Glen O'Driscoll has been living out of his suitcase in hotel and motel rooms for the past four months.
He's a registered nurse, plugging staff shortages at aged care homes with COVID-19 outbreaks across New South Wales.
"COVID has not gone away, it's still very much present in aged care," he said.
Mr O'Driscoll, who's a member and former branch secretary of the nursing union, says COVID-19 has put pressure on the sector but he was seeing chronic staffing issues well before the pandemic.
"COVID has not created these workforce issues, it's exacerbated them," he said.
It's been more than a year since the aged care royal commission painted a damning picture of an understaffed aged care system riddled with substandard care and an underpaid and under-trained workforce.
Mr O'Driscoll says for staff, nothing has changed.
"[Staff] work double shifts, they work overtime, they work extended shifts, they are tired, they are worn out," he said.
While the Coalition has pledged billions in aged care funding since the royal commission, Labor is making aged care a key election platform, promising $2.5 billion over four years for measures including better food, stricter reporting rules for providers, and greater penalties for covering up abuse.
Wage increases
The royal commission made it clear the aged care sector needed to attract more nurses and care workers, and recommended an increase to award wages.
The government left that to the Fair Work Commission, which started hearings on Tuesday into whether workers under three awards should receive a 25 per cent pay rise.
The Coalition has said it would ensure the Fair Work decision was honoured, but hasn't committed to fully funding it through government subsidies.
Treasurer Josh Frydenberg said a soon-to-be-expanded independent pricing authority would determine "what that increase in subsidy will be".
Paul Sadler, from Aged and Community Services Australia, said workers deserved a pay rise, but providers wouldn't be able to pick up the tab.
"For a sector where 60 per cent of residential aged care homes are in deficit at the moment, and basically two-thirds of all homes in regional Australia are in deficit, we can't afford a pay rise without the government fully funding it," he said.
Earlier this year the government promised workers bonus payments up to $800, but not all staff have received their first instalment yet.
Labor has committed to fund whatever pay rise the Fair Work Commission decides.
"We don't know what the increase will look like. We don't know over what time period it will be," Labor's aged care spokesperson Clare O'Neil said.
"These people need and deserve a pay rise and aged care is not going to get fixed without it. So from my perspective, Labor is just being realistic about that."
Labor is relying on the aged care workforce being paid more to underpin its other promises to boost nursing and care time in residential aged care.
Nurses and care minutes
One of the key recommendations of the royal commission was for a "minimum staff time standard" for residential care, requiring aged care providers to have registered nurses, enrolled nurses and personal care workers providing at least 200 minutes of care a day for each resident by July 2022.
The recommendation also called for a registered nurse to be onsite for 16 hours per day by July 2022.
By July 2024, the royal commissioners recommended care time minutes step up to 215 per day, with a registered nurse on deck 24/7 at every aged care home.
In its response to the royal commission, the government committed to mandating 200 minutes of care and a registered nurse onsite 16 hours a day by October 2023.
Labor has made nurses and care minutes a plank of its election platform, promising to have 24/7 registered nurses by July 2023, 200 minutes of care per day by October 2023 and 215 minutes of care per day by October 2024.
Since the campaign began, the Coalition has changed its lines on nurses.
Minister Anne Ruston told Sky News last week that the Coalition had "accepted the recommendation … for nursing staff to be on premises 24 hours a day, seven days a week" but also accepted "the commission's recommendation that it would take us until 2024".
Two days later, Prime Minister Scott Morrison told ABC Radio Brisbane the Coalition had "a target for 24/7 nurses by 2025, the back end of 2025".
In a statement to 7.30, a spokesperson for the Minister for Aged Care Services Richard Colbeck said: "The Morrison government supports 24/7 nurses in aged care by 2024 — in line with the recommendations of the royal commission."
The spokesperson clarified that meant registered nurses, and funding for the increase in nursing hours would be subject to further analysis with the Independent Hospital and Pricing Authority in 2023.
If Labor wins, where will the nurses come from?
A key question for Labor has been where it would find the staff to meet its nursing and care minute commitments, given existing workforce shortages.
Labor's aged care spokeswoman Ms O'Neil told 7.30 the party's commitment would require about 750 full-time equivalent nurses.
"Most nurses in aged care work part time, so it's somewhere between 2,000 and 3,000 new people coming into the sector," she said.
Ms O'Neil said that was "eminently doable" and Labor would recruit new workers and staff who'd left the sector by paying more, introducing fee-free training places and making aged care a more attractive place to work.
Hal Swerissen, who was a policy adviser to the Keating government and is now an emeritus professor with La Trobe University, said finding the workers for Labor's nursing commitment would be a challenge, but not impossible.
"If the Fair Work Commission makes a ruling soon that aged care staffing pay should go up, as I think most people think it should, and that staffing is paid for - that will make it more attractive to bring people into the aged care sector," he said.
"And provided that funding is available, that should be manageable. But there are a fair few ifs in that equation."
On Tuesday, Opposition Leader Anthony Albanese confirmed overseas workers would need to be recruited as a "stopgap measure".
Billions pledged since royal commission
Following the royal commission, the Coalition has pledged $18.8 billion over five years to improve the sector.
As part of that, the government gave nursing homes an extra $10 a day per resident to improve nutrition, but a recent audit found a third of homes were still spending less than $10 a day on each resident's meals.
In a statement, a spokesperson for Aged Care Services Minister Mr Colbeck said services that weren't properly reporting their spending on nutrition would be "checked" and might have to participate in an education program, or further regulatory action could be applied at the discretion of the regulator.
Another of the Coalition's big-spending promises was $6.5 billion to roll out 80,000 home care packages over two years.
Of those packages, 32,310 had been released at the end of April but more than 62,000 people were still on the waitlist, according to the most recent data from February, with wait times up to nine months.
"That's an improvement - there's no doubt about that," Professor Swerissen said.
"But [the wait times] are still massively unacceptable."
Mr Sadler said Labor needed to come forward with plans for home care, given more Australians accessed home care than residential care.
"This is one where the Coalition has the stronger both track record but also statements about what they plan to do for the future," he said.
Ms O'Neil said the party's policy on home care was the same as the government's - to fund 80,000 additional places.
"The difference between Labor and the government is that right now, there are no staff to deliver those home care packages," she said.
The royal commission recommended the government look into an aged care levy to address chronic underfunding, something that's not palatable to either party this election.
Professor Swerissen said despite the attention on aged care this election, fundamental changes to the sector were not being talked about.
"The community needs to bite the bullet on this - either you fund this thing properly and you do require proper management, and you put in place a real system of supporting people and giving older people universal access to aged care," he said.
"Or you continue with a system which is always going to have quality problems, access problems, management problems, as we've currently got."
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