I first began working with older adults in a nursing home in Worcestershire, UK, before I even began my nurse training at Guy’s Hospital in London.
I was a health-care assistant (HCA) and loved working there — it stood me in really good stead, learning how to talk to all kinds of people. I’d cared for people who were dying and had all sorts of conversations before I even began my training.
After I graduated, I carried on working with older people, including at a rural community hospital on the Welsh border which ran a rapid response / intermediate care service to try and prevent hospital admissions for older adults.
A few years down the track, my husband and I decided to emigrate to New Zealand with our children in search of better lifestyle opportunities.
Landing in Waikato, I got a job as clinical nurse specialist at the hospital’s older persons rehabilitation service.
I later worked as a community support coordinator, then qualified as a nurse practitioner (NP) before returning to residential aged care. Nowadays, I still work for an aged-care provider in Waikato, providing primary health care to residents.
Gerontology is caring for older adults, who are everywhere — primary health, communities and hospitals, as well as rest homes. And wherever they are, we are.
So I’ve pretty much been working with older adults my entire career — more than 40 years! And I love it. Pay gap aside, I don’t know why more nurses don’t want to work in aged care — it’s a very varied and satisfying role.
And gerontology is caring for older adults, who are everywhere — primary health, communities and hospitals, as well as rest homes. And wherever they are, we are.
At our “silver tsunami — surfing the waves of ageing” conference in May we had attendees across all those areas coming to hear speakers like Australia’s professor of healthy ageing Victoria Traynor.
Like whānau
In older persons’ care, it’s different every single day.
In a GP practice, for example, you tend to get everyone coming in with coughs and colds at the same time. Or everyone’s slipping on ice and needing X-rays.
This week, I had a resident who couldn’t sleep because of a sore shoulder who needed a physio referral. And another who was really confused and needed hospitalisation for low sodium. She’s back now, and I’ve written her a wee note to remind her that she needs to pee and have plenty of salt!
You can also build deeper relationships with people than in a hospital, where they come and go.
Sometimes it’s hard to remain detached — I don’t think you really can. It’s about humanity, being human.
One of my residents is not doing very well so I’m just popping in to check on her regularly. It’s like a hospice relationship. It’s lovely — you get close to people. It’s professional, but you also share things with them, like a family member. So they’re often like whānau.
Residents have said I’m like a daughter to them. So it can be very satisfying — but also sad as you know they’re not going to be around forever — none of us are!
Sometimes it’s hard to remain detached — I don’t think you really can. It’s about humanity, being human. Someone’s distressed, so you hold their hand, that sort of thing.
Improving older adult care in Aotearoa
At the college, we’re really focused on trying to improve the care and experiences of older adults in Aotearoa so people can have the best quality of life possible until the end — and then the best quality death. It’s one of those things we only get one go at.
Last year, we submitted on the Ministry of Health’s review of the 2019 End of Life Choice Act, to say nurse practitioners (NPs) should be allowed to provide care from the start of someone’s assisted dying journey, not just at the end. That would mean patients could continue to be cared for by their primary health NP, if the NP is willing.
As a result, allowing NPs to provide better continuity of care to assisted dying patients, through NPs, was one of the ministry’s recommendations (20) in its review.
We also gave an oral submission to Parliament’s health select committee looking into aged care, on how to better care for the growing numbers of younger patients with degenerative neurological disorders like Parkinson’s Disease, as well as brain and spinal injuries.
Then in April this year, we met the Ministry of Health’s ageing well team to discuss planning needs for older people over the next 10-plus years.
We’re so used to being understaffed that we feel like frogs in a pot of water that’s gradually being heated up.
We’ve updated our gerontology nursing knowledge and skills framework and are keen to get more older person services — like district nursing, general practice, hospices and hospitals — to join up and share resources with residential aged care, especially at weekends.
But we’ve love to hear what our members’ priorities are — how can we help them and be their voice? Let us know at: [email protected].
There are nearly 600 of us in the college but we’re all working in our own little areas around the country and so it’s good to connect and share our expertise and experiences.
Not enough staff. Full stop.
A huge problem in aged care is not enough staff. Full stop. We’re so used to being understaffed that we feel like frogs in a pot of water that’s gradually being heated up.
When COVID came along, we suddenly had to be everything to our residents because family couldn’t visit. We had staff who would work, eat and sleep there, to keep residents safe.
At the college, we’re really focused on trying to improve the care and experiences of older adults in Aotearoa so people can have the best quality of life possible until the end.
After that, we lost a lot of staff — and it just hasn’t bounced back.
Being paid more would definitely help. Currently, aged care nurses and HCAs get paid about 20 per cent less than our friends at Te Whatu Ora.
So I’m involved with NZNO’s Age Safe campaign, which is advocating for more funding from Te Whatu Ora to allow care that meets residents’ needs — both clinically and culturally.
We want:
- Mandatory minimum staffing levels that allow us to give safe and quality care.
- Funding transparency and reform, so we can make sure money intended for staffing is passed on by the employer and nurses and kaiāwhina are paid fairly.
- Culturally safe care for kaumātua.
Unionising aged care!
We also have a lot of internationally-qualified staff in aged care — about 80 per cent — which can make it hard to grow union membership. Many come from countries where unions are not strong or don’t even exist and are on working visas tied to their employers which can make them a bit nervous about challenging them.
Also, some of the larger private aged care chains offer indemnity insurance. But what staff don’t realise is, that wouldn’t cover them if they had failed to follow the employer’s policies, so it’s really important they join a union, for their own protection and also to grow the collective voice and power of aged care workers.
Whether it’s NZNO or another union, I don’t mind — just join a union!
- Waikato nurse practitioner Bridget Richards is chair of the NZNO college of gerontology nursing.