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Unhappy workers: tackling the reasons why aged care staff leave

The first research of its kind has highlighted the importance of workplace conditions, support and culture in understanding why aged care employees stay or leave the sector.

Retention and turnover in aged care has been a significant and longstanding problem in the sector, with estimates pegging average annual turnover at 25 per cent. Retaining the right staff not only has important benefits for clients and continuity of care but also reduces replacement and retraining costs for organisations.

Dr Katrina Radford, a lecturer at Griffith Business School, said the factors influencing whether staff stayed or left aged care were overwhelming under the control of employers.

Dr Radford, who completed her PhD thesis on staff retention and turnover in aged care, found that organisational factors such as working conditions and job satisfaction were far more important than personal factors in determining whether a person continued working in the sector.

“When I looked at personal factors against organisational factors, while around 12 per cent of people’s intentions to leave were impacted by their health, age or intention to retire, the vast majority of turnover intentions were influenced by things the organisation does,” she told Australian Ageing Agenda.

“This shows that there is a great opportunity for organisations to invest in their staff, particularly, in a way that works for them.”

Dr Radford said there was no one-size-fits-all approach to encouraging workforce retention and strategies had to be shaped by the aged care setting and by organisations knowing their staff.

One clear finding to emerge from her study was the importance of organisational culture and support from both supervisors and the organisation as a whole to employees’ intentions to stay.

Employers should be investing in leadership training for supervisors and have a clear succession management plan in place, Dr Radford said. Anecdotally, it’s reported that staff are promoted into supervisory roles because of their clinical rather than leadership skills, demonstrating the importance of formal leadership training in the sector.

The study highlighted the significant influence supervisors had on employees feeling valued by their organisation and, interestingly, that the physical presence of a supervisor may not be needed for staff to feel supported.

When analysing the differences between community and residential care, a surprising finding in Dr Radford’s research was that community care staff reported higher levels of organisational and supervisor support and significantly higher intentions to stay.

Dr Radford said a possible explanation for this finding was that their perception of support could be influenced by the virtual and immediate support provided by supervisors remotely.

A lack of career opportunities was also consistently rated by employees in the study as a factor that would make them leave, which busted the myth that career development was only valued by younger workers. “The older workforce still wanted opportunities for career development,” she said.

What about pay?

According to Dr Radford’s research, pay was important but not as influential as other factors such as job satisfaction, job security, having a positive work environment and opportunities for career progression.

In terms of organisational factors influencing staff intentions to stay, job satisfaction and the work environment including culture, management and supportive co-workers were the most dominant factors.

While improvements to pay are needed in the future, Radford says clear succession planning, promotion opportunities, a supportive working environment with manageable workloads, flexibility and choice of hours may influence employees’ intentions to stay in the meantime.

Rewards and recognition

Chris Westacott CROPPED

Chris Westacott

Chris Westacott, managing director of consultancy firm Realise Performance, agreed that retention strategies in aged care should emphasise a positive organisational culture and career pathways, especially for younger workers.

“It’s all about culture,” he told AAA. “When staff feel they are valued and recognised and there is a culture of appreciation, then that supports retention.”

This meant engaging with staff and recognising the contribution that they make to the organisation and to clients. Staff that feel undervalued will soon look for opportunities elsewhere, Mr Westacott said.

Dr Radford’s research also supported the importance of developing a culture of rewards and recognition. “Being appreciated and valued and knowing how staff contribute to the organisation’s aims is really important, especially as the industry becomes more competitive,” she said.

An extended version of this report appears in the current issue of Australian Ageing Agenda magazine (Jan-Feb 2016).

Want to have your say on this story? Comment below. Send us your news and tip-offs to editorial@australianageingagenda.com.au 

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24 Responses to Unhappy workers: tackling the reasons why aged care staff leave

  1. Kathryn Evans January 27, 2016 at 2:59 pm #

    One doesn’t require a phD to have an understanding of why staff do not stay in the aged care sector. The unrealistic and increasing demands from management with regards to work load and the mental and physical stress to the body for ‘kiddie wages’ probably has a lot to do with it!

  2. Kylie Wise January 27, 2016 at 6:27 pm #

    More startling results that we already knew.

