Back in early May, at the height of the Newmarch crisis, I was surprised to see an ad posted on our Aged Care Worker Support Facebook Group in which a nursing agency was advertising for staff “wanted urgently” to work in a “declared COVID-19” aged care facility.

It was jarring to see the urgent call for staff when we knew residential aged care homes were under siege from the deadly virus.

“We’re looking for RNs, EENs and ENs with a minimum of one-year clinical nursing experience. “This is crisis response work,” the ad read.

It turned out the agency had been contracted to find staff by the ‘Uber of aged care’, Mable, and the staff were being recruited to work at Newmarch House, as the facility battled to contain the most serious COVID-19 outbreak in Australia in which 70 people became infected and 19 died.

The advertisement raised questions in my mind about Mable putting so much trust in a third-party website, and I wondered about how well these staff members were vetted through police and security checks, and about the quality of the people Mable was sending to Newmarch.

Only two weeks earlier, the government had heralded the announcement it had awarded Mable, a $5.8 million limited tender contract to provide “surge workforce” capacity to aged care facilities that experienced an outbreak.

The cost of staff hired through Mable would be covered for four weeks, with the three-month contract expiring at the end of June.

Now, there is nothing wrong with finding staff online, and during a pandemic there is nothing wrong with a limited tender contract being issued. But some in the industry are questioning giving the contract to a privately owned, for-profit supplier of aged care staff with no duty of care for the services provided.

What is Mable?

Mable is the Uber equivalent for aged care. It allows people who need care to find freelance carers, whether they are nurses, ENs, or care workers. Those carers are effectively working in the ‘gig economy’. Mable doesn’t employ carers directly, just as Uber drivers are not employed by Uber. The carers are freelancers, they work for themselves.

Quality

Rick Morton, social affairs reporter for The Saturday Paper, said in a podcast last week there are two problems with Mable’s services: quality and coverage, raising concerns about the government’s awarding of the contract.

Mable has no duty of care over the services its carers provide to clients, which raises serious problems about accountability and quality of care. 

“The app gives no warranty regarding the quality of care. It’s not responsible for the accuracy or reliability of information provided by someone. You hire through it and it takes no responsibility for anything, it’s just left in the lap of the gods,” Mr Morton said.

Though Mable does provide insurance and makes every effort to check qualifications, it does not take responsibility for the information on its site being correct. In its terms and conditions, Mable says that anyone hiring a carer should check qualifications themselves as they, Mable, can not be held responsible if the information on the site is wrong

When a dispute arises, the carer and care recipient are on their own. The Mable website states, “In exercising your choice as a client or care worker on the Mable platform, you are also accepting certain responsibilities for those choices, and responsibility for managing the relationship with your client/care workers. 

“Whether you are a client or a care worker, where possible, is your responsibility to resolve any issues directly.”

Coverage

The other question about Mable is the breadth of its coverage around Australia. Founded in Sydney, the platform’s Sydney coverage is sound, but in other cities, and especially in regional and remote areas, coverage is thinner.

Mr Morton said this was a concern for providers outside the capitals. “If you were a nursing home operator in a regional area and you jump onto Mable because the government’s paying the wages through Mable, and you can’t find a support worker that is high enough quality or is even available, then what do you do in the middle of this crisis?” he asked.

Indeed, the agency that posted on our support group targeted staff in “rural and remote” areas.

The contract

The Mable contract was issued under ‘limited tender’, which means it is exempt from normal rules around government contracts, including around accountability, value-for-money, transparency, economics and ethics, and the contract cannot be reviewed, according to Mr Morton.

Mable is also backed by heavyweight investors, raising further questions about the appropriateness of the government contract.

Mable is part owned by the former chief executive of gaming giant, Aristocrat, as well as James Packer’s investment company, Ellerston Capital. Aged care advocacy group, COTA South Australia, was also granted a 2 per cent stake in Mable in lieu of consultancy work it did for the group.

“Defective thinking” the market will solve government’s problems

Mr Morton said the outsourcing of recruitment to Mable during the COVID-19 pandemic is another example of the government turning to the market to solve its problems when it finds itself “bereft” of ideas.

But the policy of relying on the market was loudly condemned in the royal commission’s ‘Interim Report’.

“It is a myth that aged care is an effective consumer-driven market,” the report states. “The system lacks transparency in communication, reporting and accountability.”

As the sector drifts towards increasingly “privatised” and “for-profit” services, Mr Morton said, “along the way we’ve lost sight of the fact that this isn’t about money, it’s about people who need care at a point in their life when they are most in need of getting proper, safe care.”

The reliance on market services is “defective thinking”, Mr Morton said, and it “needs to change”.

We don’t know if any member of our support group ended up working at Newmarch House. The facility was only declared COVID-19 free today, six weeks after a staff member came to work while infected, sparking one of the biggest aged care crisisses in Australia. The need for ‘surge staffing’ has eased. According to Mr Morton, only two aged care facilities accessed Mable’s $5.8 million in government funding, and unused funds will be returned to the government. But the problem remains. If the market can’t deliver safe and effective care for older Australians, the government must step up.

Mable responds

Background information provided to HelloCare by Mable said the organisation is not a ‘gig-economy model’ because there is little demand for one of “one-off ‘gigs’” and because Mable does not set rates or allocate jobs. 

“Via Mable, workers are truly empowered to build their own business,” the information states.

The information says Mable undertakes national police checks and reference checks, it sights certifications and qualifications, and checks AHPRA registrations. 

But ultimately it says their approach to providing aged care staff to residential facilities and for home care “puts the judgement of quality firmly in the hands of the consumer, who can choose to continue or discontinue services and rate and review those services”. 

In an industry plagued with scandals about abuse and poor quality of care, is that enough?

Edited on 3 June to incorporate information provided by Mable.

Image: SilviaJansen, iStock.

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