Home Care Work in the COVID Era
Sara Charlesworth & Wendy Taylor
Concern about the impact of COVID-19 in aged care has focused almost exclusively on residential aged care. In Victoria, in particular, the spotlight has been on the rapid spread of this virus through facilities and the tragic number of deaths among residents. There has also been a belated recognition of the importance of frontline staff in providing daily care for residents in these facilities, despite their historically poor pay and inadequate working conditions.
In contrast, we have heard almost nothing about home care clients or the workers who support them. Today home care workers support nearly 1 million older Australians to remain living at home through the Commonwealth Home Support Program and the Home Care Packages program.
Department of Health data suggest as of 13 September that 82 home care clients have been infected by COVID with 7 COVID-related deaths of home care clients. As in residential age care, both infections and deaths in home care have been concentrated in Victoria.
However, there has been no media focus on home care workers and public data is not available on the numbers of workers who may have been infected by COVID.
Despite their invisibility, both now and before COVID, home care workers remain essential workers. Yet their minimum award pay and working conditions are some of the poorest in the country. We highlight six conditions of home care work that are in urgent need of reform
- Home care workers pay rates are very low
The Award minimum hourly rate of pay for entry-level home care workers is just $21.35. Of just as much concern though are effective limits to any further wage increases. The minimum rate for experienced home care workers, who provide more complex personal care, is only a couple of dollars more, at $23.81.
- Home care workers don’t have to be paid for the time they travel between clients
Travelling between clients is an integral part of the job of home care. But while in New Zealand and the United Kingdom home care workers must legally be paid for this time, in Australia there is no Award provision for paid travel time. It is hard to think of any other job where work-related travel time is unpaid. A recent UK Employment Tribunal decision underscored the right of home care workers to be paid for the time spent travelling between clients and extended this right to paid time to cover up to 60 minutes ‘waiting time’ between client visits.
- Rostered ‘shifts’ can be as short as one hour
Casual home care workers can be employed for shifts as short as one hour and could have one, two or more of those shifts in a day. This compares to a four-hour minimum shift for casual manufacturing workers and a three-hour minimum shift for casual health workers.
For permanent part-time home care workers, it’s even worse, they have no entitlement at all to a minimum shift time. This compares to a four-hour minimum shifts for part-time manufacturing workers and four hours minimum for part-time patient transport workers.
- Workers wear the risks and costs of staff shortages and client cancellations
Permanent part-time home care workers are expected to nominate their ‘availability’ outside their ‘guaranteed’ minimum hours. This basically means they are effectively ‘on call’ for this period, yet are not paid any allowance for being available. Patient transport workers and other health workers are paid an allowance where they are on call and available to work if needs be
If a client cancels their scheduled visit before 5 pm the previous day, permanent part-time home care workers are not paid for this visit and have to make up the time lost.
- Home care work is increasingly complex and demanding
Population ageing and a long-term policy shift towards home care means older people living at home are increasingly frail and have complex health issues.
Caring for older people with dementia, depression, diabetes, heart conditions, cancers or arthritis can be extremely challenging. Many people approved for home care packages are so frail or disabled they meet the requirements for permanent residential care.
Yet the home care skill descriptors in the Award do not recognise or reward the greater level of specialist skills, judgement and decision-making or the interpersonal skills increasingly required by home care workers to provide good quality care to frail older people.
- Home care workers suffer high rates of injury
Health and safety regulators have identified home care work as a high-risk occupation. Common conditions reported include musculoskeletal injuries, injuries from falls and trips, work-related stress, injuries from vehicle accidents, verbal abuse and assault. Common risk factors are poor systems of work, such as not enough time allocated to complete care tasks. Despite this, home care workers are often reluctant to report health and safety risks such as having to transfer very heavy clients alone or work-related violence.
These working conditions have existed in Australian home care long before the COVID-19 pandemic. Poor working conditions compromise sustainable good-quality care in government-subsidised home care services. The need for reform of home care workers’ basic working conditions is urgent.