    Workplace conditions and organisational investment in staff are key factors; who would have thought? Good to see we’ve trotted out the old chestnut about wages not being all that important.

    Research or just rehash? I think most of us would expect a bit more than this in order to earn a doctorate.

    ‘The first research of its kind’ is a dubious claim. Wonder what will change?

  3. Kevin jove January 28, 2016 at 12:08 am #

    What about wanting to work in an industry that actually cares for it clients, the residents that call our nursing homes home.
    So if you were given more money for doing less you would be happier working in aged care?

    The disparity in wages between hospitals and aged care is the real issue here. Increase the funding to aged care so providers can pay more for a fair days work. Weed out the staff that think aged care is only about the money

  4. spanner January 28, 2016 at 10:49 am #

    I total agree with Karen Evans. I work in the aged care industry. there is little support from management. The increasing workloads and expectations from resident way out balance resources. Staffing levels are so low one can only provide the very minimum of care to each resident. The whole industry needs to be reviewed ….Sadly, as an aged care worker I feel no one is listening

  5. sue mcgovern January 28, 2016 at 11:40 am #

    Totally agree with Kathryn Edwards comments. Mine are: after 22 years in aged care, it is now a money making business, frail aged residents are a commodity for profits. The government has a lot to answer for! they make the rules, they oversee the facilities BUT the key important factor of quality life enhancing time spent with them does not count! No ratios give management no rules as to how many people one staff member looks after. Aged care staff are expected to do many tasks during there shift as well as care for too many people – quality time, remember-Because residents don’t VOTE governments take no real interest.

  6. mazza January 28, 2016 at 2:54 pm #

    Take Aged Care out of the hands of private providers. The current direction appears to be less regulation. In my experience more money going to facility based care will not result in higher staffing levels or more care, it will result in continued cost cutting and more profits to the large companies purchasing into the sector. I have seen residents who are deemed (by the facility at initial assessment) to require levels of care which they currently do not require (but may in the future), resulting in less autonomy, to enable the facility to receive higher funding under the current Funding Instrument.

    Sue McGovern – I totally agree with you, except it is not individual ‘management’ of the facility but rather the broader Company which directs management of the expected outcomes (read profits) required by that manager to produce, to retain the management position. To extrapolate that, each year, the Company will expect a higher percentage profit. There are only a few ways that can happen – charge residents more while cutting costs such as staffing, food, maintenance and cleaning.

  7. Maria Berry January 28, 2016 at 11:47 pm #

    Aged Care workers are leaving the Industry because of many reasons.
    – they go to work each shift in many Residential Care Facilities in the hope they have enough staff to provide adequate care to the Residents. Is everyone rostered going to turn up for a shift? If they can’t …have they replaced them, Is there anyone available to replace them. I recall weekends were like the lotto draw….count the heads in the staff room before you head to your rostered wing..
    – they are often at risk of injury and physical fatigue due to staff shortages
    – their concerns about quality,safety and care are not supported by Management, complaints are often swept under the carpet and not responded to or at times covered up
    – they go to work knowing they can’t make the difference any more….change what is happening……..they care…but can’t change or fight the system anymore
    – they end up burnt out or injured
    – they feel completely frustrated and inadequate
    – they can earn the same money or more for less stress and responsibility….no pressure…no guilt ….quiet often same money earnt being on a check out in a Supermarket
    Our system is letting our Older People down and the people who genuinely want to work in the Industry .

  8. Louise January 30, 2016 at 9:30 am #

    I concur with every comment made. The level of frustration is clear for all to see just by this post alone … Profits is what is driving the industry. Push nurses and care staff in creating high care needs reports for extra funding on individuals. Person centered care is a myth. Pretty words and ideals. The basic level of care that is required is shameful. Owners of private groups do not respect or support the people they hire to care for one of our most vulnerable people. There is NO ratio levels. 2 people to assist 14 people most high care these days and govt believes this is acceptable practice? Skin tears, falls etc are a direct result of pushing staff to the point of exhaustion. Aside from this is the high level of reporting. No support or quality training received and given to staff. You make a noise and your role is at risk… People want to earn a decent wage for the work they produce. Lets face it there is exploitation of migrants who are the majority of carers and nurses… If they resign who cares there is more like them out there. A true comment. I found the report light and fluffy and a little insulting to the intelligence of people working in the industry who deep down care but are terribly frustrated.

