A Hawke's Bay support worker says a restructure of Healthcare NZ has made her "scared" for the safety of the people she looks after.
Healthcare NZ axed more than 100 regional admin and coordinator jobs in February, including 20 in Hawke's Bay, and replaced them with call centres in Auckland and Dunedin.
The support worker, a woman in her 60s who has been caregiving for 10 years, says the care clients are getting has gone from "bad to worse" since then.
Healthcare NZ has admitted the centralisation of the service has had "teething problems" and has vowed to investigate problematic individual cases being raised by its staff.
It says many of the fears support workers have raised with it are being addressed.
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The Hastings-based support worker says some who need care have been waiting for an hour or more when they attempt to call the new service centre.
"Our clients have been rung up and told they won't be getting care, or sometimes they don't get rung up at all.
"One client of mine, who is in her 80s is bed-ridden and incontinent, wasn't washed, wasn't fed, which can cause infection, all because they had not been advised about the carer not turning up.
"Another client of mine who is 92 and in palliative care has no control of her bowels.
"She had to wait two and a half hours, last week, on the phone trying to get help and not receiving it. By then she had soiled herself.
"Our clients are not being treated with respect and dignity. Their needs are not being supported.
"I am scared for our clients' safety because of neglect for care. HealthCare NZ is not providing the service it is funded for."
She said support workers, including herself, had also been sent into dangerous situations by the national service centre.
"I had to go over to a client in Flaxmere at night and there were drug fights outside and I was verbally abused by my client, but I had to check on my client to make sure they were okay," she said.
"We have to report these incidents but previously the local coordinator would handle it professionally but I asked the service centre staff what to do and they couldn't tell me.
"We are at the coalface and we want HealthCare NZ to talk to us,
"Our jobs are hard enough and this has taken a huge toll on me."
HealthCare NZ chief executive Vanessa Dudley said they took all issues and concerns regarding the care and support they delivered "very seriously".
"This is especially important as we make changes and progressively centralise our administration and service co-ordination functions into our service centres in Auckland and Dunedin," Dudley said.
"Our service centre model is new and there have been some initial teething problems. We sincerely apologise for any resulting shortfalls in our service delivery.
"We met with the PSA on Tuesday to directly address their concerns and have committed to investigate any information provided on incidents involving individual clients."
Dudley said it was important that staff, especially those in frontline roles, and clients had the opportunity to raise any concerns they had, so these could be addressed.
"Staff can raise any professional or even personal concerns or issues in confidence at any time, including talking to their team leader, manager, or emailing myself as chief executive."
HealthCare NZ had also put plans in place to manage the more than 200 per cent increase in call volumes that it has, and provide additional training and guidance to the service team.
"There is still room for further improvements in our service, however call wait times and service responsiveness has already improved."
Support workers' union PSA spokesman Chris Ollington said it took years to develop the skills and local knowledge of clients, whanau and workers which HealthCare NZ's admin and coordination staff used to provide.
"The buck stops with the leadership of parent company NZ Health Group, and with the DHBs, ACC and the Ministry of Health who fund these services.
"Action is urgently needed before something terrible happens."
The PSA has written to the Ministry of Health requesting it intervene.
Hawke's Bay DHB's acting executive director of planning and funding Emma Foster said the DHB regularly met with home support providers it contracted to deliver services within homes across the region.
"Centralised service centres are common among some providers," Foster said.
"The DHB was made aware of some unexpected teething issues while HealthCare New Zealand transitioned to its new centralised system. However, it understands these are being actively resolved."
An ACC spokesperson said HealthCare NZ had requested last week, and it agreed, to temporarily refer new ACC clients to other providers while HealthCare NZ undertakes further staff training.
Ministry of Health director general of health and disability Adri Isbister said it was aware of concerns and was monitoring the situation.