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Thursday, December 7, 2023

In-home care provider CEO says workforce equally under pressure and battling to maintain care levels

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Aged care staff are scrambling to stay afloat as COVID-induced workforce shortages weigh down on the sector.

While much attention has focussed on the devastating impact the virus has had on residential aged care facilities (RACFs), it has also seen an unprecedented strain put on the at-home care workforce.

Aged Care News spoke to Stuart Miller, CEO of myHomeCare, the largest home care provider in the country, overseeing ten difference brands which service 21,000 older Australians.

Miller tells Aged Care News that the spread of the Omicron variant through the community made life especially tough for the 2000 aged care workers employed with the company.

“Coming into Christmas. like everyone else, we had a workforce that badly needed a rest,” he says.

“And I can say this for myself, for the management team and for field staff, down at every level: last year was a tough year.

“Lockdowns, constant changes in workforce and a massive bleed out of the sector from our workforce left the remaining people in the workforce working that much harder.”

Stuart Miller, chief executive officer of myHomeCare, says that the spread of the COVID-19 Omicron variant has put further pressure on the aged care workforce and older clients alike.

Miller notes that for older Australians receiving in-home care, the tumultuous situation was challenging, with the best care relying on long-term relationships and trust.

“When you’ve got a 50 per cent turnover, one in two relationships have to change,” he says.

“And these are very personal services.

“If you put yourself in their shoes, would you want a different person coming in showering you naked every day when you’re most vulnerable?

“You want someone you trust, someone you know and someone you have a relationship with.

“So, [the pandemic has] definitely impacted our client satisfaction as well.

“Whilst we’ve kept our turnover lower than the rest of the industry, I still call us the ‘best loser’ because no matter what, we’re losing out of this. 

“We’re losing our staff loyalty, our staff skills, our client relationships and our client satisfaction.

“Those things are really hard to recover in this industry. This industry will be reeling from this for many, many years to come.”

Omicron plunging the industry into further despair

Miller notes that despite maintaining the same uniform of personal protective equipment (PPE) and same mitigating strategies, the Omicron strain of COVID-19 was a real test for the already strained workforce.

“The speed was what surprised us, so we had a whole team working on this over the Christmas period, myself included, to make sure that we can get on top of that.

“Now, the differences in terms of PPE or normal sort of things you do with COVID hand washing techniques, training, etc – that was not the big change.

“The speed and transmissibility was what really caught us – caught everyone – by surprise. It was really exponential.

Whilst at the beginning of the pandemic, client trepidation affected the volume of service delivery, Miller notes that during the opposite wave, staffing took over as the main point of crisis.

“This was the complete reverse, where client cancellations were much lower than any of the other lock downs or intense periods. The staff were the ones who were catching [COVID] and being put out of commission.

“For every staff member, each day they were off, you were potentially letting down six or seven clients, whereas it was the inverse the previous year, where clients were cancelling because of fear and concerns about the virus.”

How then, did the company work out where to direct the remaining workforce?

“Unfortunately, it comes down to a triage process,” Miller explains.

“That’s what our team is doing every single day, to make sure that those people with the most needs get it.

“But you know, unfortunately when you’ve got a staff member [isolating] and potentially six or seven clients a day disappointed, the reality is we had to cancel some of those non-essential social support, respite or transport services and make sure that we prioritise things like people being fed, their medication is given to them, that they can get out of bed.

“Without prioritising them, you seriously put their health at risk.

“But we couldn’t deny that social contact is a serious component of health risk as well, so we had to have a team put aside to make sure that we contacted each of those clients.

“So we have COVID-calls and we’ve got a team who basically just call clients all day long to make sure that they get some contact with people and that they are OK, and there is a mechanism for them to let us know if they need to accelerate [their care delivery], so they’re not just sitting there by themselves isolated.”

Technological solutions

Although it has been an unprecedented, testing time for the home care industry, Miller notes that it encouraged the company to innovate like never before.