  9. Susan Banks February 12, 2016 at 11:42 am #

    Thank you for an interesting article about Dr Radford’s research. It’s good to see an Australian study that confirms things found elsewhere, and that brings the role of organisational culture into the frame. It’s also useful to see from the comments that care and support workers clearly agree!
    While it would definitely be a ‘duh’ moment for wqorkers, that Dr Radford’s research rigorously confirms it is important for pushing culture change. There has been very little research that has focused on staff in the sector who are not nurses, allied health professionals or doctors. That fact alone, I think, is a signal that care and support workers have been seen as not important, or not people to be taken seriously. That lack of attention and interest was part of the spark for my own PhD study (almost complete) into aged care and disability support work, from the perspectives of PCAs, ECAs, CCWs and DSPs and clients/residents. It is showing that organisations’ attitudes to both clients and staff have an important role in shaping service encounters.
    One other thing that is worth remarking on in the study is that of the question of pay not being a major factor in turnover. That, to me, does not signal that pay is not important (and Dr Radford notes that); there remains a real pay deficit for care and support staff in this sector. Gendered ways of thinking about care and support, who should do it and what it is ‘worth’ remain firmly entrenched. This keeps wages low, and conditions far from ideal. It also signals that neither policy makers nor organisations (or maybe society as a whole) consider that people ‘at the coalface’ – clients, residents and care and support workers – have the right to a decent, ordinary life.

  10. Samantha Bowen February 12, 2016 at 2:24 pm #

    This article is just one of many backing up the workforce issues prevalent in the aged and community care sector. Yes, wages are important – and I agree that strategies for retention also need to involve staff engagement, safety, and leadership development.
    With large proportions of older workers, low engagement of young staff, and poor succession planning … how can this body of research build momentum to make a difference?

    Something needs to be done now to improve training environments, leadership development, and career pathways – or things will get much worse.

    The real question is what are organisations doing about it?

  11. Michael Eastman February 13, 2016 at 5:29 pm #

    I notice a recurring theme throughout this publication: Experts comment and workers disagree. The disparity between boardroom and coalface is vast.

    Surely aged care is the only industry where you can be an expert without ever having worked in it?

    It’s also probably the only one that stacks its expert panels with people that have never spent a day on the floor caring for residents.

    So many people wanting a slice of the pie (too much government money available, too many academics and accountants?) instead of just doing what we’re here to do; Care for the elderly with skill and compassion.

    It’s a simple pursuit that only becomes complex when your focus is profit.

  12. Lee May 18, 2016 at 4:52 pm #

    Michael Eastman “Surely aged care is the only industry where you can be an expert without ever having worked in it?”

    I am not sure if you made an error when you wrote the above comment.

    You definitely CANNOT be an expert in the Aged Care industry without ever having worked in it. Caring for people with dementia and limited mobility takes a great deal of skill, knowledge and experience. In the absence of either, the individual cannot be an expert at all.

  13. Healthychic October 23, 2016 at 8:34 pm #

    One 99 year old resident confided in me as I was leaving aged care forever ” if I’d known this organisation was going to treat me and others with such little dignity I would have found a better alternative, death!”

    My heart grieved everyday for each and ever resident because the organisations who run these homes only care about the ‘bottom line’ and have absolutely NO understanding how hard the staff work and are treated!!

    It is the most demeaning workplace I have ever experienced. If nothing changes in the future I’ll be choosing the alternative too.

  14. Fed up October 25, 2016 at 12:49 am #

    You are sooo correct,HealthyChic.

    It’s so sad and it infuriates me to no end,how the aged are treated as such.Also the staff,one day there’ll be a revolution I’d say.

    Such a gigantic disgrace.

  15. Caroline Romeo October 25, 2016 at 11:41 am #

    So good to read that Sue Banks is doing (or completed) a study about aged and disability care workers. I did an Honours thesis about aged care community workers in 2006 but I’ve seen very little (if nothing) in academic research that investigates careworkers’ experiences. If your piece of hard work can be shared, I’d love to read it.

