Nursing ‘crisis’ in aged care

July 1, 2021

Many of us fortunate enough to live to a ripe old age will likely end up in a rest home or aged residential care (ARC) facility and would like to enjoy a high standard of care. So why are ARC nurses fleeing?

From left to right: Natalie Seymour, Rhonda Sherriff, and Simon Wallace
From left to right: Natalie Seymour, Rhonda Sherriff, and Simon Wallace

Underpaid, overworked and unappreciated – that is the feeling of nurses and caregivers in aged residential care (ARC), says chair of NZNO’s College of Gerontology Nurses Natalie Seymour. And they are leaving “in droves”, she says.

While pay rates for their district health board (DHB) colleagues rise steadily over successive collective agreements and high-profile strike action, “our nurses are feeling devalued, underappreciated and not listened to”, Seymour said.

“We are losing nurses in droves – nurses are not staying in aged residential care.”

Add to this roiling dissatisfaction a sudden drying up of an immigrant workforce that makes up about 50 per cent (and up to 70 per cent in some cases) of staff, according to the NZ Aged Care Association (NZACA) – and you have an explosive staffing shortage on your hands.

“We are at crisis point,” says NZACA nursing leadership group member Rhonda Sherriff. “With the borders closed, as we rely so heavily on our immigrant staff, this is causing quite a crisis in our sector – it’s very urgent.”

Philippines’ cap

The Philippines has put an annual cap of 6500 on the number of nurses who can work abroad. India’s health workforce is trying to manage its own catastrophic COVID-19 outbreaks, while Fiji is shutting down its borders.

“At this stage, it’s looking very much like we’re struggling to tap into any overseas streams of RNs coming into our country,” Sherriff says – a situation she says is unlikely to change in a hurry.

At last count there were an estimated 300 to 500 registered nurse (RN) vacancies in ARC facilities around the country out of a workforce of 5000, says ACA chief executive Simon Wallace.

“The situation is not sustainable. Care homes will close,” he said, predicting small rural homes would be hardest hit.

Aged care is also competing with DHBs, which are on a recruitment drive to fill 500 RN vacancies and meet safe staffing levels agreed with NZNO in 2018 – being hammered out again in the current bargaining round.

The Ministry of Health (MoH), too, is seeking nurses for its COVID-19 vaccination rollout.

Pay gap

With DHB RNs and enrolled nurses being paid on average $10,000 more per annum – including penal rates and shift allowances – than their ARC counterparts, it’s “really difficult” to recruit and retain nurses in aged care, says Sherriff. The situation was quickly becoming “desperate”, she said.

“We can’t compete for RNs on the same level playing field.”

Large corporates were able to subsidise their rest homes from profitable retirement villages and pay better rates to nurses – but this was not possible for smaller operators, she said.

Government funding for aged care is filtered through the DHBs, which have been allocated $16.2 billion to provide services for 2021/22, according to NZACA figures.

A MoH-NZACA taskforce in 2020 estimated $85 million was needed to bring ARC nurse pay rates into line with DHBs. Negotiations were continuing, but offers so far had fallen well short, Sherriff said.

‘The tragedy is the Government doesn’t really acknowledge the worth of the sector.’

“The tragedy is the Government doesn’t really acknowledge the worth of the sector. We’re looking after 40,000 residents throughout the country, compared to 11,000 hospital beds. We are a significant sector alongside them [hospitals], and in many ways act as a moat,” Sherriff says. “When patients need 24/7 care, we are where these people get discharged to.”

Aged care provided a “fantastic” service yet was funded just $200 per patient per day, compared to $1000 per patient in hospitals, she said.

“We’re delivering a good standard of care for a fifth of the price and the sector has been dreadfully underfunded for years.”

Neither Sherriff nor Seymour can see any reasoning for the pay disparity. “It makes no sense,” says Seymour.

An ARC nurse often had more responsibility than a DHB nurse, and they were frequently in sole charge.

“They are making really significant autonomous decisions every day”, Sherriff said.

The NZACA set up its nursing leadership group two years ago to raise awareness of the staffing pressures and lobby Government.

Since then, there had been much sympathy but very little cash, Sherriff said.

“At the end of the day, if they don’t fund us, there won’t be beds available for people and that would be tragic,” said Sherriff, noting a huge projected leap in the aged population over the next 20 years.

“We’re highlighting it really clearly with the Health Minister… but it just seems to be falling on somewhat deaf ears, which I find rather tragic as our aged people deserve as good care as anyone else in this country.”