Elderly Kiwis are languishing in hospital or at home with family unable to properly care for them because rest homes struggling with nursing shortages have stopped admissions.
The country's first aged care commissioner - a watchdog created by the Government in February - is now warning that better pay for nurses is urgently needed, to ease a crisis that's left the aged care sector short around 1200 nurses.
Aged care nurses are generally paid about $10,000-15,000 less annually than a hospital nurse. Hospitals use that difference to poach staff from aged care homes.
Carolyn Cooper is New Zealand's inaugural Aged Care Commissioner, and has been tasked by the government with identifying systemic problems in the sector.
In an exclusive interview with the Herald she warned the loss of hundreds of rest home beds is causing "bed block" in public hospitals - when patients can't be discharged because there's nowhere for them to go.
Older people often can't return home because they need ongoing medical care and monitoring, such as that provided by rest homes.
"Leaving older people in a public hospital for longer than they need to is a risk to them," Cooper said. "And it is not what older people or their family or whānau want, either."
The pay gap has driven workforce shortages in aged and home care for years, but vacancies reached new levels after Covid closed borders and increased international competition for nurses.
Health Minister Andrew Little says he's committed to closing the nursing pay gap - something likely to cost north of $100m a year - and has asked officials to urgently work on doing so.
However, there has been little visible progress for two years, nor any confirmed timeframe. An imminent pay deal for hospital nurses will worsen the pay gap.
"It needs to happen as soon as possible," said Cooper of pay parity. "It remains urgent."
The aged care sector is currently short around 1200 registered nurses out of a workforce that should number about 5100.
In February the Weekend Herald published an investigation revealing how dire shortages had become, and the disturbing effect on staff and vulnerable residents.
Nurses are working double and even triple shifts - 24 hours straight - to plug gaps, and facilities are breaching their contract by not having a registered nurse at all times in hospital-level areas.
Simon Wallace, the chief executive of the Aged Care Association, said so far this year about 940 aged care beds had closed or weren't operational, "and more are about to close".
Another sign of stress is the number of "Section 31 notifications", which must be filed to the director general of health when an aged care facility doesn't have enough nurses to ensure the safety of residents.
There have been 2000 and counting so far this calendar year, Wallace said - up from 851 incidents last year and about 200 in 2020.
Cooper told the Herald she didn't have any indication residents were getting substandard care because of the workforce issues, and responsible facility operators were simply closing down beds rather than risk harm.
However, Wallace - whose lobby group represents most aged care facility owners - said in his view, "optimal care may not be delivered in some circumstances".
Some facilities used workarounds, like having a senior caregiver to cover a nursing shift, he said, with the ability to virtually call an offsite nurse for advice.
Cooper expected the end of the vaccine mandates would provide a significant boost in returning staff for some in the health sector, including home care. However, Wallace said 95-98 per cent of aged care staff chose to get vaccinated and keep working.
"There will be a few that come back, but for us it wasn't as big a deal as it was in other sectors."
Both Wallace and Cooper said other steps were needed as well as pay parity, including a more responsive immigration system and a strategy to train and attract nurses in NZ.
In February Little told the Weekend Herald he had already instructed officials to urgently work on pay parity for aged care and other nurses.
One complication, Little said, is that aged care is made up of large companies as well as "charitable and small family-owned facilities who are in genuine need of additional support", and extra funding shouldn't "line the pockets of the large corporates who just use it to pay an extra dividend to their shareholders".
Wallace said the larger corporates who used earnings from retirement villages to subsidise aged care-level beds (often located on the same site) were the only ones building the latter - and on current projections there would be a large shortfall of such beds in the future to care for the aging population.
"The last thing we want to do is take away any incentive for [building new beds]."
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