    Incidentally, while the discussion is all about careworkers who are leaving and lack of support from management who are constrained by funding and organisation preferencing (shareholders, profit, etc), I would suggest that an investment of support will make a huge difference. I am plugging my own interest and curious to know if anyone in Sydney metro would be interested in testing out counselling support for community care workers. This could be one way to allow workers through talking therapies to talk through their issues. I will soon complete a postgrad in counselling and my dissertation focuses on counselling’s support in a certain sub-group (to be revealed later).

  16. Oktagenarian October 27, 2016 at 2:19 pm #

    It’s all a cry in the wilderneness. I’m a “resident” and have seen care diminish on a daily basis. I have mid levels of assisted care and never know who’s coming for me. The frazzled permanent staff always fob off an agency or casual staff onto me, requesting I tell them what to do. I often joke that I want a training allowance to come off my bill ha ha!

  17. Steve October 28, 2016 at 1:43 pm #

    We need a royal commission into Aged care. The current Government is not doing a thing . All these reply’s show the same problem that all aged care workers are going through.
    Who will listen and what do we do ?

  18. JenU October 28, 2016 at 2:31 pm #

    There’s a great disconnect between providers of services and accreditated aged care providers.

    I have a carer who provides 5 hours at home care, per week. She works for an Agency who provide services to an Aged Care provider. I act as conduit between all three parties to convey my mother’s needs. All 4 (Agency, Carer, Accreditated Provider and me) should be working together to deliver ‘best outcomes’ for my mother.

  19. J.Tan January 22, 2017 at 4:06 pm #

    I work in an industry that supplies goods to aged care facilities. I get to speak (at considerable length) to PCA’s, the relatives of those residing in aged care facilities, and I get to talk to those at management level/supervisors of the PCA’s.

    The work of the PCA is not well paid given the physical challenges of their role and given the stresses associated to their job; rushing (not just walking at a normal, safe pace) from one resident to the next, bullying from other staff, being bullied by the residents and even being bullied by the relatives of the residents. Sadly, the new-migrant PCA’s appear to cop the most bullying from the residents and their relatives, and believe me, there will be a class action one day for workplace bullying, as these wonderful, willing, migrant workers are all too often walking out of the aged care facilities in tears at the end of their working day. Yes, WorkSafe laws exist, but most workers fear being sacked if they stand up for their workplace rights.

    Out of the hundreds of PCAs whom I have spoken with regarding their work, I have only met one PCA who said that she loves her work; all of the other PCAs have said to me that they would leave their Carer jobs immediately if another secure job was offered to them; most are aged from about 42 – 60 years of age, they have been retrenched from their previous job due to industry down turn, and they went into the aged care industry as it offered a stable income – the other PCAs are the migrant workers who have no hope of jumping job. (I am describing the PCAs who have confided in me, not all PCAs fit that description.)

    I have aged relatives of my own, and I expect a good service from Carers, but not at the exploitation of our hard working PCAs.

    Relatives must be asked to do more for their elderly loved-ones; more visits, flowers, pretty clothes – these gestures lift the morale of the elderly. A happy resident is less likely to strike out at the hardworking PCA. Yes, our PCAs get physically and verbally attacked/bullied by some of the angry residents who take out their frustrations on the PCAs, knowing full well that they (the resident) can get away with bullying the PCA’s.

    I personally know of a PCA (with almost 20 years experience at the same aged care facility) and she works alone, caring for up to 14 dementia- residents, for up to 3 hours at a shift (until the next staff arrives to assist) in a dementia specific unit, with residents known to be physically and verbally abusive to the PCAs.

    One PCA was punched so violently by a dementia-resident, that the resident broke a bone in their hand. (In a psychiatric ward patients known to be abusive are attended to by two nurses in attendance at the one time,so as to protect the staff/to control abusive behavior from the patients – but the aged care industry is a law unto itself!

    To reduce high staff turn over at aged care facilities, working conditions for PCAs must be better; more staff on the floor, put an end to workplace bullying by putting controls in place.(It was recently suggested that CCTV be installed in aged care facilities to monitor behaviors of both staff and residents.)

    PCAs who are made to feel valued will deliver better care to the residents.

