A nurse who headed a huge rest home and retirement village business has been appointed as New Zealand's inaugural Aged Care Commissioner, and tasked by the Government with "leading much-needed systematic change in the sector".
Carolyn Cooper has resigned as the managing director of Bupa Villages & Aged Care NZ, which has about $1.6 billion of assets in Aotearoa, to take up the new watchdog role for a five-year term, starting next month.
She has also been on the board of the Aged Care Association, which represents most rest home owners and operators and in the past criticised the Labour Government's decision to establish an Aged Care Commissioner as "another layer of bureaucracy doubling up on already rigorous audit and reporting".
She told the Herald the association's concerns lessened as it became clear how the role would work with other regulators. However, her industry ties wouldn't mean she lacked bite as a new watchdog, she said.
"I have a very broad health experience background. I understand the way DHBs work, I understand how other parts of the sector work. And I am there for older people, that is my main thing - to make sure of their rights, protection and access to healthcare.
"I have lived experience in the area - my mum is in aged care - so I understand what it's like to be a family member. There's lots to me other than my experience with Bupa."
Seniors and Associate Minister of Health Dr Ayesha Verrall said Cooper had a more than 40-year career in all parts of the health service, mostly in the public hospital system and including governance, executive and clinical leadership roles.
Her appointment was made by the Ministry of Health with input from the Health & Disability Commissioner, Verrall said, "a position wholly centred on patient rights".
"The majority of the sector is private, so anyone with any sector experience would have worked in the private sector at some point ... she is someone who has a very practical knowledge of how you fix healthcare quality problems."
The position would be part of the Health & Disability Commission, and investigate complaints about aged care, home care, needs assessment and palliative care.
Verrall said there would be mechanisms to deal with potential conflicts of interest. She also wants Cooper to investigate systemic issues in aged care and advocate for improvements.
Neither Verrall or Cooper would say what they thought those issues were, with Cooper planning on first consulting with older people (last October when still at Bupa she said the sector's biggest challenges were a lack of government funding and a labour shortage, which are linked: "We would pay our staff more if we had more funding").
Verrall said the vast majority of people in aged care experience high-quality care, but multiple reports had raised problems including a complex complaints process, people fearing repercussions if they raise issues, and examples of poor care.
"[Substandard care] is deeply troubling to me. And I saw some instances of that when I was a doctor caring for older people at Wellington Hospital."
Before the 2017 election, Labour promised a new aged care watchdog would be provided in its first Budget, but money ($8m over four years) wasn't pledged until Budget 2021.
Groups including unions representing nurses and caregivers and Grey Power have for years called for such a position, saying current oversight of a sector looking after 36,000 of the most vulnerable New Zealanders is ineffective and split between different groups.
Australia recently set up an independent Aged Care Quality and Safety Commission, following findings of widespread poor rest home care.
The NZ Aged Care Association has said it hopes the new commissioner will be a voice for a sector that has a severe nursing shortage made worse since Covid-19 closed borders and increased competition for nurses domestically, with much higher pay offered at DHBs because of what the association says is significant government underfunding.
Other groups including the NZ Nurses Organisation, which represents both nurses and caregivers in aged care, have warned the existing workforce is stretched to the point of burnout and exhaustion, and the Government needs to urgently act on steps including bringing in mandatory ratios for staff-to-residents (presently there are only guidelines).
The surge in Omicron cases will add to the current pressures in aged care. Rest homes accounted for most Covid-19 deaths during earlier outbreaks, and Waitematā DHB chair Judy McGregor called for an aged care commissioner soon after West Auckland rest home patients died following their transfer to hospital, saying Covid had "critically exposed the frailties of our regulatory and oversight systems surrounding aged care".