At least one New Zealand rest home has had to close its hospital wing because of a shortage of registered nurses, and New Zealand Aged Care Association chief executive Simon Wallace has warned that if the government doesn't act there will be more.
Switzer Residential Care general manager Jackie Simkins said last week the Kaitaia home could well be one of them.
The Claud Switzer Memorial Trust has long been appealing for a change to immigration rules to allow the continued employment of a Filipino healthcare assistant, but of greater immediate concern was the ability to fill the home's 20 registered nurse positions, five of which would become vacant over the next three months.
The problem had been exacerbated by the government's funding of substantial salary increases for DHB nurses, which Mr Wallace said had turned what a few months ago had been a trickle of staff losses into a torrent.
Mrs Simkins said Switzer had faced closure in 2010 due to a critical shortage of registered nurses, which had been resolved via a memorandum of understanding with NorthTec, which focused on luring RNs who had left the profession back to work, and the employment of immigrants.
The situation wasn't much better at Kerikeri Retirement Village, where jobs had been offered to three RNs over the last couple of weeks alone, and all three had gone to a DHB.
"We're permanently running short on RNs, which means people are working more than they should to fill the gaps, and that's not sustainable," chief executive Hilary Sumpter said.
The Switzer Trust had received a 2 per cent funding increase to lift its nurse salaries, and had added what it could to that to boost from its own resources, but its ability to pay more than the extra 2 per cent was every limited.
"We're doing what we can," Mrs Simkins said. "We have very, very little surplus to play with though, and the disparity between DHB and in many cases aged care is now substantial."
Finance Minister Grant Robertson had told her immigration rules were to be reviewed, but nothing would happen "overnight."
"It has to happen overnight," she said. "If we can't get the registered nurses we need we might well have to close our hospital wing. That's 51 beds. Where are these people going to go? Kaitaia Hospital won't be able to care for them.
"And how are we supposed to meet Ministry of Health standards of care when we haven't got the staff to do that? Inevitably, care will deteriorate if we can't get the skills we need. And it's a vicious circle — when someone leaves that adds to the pressure on those who remain, and makes leaving a more attractive option for them.
"We are losing skills and knowledge that are very difficult to replace. I don't understand why the government can't see this."
Switzer's position was not unique, however. Mr Wallace said two months ago registered nurse vacancies reached a record 10 per cent — 500 out of almost 5000 positions — but that had now accelerated.
"Every day members are ringing and emailing me saying they've lost another nurse to a DHB because of the pay gap, and the vast majority are not able to pay their nurses more than they are funded for," he said.
"We are in discussions with the DHBs and Ministry of Health to find a solution, but this is a lengthy process, and the crisis is here, now.
"We need government action. They have responded to the teacher shortages by committing to recruit up to 900 teachers from overseas.
"Why aren't we seeing the government respond in the same way and bringing in hundreds of registered nurses from overseas to ease the desperate shortages in our aged residential care facilities?"
The current shortage meant some RNs were working double shifts, recently retired nurses were being "pulled back to work" and clinical managers were taking on nursing shifts at night.
The annual turnover of nurses had risen from 26 per cent in February last year to almost 38 per cent in August this year, and had likely worsened since then.
"And there is no relief," he said.
"Ultimately it is our older people in aged residential care who will be impacted. The potential closure of specialist units, as well as whole facilities, will put pressure on the DHBs. Where else will these residents go?
"We need intervention now," he added. "This is a government that stands on empathy and compassion. When is it going to show some for our vulnerable older people and the providers who care for them?"