Shane Reti: Aged residential care sector under pressure

The aged residential care sector is under pressure and needs an urgent fix, writes Shane Reti.

OPINION:

The health system and our hard-working health workforce are exhausted and under strain and I want to acknowledge their enduring commitment to keeping us and our loved ones safe.

In many areas the common stressor is an insufficient health workforce including senior medical officers, ICU nurses, midwives and GPs.

As the health system stretches and strains, it is a challenge to anticipate where the system will break next and to implement a remedial plan.

I am becoming increasingly concerned that the next area to break will be the aged residential care sector.

At an overview level the long-term importance and magnitude of the approaching quantum of care required for older people was evident in the 2021 Treasury document He Tirohanga Mokopuna.

This described a long-term fiscal position over a 40-year horizon. The care of older people especially was highlighted in the statement: "The most significant spending pressures come from a combination of healthcare and NZ Superannuation, which we project will increase by 6.4 per cent of GDP from 2021 to 2061."

The care of older people is an approaching reality and a privilege. Living arrangements range from independent living, to shared family living, to aged residential care facilities and many variations in between. My concern today is for the health workforce in aged residential care facilities, especially registered nurses.

When fully staffed, there are 5000 registered nurses working in the aged residential care sector - nearly 50 per cent of these on a visa.

At the moment there is a shortage of roughly 1000 registered aged residential care nurses. This is due to a perfect storm involving restrictive immigration settings, Covid and vaccine mandate impacts, work conditions, increasing acuity, sector funding and pay parity. Recently announced immigration settings will bind migrants to one employer for
two years and may provide some relief but unexplainably, nurses are not part of the fast track to residency.

The current salary difference between aged residential care and DHB nurses is estimated at around $10,000 to $15,000 less for residential workers. When pay equity for DHB nurses eventually lands it is estimated that there could be a staggering salary difference with DHB nurses earning $22,000 to $30,000 more than their counterparts in aged residential care (and primary and community care).

This would have a significant impact on nurses migrating from aged residential care to DHBs from a base that is already 1000 short.

One response from facility owners could be to reduce bed supply, which in turn could place vulnerable residents back in the community. High Labour and resource-intensive beds such as dementia beds could be particularly affected.

There are several actions we can undertake now. The most obvious is to increase the health workforce as a mix of welcoming immigration settings, quickly onboarding already resident nurses awaiting CAP competency, and to turn on the domestic supply of home-grown culturally competent New Zealand nurses. Sector funding and Covid remuneration also needs to be explored as does sector-wide pay equity implications.

To reflect our urgency and concern, the National Party will be placing two Supplementary Order Papers (SOPs) on the table for inclusion in the Pae Ora (Healthy Futures) Bill.

These will require the Government to formulate a Health Strategy for Older People and a Health Workforce Development Strategy, both of which will bring attention and resources to an important sector that is slowly breaking before our eyes.