CEDA’s report on how to fix the aged care worker shortage claims migration is key – but a closer look at the data reveals a very different picture. Before we reach for new visa schemes, we need to focus on the workers already here: most are permanent residents or citizens, and many want more hours. The answers are hiding in plain sight.

Is aged care dependent on migrant workers?

The first step in answering this question is to define ‘migrant workers.’ The widest definition is all those born overseas. This figure has been around one third of the aged care workforce over previous surveys: 35 per cent in residential care and 18 per cent for the two home care programs in a 2020 survey. Surveys conducted by the National Institute of Labour Studies (NILS) in 2007, 2012 and 2016 reported that in residential care, this proportion fluctuated marginally between 32-35 per cent, and in community care declined from 27 per cent in the earlier surveys to 23 per cent in 2016.

Further insights into the composition of the workforce are provided by additional items on visa status collected in the latest surveys.

The Worker Survey reports that 57 per cent were born in Australia, 20 per cent were born overseas and had become Australian citizens or were New Zealand Citizens, and 9 per cent were born in other countries and had permanent resident status (PR) – 86 per cent in total. The remaining 11 per cent holding temporary visas divided almost evenly between those on student visas and other graduate or skilled visas. Another 2 per cent were on another temporary visa and only 1 per cent did not know their visa status.

The Provider Survey reported 83 per cent were Australian or New Zealand citizens or permanent residents, and 17 per cent held temporary visas. These results for valid responses are consistent with the figures above. A different picture emerges when ‘unknown’ responses are taken into account. The total share born in Australia plus overseas born citizens and permanent residents is estimated at 56 per cent, yet the Worker Survey reports this share just for those born in Australia. The proportion on student visas falls to 6 per cent and other temporary visas rises to 11 per cent. Fully 33 per cent are recorded as ‘unknown’ status.

The Provider Survey notes the need for caution in interpreting these figures, yet CEDA’s projects a substantial increase in temporary workers based on apportioning unknown responses in accord with valid responses.

CEDA identifies increasing temporary migration as a source of workers and proposes a new essential skills visa for aged care occupations with wages below the thresholds that apply to such visas in other fields.

Three considerations qualify this proposal. First, the high proportion of ‘unknown’ responses may be explained by providers varying knowledge of workers’ visa status. They are likely to know international students through contact with tertiary institutions, but be uncertain of the visa status of those who are citizens or have PR. Some may remain on PR visas for extended periods if their native country does not allow dual citizenship, as is the case with India, China and Korea.

Those who work while studying, especially nursing and allied health, and stay after they have qualified are an important part of the skilled professional workforce, not only in aged care but in health care more widely. Continuation of this flow will depend on sustained numbers of international student places in relevant fields.

Second, CEDA rightly recognises the failure of the Aged Care Industry Labour Agreement and the Pacific Australia Labour Mobility Scheme. It argues that the proposed essential skills visa would be less burdensome for providers, but does not demonstrate how it would be more attractive to workers even with a guaranteed path to PR. Apart from international students, aged care is rarely an entry job for new arrivals. Viewing all those who have migrated to Australia at some time in the past as ‘migrant workers’ implies a misleading degree of mobility. Migrants to Australia come to stay: fully 9 out of 10 overseas born aged care workers have been here for six years or more, and close to half for more than 15 years.

Third and most importantly, what essential skills are to be required? The lack of defined skills for much of the existing workforce led the Aged Care Royal Commission to recommend mandatory minimum qualifications for Personal Care Workers. Four years on from the Commission’s 2021 report, the Office of the Inspector General of Aged Care found that action on implementation of this recommendation was lacking.

A start would be to recognise current qualifications. Contrary to the view that many are unqualified, 95 per cent have qualifications in a care field. Some 60 per cent have a Certificate III or IV or a diploma, 20 per cent a bachelor’s degree, most in nursing, and close to 5 per cent a postgraduate degree; 10 per cent are qualified in another field. Almost all gained their qualifications in Australia.

Instead of looking far afield for a marginal flow of temporary workers, a solution to workforce shortages is hiding in plain sight. It lies in increasing hours for part-time workers who want more hours.

At least half the workforce are employed on a permanent part-time basis and another 20-25 per cent are casuals. Among Personal Care Workers – who make up close to 80 per cent of the workforce – the Worker Survey found 30 per cent wanted more hours, outweighing the 10 per cent wanting less hours. The additional hours they wanted represent a 50 per cent increase over their current median 20 hour work week.

These results are consistent with the 2016 Survey which also found a strong preference for permanent part-time over casual employment. Both surveys also found that multiple job holding was limited, with little overlap with the disability sector. The small share employed indirectly on a contract also counters previous expectations of the Productivity Commission that ‘platform’ work could be attractive to aged care workers.

Taken together, the NILS reports and more recent surveys show that aged care is no more dependent on migrants than other sectors. The share of overseas born workers has been close to the one third of the total population born overseas at the 2021 Census and in earlier Censuses.

Despite limitations in the 2020 and most recent surveys, the picture that emerges is sufficiently consistent with earlier surveys to demonstrate the scope for consolidating the workforce in ways that would increase incomes and security for workers and reduce costs of turnover and workforce management for providers.

Instead of looking to recruit from afar, providers and policymakers need to shift their focus to opportunities for increasing the capacity and quality of the workforce that are right in front of them.

The report _Duty of Care: How to fix the aged care worker shortage_ released by CEDA in October states that the aged care sector is dependent on migrant workers and sees the solution to workforce shortages in an increased flow of migrants on temporary visas.

CEDA draws on the 2023 Aged Provider Survey, but comparison with 2024 Worker Survey and earlier surveys suggests a different answers. All the surveys mentioned here were commissioned by the Department of Health, Disability and Aged Care

The views expressed in this article may or may not reflect those of Pearls and Irritations.

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