The Project
Expanding choice has been a central feature of health care reforms, with a focus on choices for individual patients or residents. However, choices are structured by conditions that are often beyond the control of individuals or even particular care homes and involve how the system is structured, how funding is allocated, who is eligible for care and who is available to provide that care.
Exercising Choice in Long-Term Residential Care (Armstrong & Daly 2017, p11)
Decent work is the foundation for good quality aged care. Good quality aged care depends on supportive and respectful care relationships between workers and care recipients. Yet we know surprisingly little about how government policies, funding and regulation influence how individual providers organise care work and design jobs to shape the relationships between older people and aged care workers.
Decent Work Good Care: International approaches to aged care is an Australian Research Council (ARC) Discovery study has been exploring the links between decent work and good quality aged care in Australia, Canada, New Zealand and Scotland.
This cross-national study aims to better understand how government policies, funding and regulation shape the provision of decent jobs and good quality care. This study has been examining the connections between decent work and good care and the impact on care relationships with formal aged care services.
Our focus has been on frontline workers employed in residential facilities – nursing homes, aged care homes – and workers supporting older people in clients’ own homes. In Australia, these residential aged care workers are usually known as personal support workers or assistants in nursing. In community-based aged care, frontline workers are usually known as home care workers. The study commenced in 2017. The fieldwork was undertaken between 2018 and 2019 and the main regulatory mapping between 2017 and 2020.
Background
Population ageing, a fall in the numbers of informal carers and increasing costs are placing pressure on aged care services in OECD countries. Governments have been attempting to both contain burgeoning expenditure and better meet community expectations for good quality aged care services. These competing policy priorities have been met in different countries through varying emphases on redesigning LTC funding models, quality regulation, marketisation and ‘consumer-directed’ individualised funding. Such policy and regulatory changes are affecting how and where older people are supported, and who provides this care. Increasingly, countries – including those countries involved in this study – are relying increasingly on migrant workers.
The Decent Work Good Care study builds on the findings from two other large projects: the Australian Quality Jobs Quality Care project and the Re-imagining Long-Term Residential Care: An international study of promising practices. It also draws on other research including government reports such as that commissioned by the former Australian Aged Care Quality Agency’s (AACQA) on care quality. To date, research evidence suggests:
- Government policies, funding and employment regulation directly and indirectly influence both job quality and care quality;
- How aged care providers organise the work of care shapes job quality and the care quality;
- Providing the conditions to support positive and responsive care relationships between frontline workers and older clients and residents is central to the provision of good quality aged care.
Four Long-Term Care Systems
The four countries in this study are high-income, English-speaking liberal democracies. The governments responsible for aged care in these countries have all ‘marketised’ the provision of long-term care (LTC) though contracting out the provision of services to for-profit and not-for profit providers. They have also introduced individualised funding models, known as ‘consumer-directed care’ in Australia, ‘choice and control’ in New Zealand, and ‘personalisation’ in Canada and Scotland.
Each of these countries differs in their approaches to aged care. They have varied methods of funding, ownership mixes, workforce structures, quality monitoring mechanisms and employment conditions covering frontline workers. Through identifying and comparing the aged care systems in these four countries we have increased understanding of how national contexts influence the provision of decent work and good care on the ground.
Through identifying and comparing the aged care systems in these four countries we have increased understanding of how national contexts influence the provision of decent work and good care on the ground.
This study has been working to identify the types of care markets, policy and regulatory regimes, and work organisation that best support decent working conditions for front line workers and relationship-based care for older persons needing support.
Through submissions made to various government inquiries and presentations to academic, policy and community audiences, our study findings have been able to identify practical improvements in national aged care policy, employment conditions for frontline aged care workers and in care provision. In the longer term, we are hopeful that such improvements will contribute to the sustainability of aged care programs and enhance the quality of life for aged care service users and aged care workers.