Why the markets can never teach us how to care for the aged

By Mary Leahy

In the lead up to the Federal election, aged care has emerged as a major point of difference between the two major parties

This focus on aged care is long overdue but behind the headlines lies another serious policy failure. Aged care workers are prepared for their jobs by vocational education and training courses. Described as the neglected middle child of education, the vocational education and training sector has endured waves of market-based reforms that have weakened public training institutions and hollowed out qualifications. The quality of education is important in all industry areas but in sectors such as aged care, the stakes are so much higher. 

The urgent need to improve aged care is core to Labor’s election campaign. In his budget reply speech, Anthony Albanese promised to implement the findings of the Royal Commission, including mandating the 24/7 presence of a registered nurse in residential aged care facilities, improving food, and increasing accountability for aged care providers. Labor also advocates a wage increase for aged care workers, and promises to fund any increase resulting from the work value case before the Fair Work Commission 

Aged Care is not comfortable territory for the Coalition Government. The performance Richard Colbeck, The Minister for Senior Australians and Aged Care has been roundly criticised. The Royal Commission was scathing about the inadequate monitoring and preparation for the pandemic.  A study presented to the Royal Commission, found poor quality care to be concentrated in the for-profit sector.

Aged care was covered in Josh Frydenberg’s pre-election budget speech but not as a core theme. Frydenberg recommitted the Government to the five year aged care plan announced outlined last year, supplemented with the some additional new funding. 

The Morrison Government is more circumspect when it comes to wage increases. While it has indicated that it will support the Fair Work Commission’s ruling it has made no commitment to providing the required additional funding. 

A sector in crisis 

The Royal Commission has documented in forensic detail the crisis in the aged care. This includes the appalling level of care and horrific abuse suffered by many residents of aged care facilities. It has also highlighted the difficulty of gaining access to the home-based services that could allow people to remain independent for as long as possible.  

The Royal Commission also focused on the aged care workforce. It linked the conditions of care to inadequate staffing level, poor quality training, and conditions of employment of aged care workers, which is characterised by precarity. 

Identifying this connection is vital. There has been a tendency to pit recipient and providers of care against each other. Championing the rights of workers can be seen to undermine the rights of the people in their care (and vice versa).   

The intersection between the interests of recipients and providers of aged care was brought into stark relief by the pandemic. Without secure employment, aged care workers were moving between residential facilities. Without sick leave, workers were compelled to work even if they were unwell. Pandemic pay and restrictions were introduced as temporary measures to reduce the risk, but the model of insecure employment remains intact. 

To address the abuse, the neglect, the injustice experienced by elderly people there must be consideration of the capacity and conditions of employment of the aged care workforce. This requires examining the foundational ideas underpinning aged care. 

Undervalued work

As a first step, we must confront a manifestly inadequate social settlement around care work, both paid and unpaid. Powerful fantasies of autonomy lie at the heart of the liberal political ideas that underpin our institutions. This obscures reality that we all rely on the care and support of others throughout our lives. 

Care is devalued and care work is gendered, classed, racialised and internationalised. The increasingly transnational nature of care work has been disrupted but not eradicated by the pandemic. Under these conditions, the provision of care work involves multiple levels of oppression. One clear manifestation of the way care work is undervalued is the way it is dismissed as unskilled and poorly paid

Marketisation of care and education 

The serious failures in aged care are forged at the intersection of market-based reforms in human services and education. 

Marketisation has been presented as the only way to achieve high quality, responsive and efficient services. This is not the result of inevitable evolution in service delivery but the consequence of a deliberate policy choice. The narratives supporting marketisation deflects attention from the foundational ideas informing these reforms and from alternative approaches

Over the past two decades, person-centred approaches have been introduced in aged care. Placing the goals and aspirations of older people at the centre of the design and provision of services is an urgent matter of justice. How it has been achieved, however, is the subject of debate.  

In Australia, and elsewhere, the goal of person-centred care has been realised through forms of marketisation. Independence, autonomy and dignity have been reframed as individual consumer choice

At the same time, marketisation has transformed the vocational education and training sector, which provides qualifications (mostly at Certificate III level) for aged care workers. The reform of Australian vocational education has resulted in the introduction of a narrow form of competency based training, demand-driven funding, and the allocation of government funding to for-profit training providers. 

The quality of the courses preparing aged care workers have been found to be extremely variable.  To be valued, qualifications need to be trusted. As a bare minimum, we need confidence that graduates have developed the knowledge, skills and attributes specified for their qualification. 

The promise of marketisation was that competition and choice would produce more efficient and innovative training that responded to the needs of employers and students. Instead, a ‘tick and flick’ approach to training emerged, one that is incompatible with the development of the knowledge and attributes that lie at the heart of effective practice. 

There have also been extraordinary opportunities for rent-seeking

Markets are not neutral. The introduction of elements of marketisation has a profound impact, reshaping our institutions and the services they provide.  A process of commodification transforms care and education from relational to transactional exchanges. This is reinforced by Human Capital Theory, which continues to influence education in Australia and internationally. The result is a narrow understanding of education in terms of an investment to increase an individual’s value in the labour market

The transformation of the Australian vocational education and training sector has been described as one of the clearest failures of neoliberal public policy. The work to repair the damage continues  with a clear need for systemic reform. 

The development of transactional qualifications to prepare workers for poorly designed transactional jobs has a terrible human cost. One of the challenges is the marketisation and commodification encourage approaches that set interests of providers and recipients of aged care in competition. 

Beyond the marketplace 

 A society is not just if people are not able to receive the care they need. Justice cannot be achieved if the people providing that care experience considerable hardship because of a failure to recognise and value their work. 

If we are to address the tragic conditions in aged care we must, as a nation, provide adequate funding but we need to go further and address the structural conditions and flawed underpinning assumptions. 

The complexity of the relationship between the provider and recipients of care and support needs to be better understood. Transactional approaches have not transformed the conditions documented by the Royal Commission. They have introduced new forms of oppression and an exploitative social settlement around care. The flawed assumptions underpinning Australian training markets create a much riskier environment for the most disadvantaged and produce poor quality education. In the area of aged care, the consequences of inadequate qualifications are particularly damaging.   

We need a ways of understanding care that can accommodate the needs and wishes of people requiring care without sacrificing aged care workers’ conditions of employment. We need a form of vocational education and training can prepare people for work, for changes in jobs and industries, and for social citizenship. 

This blog post draws on the article: Leahy, M. (2022). Person-centred qualifications: vocational education and training for the aged care and disability services sectors in Australia. Journal of Education and Work, 35(2), 181-194. 

Mary Leahy us a researcher at the Melbourne Graduate School of Education at the University of Melbourne. She has an extensive background in research and policy development, focussing on access to education and employment. Her research examines educational and employment pathways, vocational education, trade union education, gender and the philosophical underpinnings of social and economic policy. Mary is the Lead Chief Investigator on an ARC Linkage project examining the history of the Trade Union Training Authority.

Republish this article for free, online or in print, under Creative Commons licence.

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