the Sector Report identified that 69% of organisations were unable to fulfill service requests because of limitations with capacity. The sector wants to grow – providers can see the need for additional services and the NDIA’s own data consistently shows plan under-utilisation, indicating that participants are not able to access the services that they need and want. In particular, highly skilled activities such as behaviour support and innovative community participation are key features in provider growth plans (69% and 63% of respondents, respectively). But providers are struggling to recruit – and retain – frontline and allied health staff. 59% of providers said it was difficult to recruit disability support workers, and the number of organisations finding it difficult to fill allied health roles ranged from 75%-85%. Although retention challenges for allied health workers seemed to have eased in the last – COVID-affected year, it increased for frontline workers, with 40% of providers reporting difficulties with retention. Again, this reflects our experience, with a number of our clients reporting that some frontline employees had resigned, rather than expose themselves to the risk of catching coronavirus in the workplace.
Sadly, these workforce issues don’t just impact on the availability of services, but the quality too. Add in the Interim Report from the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability and you have the perfect workforce storm. Whereas (and I hope this won’t come as a surprise) a positive experience with disability support worker leads to better outcomes for a person with a disability, tragically, undervaluing people with a disability leads to discrimination, abuse and neglect. If we don’t value people with disability, what value would we attribute to those who are employed to support them?
Whilst there’s definitely a branding problem contributing to recruitment challenges for disability support worker roles, in comments worryingly reminiscent of the Interim Report from the Royal Commission into Aged Care, the Joint Standing Committee explicitly points out that they are not levelling criticism at individual workers, but at systemic failings. Consequently, the recommendations for the National Workforce Plan include the rehabilitation of the support worker role via improvements in workforce conditions – including stable working conditions, training, supervision and professional development – and pay structures that reflect the real life complexities of the role. Such changes are long overdue, though they would require some serious additional investment to make a new workforce model viable for providers.