Australia will need to nearly triple its current aged care workforce by 2050 to keep up with demand, but some in the sector say bringing in overseas workers with temporary visa statuses can make them more vulnerable.
At the Fronditha Aged Care facility in Newcastle, NSW, Greek personal care worker Despina Zountouridou's bilingualism is highly valued.
Despina, who is in her 50s, came to Australia this year under a special Federal Government visa deal aimed at filling niche skills gaps - in this case, native speakers - and she helps care for Fronditha's significant number of Greek residents.
"I was looking for a job at the time," she tells SBS News.
"I sent my resume to Fronditha in Melbourne. They told me about the labour agreement. It sounded good, the move to Australia".
"Apart from the cultural differences, which were just a matter of time adjusting to, I had no issues in living and working here. I received great support from my friends, including new ones, and my workplace."
Despina is one of the lucky ones.
Those on so-called 'boutique' labour agreements begin on a Temporary Skills Shortage visa, but in some cases, can later be sponsored by their employer for permanent residency.
In contrast, most overseas-born personal carers cannot move beyond temporary status, as the job is deemed semi-skilled.
Fears of exploitation
The Productivity Commission estimates Australia will need to nearly triple its current aged care workforce of 360,000 by 2050 to meet demand.
And staff shortages mean a growing reliance on temporary migrants. In 2011, 33 per cent of Australia's aged and disability care staff were born overseas, rising to 37 per cent in 2016.
But migration experts say temporary visa statuses can make workers more vulnerable. They're often non-unionised and willing to accept poor pay and conditions.
"What we need to avoid is a revolving door of low-paid vulnerable temporary migrant workers," said Dr Joanna Howe, a leading scholar in temporary labour migration at Adelaide University, who has also studied aged care.
"By doing so, there is no incentive for the aged care industry to improve wages and conditions, and we see that abroad, we also see it in Australia."
Among a profusion of labour deals and regional agreements is the Pacific Labour Scheme - which offers workers from the islands up to three years regional work - and DAMA, the Designated Area Migration Agreement, drawing workers largely from Asia.
International students working part-time are now a key source of personal care workers, who themselves comprise some 70 per cent of the sector.
The Health Services Union says carers often face problems of low pay, and serious under-resourcing, though it says "hard-core exploitation" is largely within ancillary aged care positions such as cleaning.
"For migrant workers working in aged care, there should be better recognition in terms of their ability to raise concerns without fear of being removed from that position or this country," the union's national secretary Gerrard Hayes said.
"The Aged Care Royal Commission needs to seriously consider boosting the amount of money for aged care - not $1.5 billion but more like $5 billion - so people who care for our elderly are actually cared for themselves."
This week, the Federal Government pledged an extra half a billion dollars towards addressing key areas identified in the Royal Commission's interim report.
It did not cover workforce issues though, rather the shortage of home care packages, over-reliance on chemical restraints, and the practice of placing younger disabled people within aged care.
Minister for Aged Care and Senior Australians Richard Colbeck told SBS News “the government has no tolerance for exploitation in Australian workplaces and we continue to take action to protect vulnerable workers, including foreign workers”.
“Workers on temporary visas are entitled to the same basic rights and protections as Australian citizens and permanent residents under applicable workplace laws,” he said.
Staff retention an issue
Dr Howe, says temporary migrants would like to invest in their careers in Australia, but current migration settings prevent them.
One result, she says, is high staff turnover which can impact the continuity of care for residents and ultimately its quality.
"The government must ensure the pipeline for aged care jobs comes from young Australians who are attracted to the industry, who the industry works with to retain and skill-up over time. That's the best thing for older people needing aged care, and for the workforce," she said.
"The overarching question is whether to fill gaps with migrant workers or lift industry standards and boost retention rates to get a permanent workforce."
Pat Sparrow, chief executive of Aged and Community Services Australia, representing non-profit aged care providers, says both strategies should be adopted.
"We need to address the supply locally and need to pay workers better. It's a largely female workforce so issues of the gender pay gap, and the value of work, come to the fore.”
“But at the same time, having migrant workers reflecting the Australian community, and making sure people can speak in their own language, is really important as people age."
She favours adding occupations such as personal care workers to the skilled migrant list, for an easier pathway to permanent migration.
There is no mandatory training for personal carers, though many employers demand at least level three certificates of their staff.
While overseas-born care workers overall have higher formal education than those born in Australia, some aged care advocates urge enhanced training in language skills, cultural norms, and how the Australian system works.
The Health Services Union supports this.
"There's a diverse range of aged care recipients,'' Mr Hayes said.
"Any extra training that could go towards migrants being able to deliver quality aged care is fantastic."
Mr Colbeck said through the government’s Aged Care Workforce Strategy “a review is underway into the Certificate III in aged support qualification and will examine ways to enhance career pathways, including in nursing”.