Samantha Heath: Aged care in critical need

New Zealand faces a surge in elderly needing specialist care while half of the registered nursing workforce will reach retirement age in the next 15 years. Photo / 123rf

OPINION

The announcement that Mercy Parklands will close in a few months because of staffing issues is an absolute tragedy for the affected residents and their families. It is doubly tragic because this closure, and the many before it, could have been avoided.

Nursing workforce shortages have been consistently signaled in New Zealand, where half of the registered nursing workforce will reach retirement age in the next 15 years, and globally too, where trends are similar.

We have also known for several decades that our population is ageing rapidly; about a quarter of the New Zealand population will be over 65 years by 2035; by 2052, half of us will be over 50. Yet, we have consistently failed to plan effectively and have largely contributed to our own crisis — a situation further complicated by disparities in remuneration across the health service.

Simon Wallace from the Aged Care Association has proposed some quick fixes. Of them, pay parity is an absolute requirement. It is unacceptable to pay nurses less for work equally as important as other types of healthcare. It devalues the critical work undertaken by nurses in the sector.

Working in care facilities with older people takes lengthy preparation and development of an extensive skillset, utterly deserving of equity in remuneration.

Wallace has also called on the Government to change immigration settings for nurses. Whether adjustments would fix current staffing issues in rest home or hospital-level care facilities is contentious. The sector competes domestically and internationally as our hospital services are also understaffed.

Of the overseas nurses who choose New Zealand, many may not want to accept the significant pay differential to take up employment in rest home care facilities.

Undoubtedly, the quick fixes proposed by Wallace would be welcomed but could also serve as a façade for the more profound issues we need to consider. New Zealand has an ageism issue and the problems it creates cost the country millions of dollars each year.

Dr Samantha Heath. Photo / Supplied

Internationally, ageism influences the outcomes of health and social care. Where treatment decisions are shown to be made on age rather than the clinically-assessed picture, it can be life-limiting or deny access to appropriate services.

Where other discriminations prevail, systemic and individual ageism furthers intersectionality. Ageism now needs to be considered as another social determinant of health. As the biggest risk factor for a range of conditions like cardiovascular disease, dementia and cancer, age must be a significant consideration for New Zealand’s future economic and social landscape.

With the amplification of age-related diseases, and consideration of those living with chronic illnesses, disabilities, and mental health issues into their later years, supporting people to enter later life as healthy as possible will be of primary concern. Looking after older people will not simply be the burden of Wallace and his colleagues or just a problem for facilities like Mercy Parklands, it is a collective responsibility and a challenge we must all rise to.

As the number of New Zealanders aged over 65 grows by 36 per cent over the next 10 years, reducing ageism could prove cost-effective. It should start with our future healthcare workforce, who, as a reflection of broader society, echo its ageist attitudes.

Our recently completed national study at the Centre for Research in Education for Healthcare Professionals has helped to identify ways in which nursing can respond through educating the future nursing workforce.

Clinical placements that reflect older people across the spectrum of health need rather than just the most vulnerable must be made available. An inclusive consideration of older adults as service users which recognises culture and diversity will be a perspective necessary for the coming years.

Our research showed too, that our students see the issues clearly. They understand first-hand through their placements, the impact of short staffing and poor resourcing on society’s most vulnerable.

They also see the complexity of the care required, the depth of skill possessed by staff and the importance of healthy ageing. However, working with older people is no longer a choice. It is an essential component in every health and social care discipline.

Our challenge is in responding quickly enough for a workforce whose preparation takes several years.

The advent of a unified curriculum for undergraduate nursing across New Zealand through the new Te Pūkenga New Zealand Institute of Skills and Technology, provides a unique opportunity to begin to address the enormity of change needed.

Graduating 75 per cent of New Zealand’s Bachelor of Nursing students each year, Te Pūkenga is positioned to respond to society’s need for a well-prepared workforce. Nurses are ideally placed in frontline service to respond to the challenges.

As one anonymous student respondent summarised perfectly, “Rather than try to convince nurses to work in aged care we should try to convince society to care about old people. There’s no way pay increases, resourcing, research, or anything else will improve for the elderly if people continue to disregard them.”

We must take heed.

Dr Samantha Heath is a senior lecturer and research leader at Unitec’s School of Healthcare and Social Practice.