They are the low-paid workers who perform the most intimate, most personal tasks for our frail, elderly parents and grandparents.
They change incontinence pads, they help residents in the toilet, they dress, wheel around and feed the oldest of our old people. And they do it for a median pay rate of around $15 an hour - only $1.25 more than the adult minimum wage, in what former Equal Employment Opportunities Commissioner Dr Judy McGregor called "a form of modern-day slavery" in a report last year.
These 20,000 people, mostly women and many of them new immigrants, are the caregiver workforce in our nearly 700 rest homes and geriatric hospitals.
Views vary on whether the low pay leads to an unstable, poorly-trained workforce that in turn produces poor care.
Carers and former carers told of their love for the work in spite of its low pay, but some said they had too little time to care properly and that they often weren't paid for some of their work, such as writing daily progress notes on residents after the end of their shifts.
Sue, with five years' experience, is paid $15.20 an hour at a rest home where the starting rate is $14.23.
"It's extremely low pay for the work involved," said the 63-year-old Service & Food Workers Union delegate, who asked that her surname and workplace not be identified.
"It's not a job, it's a vocation and the employers rely on that. They know we are not going to walk away - if a resident needs something, we deal with it."
But Sue finds the work rewarding and said the care was of good quality. She would be happy to be admitted as a resident when her time came.
"They are not just residents; they are like your extended family ..."
Sue said the work was physically hard and caregivers had to perform hygiene-related tasks for residents that would turn the stomach of many.
Last year, one in four caregivers left their job in aged care homes and hospitals. The all-staff annual turnover has fluctuated between 18 and 31 per cent since 2005, surveys have found.
Auckland University researchers said in a 2005 study of residential care: "High turnover rates compromise continuity of care for the older residents and continuity of carer is closely linked with quality of care."
They reported annual turnover of 22 per cent, which they said was "not ideal", although rates in the United States were 38-43 per cent for nursing assistants.
The McGregor report considered high turnover would affect quality of care, as well as discouraging spending on staff development and training.
The report said 46 per cent of the residential care workforce had no qualifications.
But Aged Care Association chief executive Martin Taylor does not accept that turnover in the mid-20s makes the workforce unstable.
"Turnover is greatest in people who are there for a year or less [51 per cent for caregivers] but there's a significant number of people ... who, after year three, stay and that's the core group that deliver great care."
No one knows what proportion of the carer workforce has received training, but NZ Qualifications Authority data show more than 5600 national certificates related to aged residential care at level 2 (foundation) and level 3 were awarded last year.
Mr Taylor said caregivers' median pay rose by 33.5 per cent between 2005 and 2012, and last year most employers increased pay by 1.5 per cent - more than the state funding increase of 0.9 per cent.
The association has been lobbying for pay parity between its members' care and nursing staff and comparable public hospital employees since the Government gave big increases to the public workers in the mid-2000s. This is said to be the Government's problem to fix because the state is the majority funder of aged residential care.
"Clearly everyone wants to go and work for DHBs. It created a real shortage [in aged care]. It meant there was a great demand for overseas caregivers," Mr Taylor said.
But he doubted parity would reduce turnover.
The McGregor report calculates pay parity for aged residential carers - and home support caregivers - would cost around $140 million a year; "less than 1 per cent of the [Government] health budget".
The state hasn't moved on pay parity and Associate Health Minister Jo Goodhew reiterated that "we are in tight financial times", that aged residential care funding had increased by more than health funding, and that big boosts had been given to dementia care.
But while pay parity is parked, unions have had success in attacking the issue from the angle of gender pay discrimination.
If the Service & Food Workers Union wins the Kristine Bartlett equal-pay case, carers' average rates could rise by more than a quarter.
The union claims rest home caregiving rates are so low because the work is done mainly by women. The Employment Court has ruled Ms Bartlett's pay rate may be compared with jobs that are not female-dominated.
One likely comparator cited by the union is DHB health care assistants, paid $19.51 at the top of their three-year scale.
Ms Bartlett, in her mid-60s, was on $14.44 an hour after working at the same rest home for 20 years.
To read more of our investigation online click here.
The preliminary ruling goes before the Court of Appeal in February.
The McGregor report also lined up with the call by unions, Labour, the Greens and Grey Power for mandatory per-resident staffing ratios.
Ratios were re-developed in a handbook of safe aged-care but there were concerns about costs if it was enforced, so it remains voluntary. It is the contract between DHBs and rest homes that is the enforceable tool on staffing.
Its requirements include two carers being on duty at all times in rest homes with 31 to 60 subsidised residents - the typical facility has 56 beds. That equates to between 10.8 and 5.6 caregiver hours per resident per week. But the handbook recommends 14 hours per week for each resident - 12 hours from carers and two hours from registered nurses - and more in hospitals.
Mr Taylor rejects mandatory ratios, saying there's no evidence they result in better care.
Some aged care nursing and medical specialists are concerned state funding levels - which determine staffing - have fallen behind increasing levels of dependency in aged care as people live longer and enter residential care later.
Dr Michal Boyd, of Auckland University, said the model of care at aged care facilities had not kept up with demands of increasing dependency.
Grainne Moss, the head of New Zealand's biggest aged residential care provider, Bupa, said its homes were generally staffed in line with the handbook, but sometimes had extra staff on duty because the guidelines were too light.
'It's better than the dole'
Rouru Kiria liked being a rest home caregiver, despite the physical and emotional demands - and the abuse inflicted on her by residents with dementia.
Now 55, she was a caregiver for 15 years at the now renamed Meadowbank Lifestyle and Care Village.
Her job became redundant as the facility moved more towards the retirement village model in 2010, the same year her husband had a kidney transplant. They are both unemployed and live in a rented home.
Mrs Kiria, a Cook Islander, mother of four children aged 12 to 36 and grandmother of five, said she was looking for work in aged care, despite the low pay. "Whatever is given, I just take it. It's better than the dole."
Before losing her job, she was on $16.18 an hour - above average for rest home caregivers, but "not much for the kind of work we do", said Mrs Kiria, who was a senior union delegate with the Nurses Organisation.
"You're dealing with human beings, not objects.
"I was showering them, toileting them - not easy because they are quite difficult."
She worked in the dementia unit and said that like other staff, she had been hit.
"I turned my back, talking to another resident at the same time. I'm a human being, I got angry, I didn't get aggressive to them. I tried to ... call staff to help out but there's no staff because everybody is busy."
Mrs Kiria said she received adequate training, but some colleagues had difficulties she attributed to lack of training.
Are you or someone in your family thinking about moving into a rest-home? The Herald has compiled this guide for you to consider before you make your choice.
The story so far
What our investigation has found:
*Older people are more likely to end up in residential care in NZ than in any other developed country.
*Care providers say they are funded only to provide "a minimum level of care", almost always without fulltime physiotherapists or occupational therapists.
*The only new care homes opened in the past decade have been in new retirement villages where care costs are effectively subsidised by profits on property investments.
*Providers say state funding is $500 million below the level required to justify building a new stand-alone care home.
*Providers are trying to close the gap partly by charging premiums for en suite bathrooms and other services.
Tomorrow: The alternatives
Friday: How to choose the best care
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