  20. Josie Edwards April 7, 2017 at 8:43 am #

    My first experience in aged care was a real eye opener after working in industry/manufacturing my whole life. The dismissal of residents concerns by management because they have dementia is unforgivable, the workplace bullying and harassment of staff by management was something I had never seen or experienced in industry as zero harm was number one priority to employees, overworked PCA to ensure profits, I found the quality and auditing process extremely flawed. The whole system is extremely backward and agree there needs to be a royal commission into aged care. If asked I would suggest the following
    1. There immediately needs to be reform on choice of site managers. This critical position should not automatically be given to nurses. They need to implement personality analysis and have evidence of experience in staff management, quality management principles, communication, and an understanding of requirements toward staff on HR and WHS prior to being placed in this position. This is the biggest issue in staff turnover.
    2. Review the requirements and standards for accreditation.
    3. Disband the Aged Care Agency and employ 3rd party auditors not associated with Aged Care as they examine and follow through on information which highlights errors in the systems.
    The current auditing process is not investigative enough. I would not place my parents into
    Aged Care based on the facility being Accreditated. After my experience, I would not place them into Aged Care at all. The fact the government and their advisors turn a blind eye to it all just shows how flawed the system is.

  21. Helen May 13, 2017 at 8:50 pm #

    In my opinion the biggest issue for PCAs is the enormous workload, and, due to this, the inability to spend any time, let alone quality time, with residents. PCAs are expected to do a wide range of duties on top of the personal care duties. Often it is not possible to take a meal break, and nearly every shift it’s not possible to leave on time. The pay is so low when comparing the workload that it is just offensive. I was delighted to start work as a PCA, but that delight didn’t last more than a few shifts. Personal exhaustion, and the profound sadness I felt for the residents soon wiped the gloss of my career change. I’ll stick it out for the next couple of years, but I certainly wouldn’t recommend it for young people looking for a career. And I’d certainly recommend families thinking about care for elderly loved ones to think twice before choosing the facility route.

  22. 5star May 31, 2017 at 12:18 am #

    I have worked in this industry for 40+ yrs. Have loved it, but now the dollar signs are more important than the care. We are preached about how our care is so valuable, but then take away staff or don’t replace staff to the point it is almost elder abuse as we are expected to work like machines and physically cannot provide the care needed. Workmates are too frightened to stand up. They call our facilities 5 star.

  23. Kia August 14, 2017 at 5:46 pm #

    My first experience in aged care. 10 straight months in high care dementia. While it’s hard for 2 carers to care for 14 residents. My partner and I had 18 high care dementia patients!!!! 18 RESIDENTS!!! every AIN I have worked with and I would brace ourselves before shift and leave stressed and sometimes crying. No support, nothing. There was no reward in helping the residents. I literally got in trouble for doing person centred care. I got in trouble for following protocals. We literally are damned if we do and damned if we don’t for what $21 an hour. No time to support the elderly. It’s disgusting. I left, never went back. I loved my residents, I love looking after people, but I felt like I was part of the abuse towards these helpless people, and I wanted no part of it. That was 4 years ago, still makes me sad.

  24. Anne Noakes October 14, 2017 at 7:12 pm #

    Made a mid life career change from finance to aged care as I love caring for older residents and hearing their life stories. The pay was a third of what I was used to, but I didn’t care as I love helping people and felt I would be contributing to my community. I lasted six weeks…… The facility I worked in continually paid lip service to person centre care and staff safety.

    Constant staff shortages meant two person lifts were conducted alone, staff were forced to work elsewhere with unfamiliar residents, not to mention lack of basic food staples, safety equipment and items required to carry out tasks such as making meals. I am totally disgusted with the whole industry. In my short time I was bullied by other staff members, patronised by management and supervisors and physically abused by residents.

    Many staff members don’t complain as they are immigrants too afraid of losing their only source of income. They are hard working, intelligent, caring, and patient individuals who put up with appalling work conditions due to necessity.

    Training courses are expensive (average $2,500 for Cert III) and getting vocational placement for 120 hours near impossible. They wonder why people don’t have qualifications and sufficient experience/training. This is because it is expensive and almost impossible to secure.

    Realistic and legislated ratios, free/decent training, wages that at least match those of retail staff and the requirement that people in management have actually worked at the coal face would go a long way to maintaining staff. Only a few of us are capable of caring for the elderly, including cleaning up bodily fluids on a regular basis, and those of us who actually choose to work in this industry can only continue to do so if major changes take place.

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