“We have had to harness technology, and particularly when the first two [years] were about fear of people coming into the home,” he says.

Although challenging, he thankfully reflects that finding unique, COVID-safe solutions was “not necessarily as hard as we initially thought.

“Telehealth was a big part of what we did in January to try to make sure that we could still see people, still get their assessments done right, and make sure they got the right health outcomes without necessarily adding to that fear of people being out in their houses.”

He notes that there is naturally a certain difficulty in conducting assessments through technology, which hastens the usual face-to-face process of a sit-down consultation.

“It takes time for the assessment, it takes time for the social component of it, and we never ignore that,” Miller says.

“They’ve got questions; they’ve got concerns; and they don’t often come out in a formal interview component: they come out in the cup of tea afterwards.”

Industry partnerships aid vital food services

Partnering with big grocery brands such as Coles and Woolworths was another vital part of the company’s supplementary strategy, allowing contact-free grocery delivery to clients.

“I’ve got to say my hat’s off to the team in Woolies and Coles because we interacted with the management team regularly to try to prioritise …  to make sure that those people who really had no mechanism for getting food from anybody were prioritised, and those teams were great in that.”

Miller says that while these digital alternatives may continue post-COVID, they will never permanently override elders’ choice to elect an in-person service option.

“You will see [that] it will be a continuing part of [our services], but what I will say is that it will be pulled back,” Miller notes.

“As much as you and I may hate shopping, you have to recognise that, for a lot of our clients, this is a social event … getting out, seeing people, doing something that’s both regular routine, so that it’s within their comfort zone, but still accessing some of that external stimuli.

“It’s an important part of what we do, so we’re not going to turn it off and say it’s all online shopping, but it will be a bigger component our service delivery and that’s to make sure that all the right people are getting seen, and all the services are getting done without detriment to clients’ health.”

New modes of delivery not to impact aged care employment

“The growth in home care and the client’s needs has been nothing short of spectacular,” Miller says.

“We employed 89 people in January…  and we need that and more every single month just to keep up with growth.

“We’ve had to look at where do you get the biggest impact from face-to-face, direct contact, and it’s not always those things [such as grocery shopping].

“So if somebody is not getting that same health outcome for it, we are having to give up on it and concentrate on the more important things.”

With a direct workforce of 2000 employees, Miller says that his company has been trying to provide as many workers as possible with part-time or full-time contracts.

“I know there’s a lot of talk about the casualisation of the industry: that’s absolutely true.

“There is still a reasonable amount of casual people but as an organisation, we push them into a part-time or full-time role where possible.”

With such work arrangements comes a variety of entitlements, including holidays, which will be an ongoing challenge for his company as COVID outbreaks still permeate communities around the country.

“During Christmas, we tried to honour those as much as possible- in fact, encourage them- but obviously it all accelerated really quickly and everyone was back off leave very quickly [due to Omicron].”

Providers push for government action

Ultimately, Millers says that a recovery from COVID and the ability to address quality of care issues raised by the royal commission rely on greater action, including funding, from the Government.

“We’re heading down towards minimum wage for most of our staff and they are doing a really tough job.

“They are on the frontline protecting the most vulnerable cohort. … that is an important job no matter what you say.

“What we need to do to really keep them in the sector and attract the numbers, is a structural change and that will need more money going into aged care.”

And by more money, Miller means more than the $800 promised by the Federal Government in the coming months.

“It’s not structurally fixing anything. It’s a sugar hit. And we all like a bit of sugar occasionally, but it doesn’t fix things in the long run.”

Particularly in the home-care sector, Miller notes that more money needs to be afforded to each level of home care package, so that rising wages can be enabled without compromising on care.

“When I first started in the sector over 15 years ago, the amount of care was really triple what you receive now in an equivalent package and that’s just bracket creep.

“If you pay staff more, the hourly rate will go up and the rate that’s charged to home care package will go up.

“If the home care factors don’t go up that just means significantly less care for those people.”

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