Monday, June 24, 2024

Legislation needed for safe staffing in aged care

By Alastair Duncan

The recent publication of a full-page newspaper advertisement signed by a number of retirement village committees’ extolling the virtues of “licence to occupy” living may, or may not, have been a genuine expression of satisfaction with their living arrangements in their corporate controlled villages. It was not clear who had paid for the advertisement and it generated some considerable debate in a range of news outlets.

Village residents may have a voice. But what about those in care?

Some 40,000 people live in rest-home or hospital care. Between them the private and publicly listed corporates control one in every three aged care facilities.1

Getting admission to quality care is no easy feat; assuming there is quality care available. Last year I contacted six Wellington providers and only one returned my phone call. Assuming you do find the care you or your loved one needs, then cost can be a real issue.

Basic services are more expensive

The state does rightly subsidise care, but with asset testing and providers today adding premium charges for what were once basic services, residential care is not cheap.

I asked one of the corporates to quantify how they calculated the ‘extra’ charges for a family members’ room. Size, amenities, and even the quality of the view out the window were all in the mix.

Yes, care facilities should look nice, but behind the themed carpet and corporate logos, the job of delivering care remains one of the hardest and most undervalued occupations in this country. As the sector moved from hospital board and church care to today’s privatised model, the few regulations that once governed staffing levels disappeared.

Providers used to have to comply with safe staffing regulations, last updated in 1987. However, these were developed when acuity levels among residents were much lower and the biggest challenge for visitors was finding a place to park among the residents parking.

In 2004, the regulations were replaced with service contract general obligations with little or no actual defined staff:resident levels.

While providers may claim to be ‘meeting’ their obligations these are at best opaque. Add in chronic staff shortages and turnover and the result is too few staff and too little care.

Regulation is at the core of how we keep each other safe. For the greater good, we regulate food safety, road safety, building standards and, of course, law and order. So why not aged care?

A decade ago, the Human Rights Commission called for compulsory staffing levels in aged care. Grey Power supported that call. As recently as Christmas 2021 a national petition called for mandated safe staffing in aged care. But it hasn’t happened.

Within the sector there are two intrinsically opposed views. The owners’ lobby group, the Aged Care Association has actively opposed regulated staffing levels, asserting that self-regulation works best.

By contrast the care unions (NZNO and E tū along with Grey Power, have repeatedly called for minimum staffing guarantees, arguing that care is complex work that requires skilled and sufficient staff.

Hard-working and committed staff

The carers I meet are incredibly hard-working and committed, a mix of new migrants and old hands. Kristine Bartlett, who fronted the court case2 that lead to the $2 billion settlement of her class action pay claim, told me “what the girls really want is safe staffing”.

Now another equal pay claim is upon the sector. It is likely the workers will win and the government will pay out – on behalf of the employers. But without enforceable staffing standards, some of those employers will then try to cut costs by reducing staffing levels again.

Will the next government act on staffing levels? Ten months after the most recent safe staffing petition was presented to a Parliament, the select committee considering the request, declined to recommend legislation and the chair declined to comment for this article.

Every day, hard-working carers juggle the needs of multiple residents; skipping breaks and going home exhausted. Too few workers mean care missed. That’s not fair on staff and not fair on residents.

Commercial law may or may not protect the interests of licence to occupy village residents. But that ignores those in the rest home and hospital wing. Without a “care” option, living in a retirement village could be just another suburban sprawl. It’s the peace of mind that onsite care delivers, that clinches many a sale.

Protecting 40,000 kiwis in care could yet be a vote winner this October. If the politicians are listening.

– Alastair Duncan is a committee member of Grey Power Wellington Central and worked for aged care unions in NZ and overseas.

¹ NZ Aged Care Association 2020
² Bartlett v Terra Nova 2014

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