Fiona Macdonald, RMIT University

While the number of care jobs is growing, cash-for-care systems such as the National Disability Insurance Scheme (NDIS) are changing the organisation and nature of care and support jobs, with significant risks for workers.

Before the NDIS, the not-for-profit organisations that have provided most disability support services received block-funding from governments and were paid in advance to provide fairly standardised services to groups of people, often within institutions.

In the new individualised ‘cash-for-care’ NDIS, which is being rolled out nationally from July 1 2016, service provider organisations are subject to greater market forces. This means increased uncertainty for the employers of disability support and care workers.

Individualisation means funding is allocated directly to consumers who can exercise choice and control over their services, including over the when, what and how of service provision. Some consumers will choose to directly engage their support workers, taking the traditional service provider organisations out of the picture altogether.

This is a major disruption to the labour market and to the nature of direct support and care jobs.

Under the NDIS, service provider organisations must compete with each other and with any new provider companies that choose to enter the market for the custom of each individual recipient of disability support funding. Organisations will receive payment only after services have been provided.

Service providers have to offer much more flexible supports to suit consumers’ preferences, as people with disability exercise choice to get the particular supports they want to meet their individual lifestyles, aspirations and needs.

For example, previously a person may have attended a specialist disability support day activity centre run by the disability services provider. Under the NDIS she might choose instead to have a support worker assist her to participate in a community-based craft class or to attend the local gym or swimming pool. These changes mean service providers must adapt to provide more diverse and variable services, at a wider range of times over the day and week and in many more locations.

The pressures on service providers to be competitive, flexible and responsive in the new market readily translate into pressures for more flexible working arrangements for the frontline disability support services workforce.

This flexibility is likely to mean more fragmented working time and reductions in the working conditions of this highly feminised workforce. For example, employers are asking the Fair Work Commission for reduced minimum engagement periods, that could see disability workers being engaged to work a single hour at a time.

Changes to shift arrangements could have disability support workers working multiple short periods in a single day with large gaps of time in between. These jobs are not highly paid and the gendered undervaluation of support and care work due to its association with women’s unpaid care work has been widely acknowledged, including through the 2012 Social and Community Services Equal Remuneration decision. Much care and support work is already short hours and the risk is that more of these jobs will become casual, with unpredictable working time and with workers unable to get enough work to make a living.

The NDIS, along with the introduction of individualised consumer-directed care in home care services for elderly people, have also brought about a new demand for services to be provided by self-employed support and care workers.

For an individual with disability who is managing their own funding, engaging a support worker as an independent contractor is likely to be much easier than becoming an employer with all the responsibilities that entails. However, self-employed contracting is in itself a form of employment in which low-paid workers can be highly vulnerable. Self-employed contractors take on individual responsibility for managing many of the risks of their employment and they have few of the protections and benefits of wage earners.

The ‘gig economy’, where consumers access services directly through technology platforms (think Uber), also might change the landscape for disability support and other care services. It could fuel a growth in the risky self-employed contracting form of employment.

There are a variety of new technology-based businesses in Australia’s disability services market already. While some are acting as employers of support workers, others have adopted the Uber model by simply providing matching services for consumers and support workers, with workers left with all the risks of running their own businesses.

The individualisation of social support and care is bringing much needed opportunities for control, choice and participation for people with disability. However, there is an urgent need to consider how to ensure the protection of care workers in this new system and provide them with decent work in the future.

The Conversation

Fiona Macdonald, Senior Research Fellow in Work & Employment Relations, RMIT University

This article was originally published on The Conversation. Read the original article.

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  1. The above article refers to ‘Uber-style’ models – perhaps referencing websites like, a platform where clients can search for local support workers and hire them directly.

    As the founder of Better Caring, in my experience, our continued growth is testament to the fact that it’s not only NDIS participants that want to be empowered with choice and control, but it is a growing community of support workers who also want greater choice, control and flexibility around they way they organise their careers.

    The Better Caring platform connects consumers and workers locally, it empowers them to determine between them the schedule, rates and services that will be provided. In most cases the balance of power between consumer and worker is fairly equal – particularly as the platform encourages transparency around rates that are charged, as well as client reviews and feedback.

    The author correctly points out that the sector currently faces a challenge in meeting the demands of individual choice and the NDIS. We believe that new, innovative models will be essential to meeting this demand.

    We are not saying that self-employment is better than employment, but if we are to attract the large and diverse workforce we need to support the growing demand of the NDIS, and our ageing population, we need to attract a mix of people to the sector who prefer the flexibility that can come with running your own business, alongside people who prefer to be employed.

    Currently, great care workers are in demand and those that deliver great customer experiences, will have no shortage of work.

    Being successful in any small business is about delighting your clients. On platforms like Better Caring, where clients have the ability to provide feedback about care and support workers, delivering the best experiences and outcomes for clients is even more critical.

    Independent contractors who deliver a high quality service will be greatly in demand and their hourly rates will reflect this over time, offering them the potential to earn more.

    Rather than being ‘left with the risks’, those who choose to use our platform as self-employed care workers are covered by insurances, supported with regular meet-ups and online forums, have all payment processed through the platform on their behalf and are offered information about their tax and super obligations.

    For some support workers, the greatest benefit of working independently is having the ability to choose the clients they work with – and to work with individuals who have also chosen them. In our experience, the best client outcomes emerge from such a relationship.

    New models like Better Caring are just as much about offering care and support workers a better deal as it is about providing greater choice and control to consumers.

    • Hi Peter,
      Thanks so much for your detailed comment and explanation of your site.

      Your platform sounds terrific and please feel free to leave a further comment or get in touch about writing an article about how your service differs from other similar sites, such as HireUp.
      I agree that being able to choose your worker, and have your carer happy with you also, is a great idea and levels the field.
      Also large employers are going to be bound by whatever the Fair Work Commission decides in relation to minimum work periods, penalty rates etc. If you hire your worker directly you can negotiate all these things between you.


      Dale Reardon Founder, My Disability Matters Publishing news, opinion and discussion on disability issues and the NDIS
      Phone: 03 6286 7305 | 0420 277 457 | Skype: dale.reardon Twitter: @audisability | Linkedin | Facebook


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