Costs for the care of vulnerable aged people have been capped at a maximum of around $250 a day. Photo / 123rf, File
Costs for the care of vulnerable aged people have been capped at a maximum of around $250 a day. Photo / 123rf, File
Opinion
OPINION
It's deeply troubling that the crisis in aged care was entirely disregarded in the Budget, despite the huge sums going into health.
The Budget outcome shows the Government isn't heeding warnings from the sector and isn't prepared to make a meaningful difference to residential aged care workers and residents.
For vulnerable New Zealanders who require residential aged care, the Government has capped their cost of care, food, activities and basic room and services at a maximum of around $250 a day.
This is supposed to be enough to provide quality nurse-led care for your loved ones. Care for those living with dementia or significant medical conditions, fragile skin and difficulty in simply being mobile. Comfort for your beloved grandparents, parents and loved ones in the last days of life, to help prevent their falls or pressure ulcers, provide a comforting hand or an understanding ear, or support them with the basic activities of daily living.
Quality of care is paramount, and providers make every effort to maintain this, but the signs of collapse in residential aged care are clear for all to see.
In 2021, providers self-reported 851 shifts where contracts were breached, and a Registered Nurse (RN) was not on site. This is an almost 330 per cent increase on 2020, and we know this is under-reported.
This is an unacceptable risk. The backup arrangements, which include having medication-competent healthcare assistants supported by a nurse on call, asking nurses or our nurse managers to work additional hours - which can mean a 12 or even 16-hour day, or sleep overnight at the facility - put even more pressure on our incredible nurses.
This further stretches an already stretched workforce. Is it any wonder that the turnover of registered nurses in residential aged care reached a deeply troubling 48 per cent in the year to December 2021? Many exit the sector altogether and have left unfilled vacancies of more than 1100 registered nurses, heaping further pressure on our wonderful healthcare assistants.
These nurses tell us they are leaving for DHBs or overseas, because DHB nurses earn significantly more, because DHBs have more staff around providing more safety, and because at DHBs the registered nurses will have time and opportunities to develop their skills. Other nurses will move overseas for more money or because immigration settings overseas provide more security for them and their families. These nurses are tired, don't feel aged care is valued and have had enough. I don't blame them.
I get frustrated for our residents and staff when I'm told talk of collapse in the aged care sector is a touch dramatic. These issues are already showing up in access to care, with some providers unable to staff admissions of residents with more complex needs, not to mention almost 800 beds closed in the last six months.
Carriann Hall. Photo / Supplied
This is at a time when we have a new health system being established, complete with its basketful of issues that, on the face of it, look to have soaked up all of the significant funding available for health.
We larger providers have resilience and options, even if they are unpalatable, but 50 per cent of the sector are smaller operators, or single facilities, and will struggle the most. Sadly, the impacts of winter place even more pressure on the public hospital system, and when we once again look to the aged care sector to release pressure on hospital beds, they likely won't find anything there.
Longer-term, without changes to policy and funding setting, there will be more areas where care cannot be provided close to home. Our loved ones will be in facilities far from their communities and networks, exactly the opposite of the "consistent access to quality care" the Government seeks with its reforms.
We need to make changes now, but it will take partnership with the wider health sector and Government to look at the system as a whole.
If the country has the nurses, and residential aged care can compete on pay, then we can focus on environments that support nurses to thrive.
We will get the numbers by making it easy for nurses to come into the country and for people to choose nursing as a profession. With the immigration reset now widely understood, I hope there is an opportunity to make Aotearoa a beacon for nurses in the face of strong international competition.
We need to reduce the cannibalisation of resources in the health sector. One simple, although admittedly expensive, action would have been a Budget that levelled the playing field on pay. A DHB-registered nurse will soon be funded about $30k a year more than an aged care registered nurse.
I fear that we will look back on this Budget and regret that we missed the opportunity to save the aged care sector from crisis.
• Carriann Hall is the CEO of the CHT Healthcare Trust.
