Elderly living in rest homes are getting around six minutes of care an hour and unions are warning some residents are dying as a result.

A shocking new report, In Safe Hands, released by the New Zealand Nurses Organisation (NZNO) and E tū, has revealed patients trying to ration their own care to help overworked staff - including one case of a man dying from an infected wound.

It was reported the man saw how over-worked the staff were and didn't want to be a burden by reporting his infected wound.


Further information about the tragic death is not being made publically available as it was collected through an anonymous survey and is still being looked into.

E tū industry coordinator care and support Alastair Duncan told the Herald this was extremely concerning and action needed to be taken urgently to ensure safe aged-care staffing.

The unions are holding a summit today in Wellington calling for an updated Government review into aged-care staffing standards - and for new and better standards to be made mandatory.

"We feel strongly that Health and Disability Commission complaints are largely under-reported and we have voice evidence of that.

"This is rotten care and it needs addressing," Duncan told the Herald.

The report also revealed many staff believe they cannot offer safe, quality care to residents because there are not enough people rostered on.

Surveyed staff said they were offering "below par service" and sometimes go home in tears due to inadequate staffing levels and care standards.

Standard care is missed or delayed in almost every shift, and that aged care staff frequently face distress and exhaustion in their work, the report shows.


The research surveyed 1194 respondents across the country, including more than 600 registered nurses, nearly 60 enrolled nurses, more than 450 caregivers and nearly 20 facility and clinical managers.

Standards for level C secure environment care, such as dementia, recommend just six minutes of care per hour be given to each patient.

But 81 per cent of staff said the needs of residents had increased significantly since those standards were put in place about 14 years ago.

Additionally, the standards are voluntary - meaning rest homes can choose whether or not they meet the suggested levels of care.

Low staffing levels and the higher needs of more frail residents mean staff are having to face the ethical dilemma of deciding who gets care, the report said.

The process of choosing who to prioritise and whose care to put off is referred to as "care rationing". Eighty-three per cent of staff said care was missed or delayed most or every shift.


Staff said this meant things such as medication and pain relief could be delayed, and that there were increases in falls and pressure injuries. Illnesses were also being missed, and diagnoses were being delayed.

"A very concerning, and common observation was residents themselves trying to ration their own care to help staff," the report said.

"Residents don't report injuries to us because they think we are too busy. In one case this has meant an assisted living resident had infected wounds no one knew about, which he later died from," one respondent said.

"Residents worry they are a burden and won't ring the bell because they know we are busy, so lie in pain rather than 'making a fuss'," said another.

Staff were concerned they had to constantly rush through residents' care, meaning people often didn't get the little things that would improve their quality of life, such as "a cup of tea, the toilet when they really need it, their teeth brushed, lipstick put on, regular turns to keep bed-ridden residents comfortable or even just a hug, a laugh or conversation".

One person said sometimes, in the rush, residents were "processed like products in a factory".


Staff reported going home crying and suffering sleepless nights as they worried about all the things they didn't get done.

They said higher staffing levels would allow them to build relationships with residents and see them as more than a name on a list.

"There is nothing better than being thanked, not just for doing something like
dressing them, but dressing them how they like – tucking a shirt in as that is their preference, only doing up half the buttons on a cardi, folding the top of their socks," said one person.

"This may sound pedantic but it truly makes a huge difference to their day knowing someone actually cares about their preferences, and that they are going into the day more confidently because of a small morning ritual that has been completed."

The public would be shocked at the findings of the research, which was conducted late last year, NZNO industrial advisor aged care David Wait said.

"Right now aged care under-staffing is hurting everybody, and we're confident the public will back our call for the Government to review existing standards."


Wait said the current standards were published in 2005, and were inadequate even then.

"Things have changed dramatically since 2005. We have more people in aged care, they're entering facilities later in life with much greater care needs and they're living longer.

NZNO delegate and registered nurse Sacha Young said if there were enough staff to meet residents' needs, people in aged care would have much better physical and emotional wellbeing.

"We don't have time to do simple things like help residents take short walks, or sit with them for a few minutes when they are distressed," she said.

She said a simple solution, however, would be to review the Staffing Standards and set mandatory minimum staffing numbers.

"It's time to set staffing levels high enough to ensure our residents are always in safe hands."


Voluntary guidelines set with the Ministry of Health in 2005 specified recommended safe rates of staffing, falls, weight loss, and pressure sores, including two hours of registered nurse time and 12 hours of caregiver time for every rest home resident a week.

The Equal Employment Opportunities Commissioner, Age Concern, Grey Power all want the standards to be reviewed (because residents now have higher needs), and then made compulsory as a "basic floor".

Labour and the Green Party called for the same thing shortly before the last election, after holding a joint inquiry into aged care with Grey Power. Another pledge was the establishment of an Office of the Aged Care Commissioner, and tasking it with investigating a government-backed "star rating" system for rest homes.

None of those policies have been acted on. In January, Associate Health Minister Jenny Salesa said the ministry was working with DHBs and other regulatory bodies to bring in "quality improvement initiatives", and she continued to talk to other ministers about possible next steps.

A Herald investigation has found a third of the country's 651 aged-care facilities have had recent shortcomings related to resident care. Residents have died from festering bedsores, and in one case a family found maggots hatching in their father's sores.

Correction: This story initially said residents were getting six minutes of care a day, rather than six minutes of care per hour.