CHT Healthcare Trust is one of the largest residential aged care providers in New Zealand, and we caught up with Carriann Hall the Chief Executive to discuss current issues in the Aged Residential Care (ARC) industry. But first and foremost, Hall wanted to make sure readers understand the difference between ARC and the retirement village sector because when these two get confused it dilutes the stark reality of many issues the ARC faces.
“ARC is about providing nurse-led care for individuals living with dementia or significant medical conditions, fragile skin and difficulty in simply being mobile. Those needing comfort in the last days of life, actions to prevent falls or pressure ulcers, a comforting hand or an understanding ear, or support with the basic activities of daily living.”
The current ARC funding model does not recognise the complexity of residential care and is applied inconsistently across the country. It also does not allow capital investment, and service fees are currently capped by the government, meaning providers struggle to compete with other areas in the health sector for resources due to funding levels. In August 2019 a review of the funding model was undertaken by Ernst & Young and its findings are still relevant and unresolved nearly three years down the track.
Staffing issues, inconsistent access to care and affordability are all problems the sector struggled with pre-Covid, and have only been enhanced over the last few years.
“ARC staff came to work, risking infection to ensure ensuring residents continued to be cared for. They came to work knowing Covid-19 was in the unit and had to rely on the infection prevention and control procedures to feel safe.”
It has also been difficult to bring in international staff and impossible for current staff to visit family overseas. Staff have had to work additional hours to cover vacancies and keep resident bubbles in place, as well as the mandatory COVID vaccinations.
All of these things have contributed to a large mental burden ARC staff have had to shoulder, while Hall is “Immensely proud of how many of them have risen to the challenge” current staff turnover rates are deeply troubling. 48 percent of ARC nurses left their jobs during the year ending December 2021, many of whom left the ARC sector, the country or the profession altogether. This turnover figure could get even higher with the borders opening and pay competition becoming fierce.
The government is promising consistent and quality care to the people of New Zealand, but while the staff shortage continues and the baby boomer generation ages this is not achievable with current funding settings. It is estimated the nation will need 15,000 more beds before 2030, but the costs of building new care facilities compared to the value they have once doors open is not sustainable.
Ultimately if beds cannot be staffed or are not available in the first place vulnerable people will be forced into challenging living situations. Either spending longer periods of time in hospital, being at home without appropriate levels of care or receiving care away from their primary community these outcomes have proven negative health and wellbeing impacts and add further strain to the hospital system.
Whilst the government missed its opportunity to advertise New Zealand as a safe haven during the pandemic and positively encourage migrant nurses and healthcare workers into the country, recent changes to the immigration system are a good place to start.
“If we have the numbers needed to take the workload and competitive pressures off of staff, alongside level pay across the health sector then we can focus on providing environments that support registered nurses to thrive in ARC.”
The current cost of living is something that heavily factors into both migrant and kiwi talent retention. The nationally agreed Care and Support Workers Pay Equity settlement rates for Levels one and two are below the living wage. These rates are paid directly by the government, and ARC actively supports staff in advancing up levels to reach higher pay brackets.
“We need a discussion as a country on what it will take to change the narrative and support nurses. Our staff tell us how rewarding this job can be when they are not overworked. We have to be creative in how we support individuals to develop their skills and career and ultimately show how much we value the role the ARC plays.”
Fifty percent of the ARC sector are small providers or operators of single facilities that do not have the resilience of larger providers like CHT. In the last six months alone, the industry has lost almost 800 beds and with the usual winter pressures on the way the hospital system will be looking to ARC to release pressure and it will not be available. Capacity is only set to worsen as longer-term as facilities reach or exceed a useful lifespan with no refurbishment investment.
CHT Healthcare Trust provides quality accessible care for people aged over 60, they have over 1,000 beds and 750 staff across 16 facilities in Auckland, Bay of Plenty and the Waikato regions.
“We have had to decline admission of potential residents whose care needs are too complex for the available staffing.”
“We have had to close beds at two facilities in order to ensure high quality of care can continue. Not all of our facilities have staffing issues but managing staff turnover, filing roster gaps and providing a safe environment is a huge draw on resources.”
“Following the DHB pay settlement for registered nurses last year, CHT took self-funded action to ensure competitive base pay rates for our staff and demonstrate their value to us. However, if the newly proposed pay equity settlement for DHB nurses is agreed upon, they will receive around $30,000 a year more than ARC registered nurses and the government is giving no indication of funding to help ARC compete.”
“For CHT this means cutting our cloth accordingly, after 60 years in the industry we are having to be extra thoughtful in our plans to stay sustainable. The situation for smaller operators will be quite dire.”
Any funding model needs to be sensitive to the market realities. Rural land might be cheaper, but building costs can be higher and local populations may not be able to provide the necessary workforce, but the problems are reversed in major cities. The demographic of a community's population needs to be a major factor in providing quality ARC services.
“I don’t think anyone would disagree with Health New Zealand and Hauora Aoetaora’s aspirations to give people access to consistent quality care to help them live healthier lives. But the government needs to be clear about what it will take to achieve these outcomes and provide the funding to support them.”
