Covid-19 has underlined aged residential care's increasingly central role in our health system, looking after the wellbeing of tens of thousands of our older, most vulnerable citizens.
The pandemic has also laid bare the negative consequences of continuing to underfund aged residential care, an issue that is global. In 2020, the first wave of Covid-19 ravaged unprepared and under-resourced rest homes in Europe and the United States with staggering fatalities among residents.
In New Zealand, thanks to a swift and decisive response led by the New Zealand Aged Care Association ahead of any nationally co-ordinated response, fewer than 1 per cent of rest homes were affected by the virus.
Lessons were learnt and continue to be learnt, by the sector, by the district health boards and by the Ministry of Health.
Now as a virulent new strain storms the world and we await a vaccination roll-out, critical decisions need to be made to ensure we can continue to protect the health and wellbeing of older people.
We urgently need rest home residents and the workers who care for them given top priority access to the vaccine, along with an assurance that whatever vaccine is administered is safe and effective.
Also, a priority is pay parity for registered nurses working in aged residential care with their counterparts in public hospitals. The gap of at least $10,000 a year makes recruitment and retention an ongoing challenge, one that's exacerbated by the significant drop in the number of Internationally qualified nurses entering New Zealand due to Covid-19.
Residents' care needs have increased dramatically over time, especially at hospital and dementia level. By 2030, with a threefold increase in people aged over 85 entering care, that's going to continue.
The cost to government of bringing aged-care nurses to pay parity with DHB nurses would be around $84 million annually - a fraction of the value delivered to the health system. Our 600-plus rest homes in New Zealand provide hospital-level care and save our public hospitals $5.5 billion annually.
Independent analysis and research also continually highlight how underfunding is preventing investment in new and existing care facilities. Indeed, during Covid-19 some rest homes, because of their varying ages and stages, were not able to physically separate or "zone" parts of their facilities.
Ultimately, the full cost of capital for rest homes has never been met and incentives are lacking to encourage investment in strategically important but otherwise uneconomic locations or situations.
Yet, with a rapidly ageing population and the number of people entering care projected to grow by up to 16,000 by 2030, there is no current policy or funding mechanism to increase the supply of new care beds to meet increasing demand and complexity of care needs.
It is families, staff and, of course, older people who are likely to bear the brunt of this.
To compound matters, the sector is also a primary provider of palliative and end-of-life care for its own residents as well as receiving patients from Hospice. Yet they are not funded to meet the needs of a dying resident and deliver the support for family and whānau that is provided in hospices.
All up, the sector is underfunded by approximately $425m per year, according to estimates, preventing investment in new and existing homes, limiting the sector's ability to attract and retain a quality workforce and discouraging innovative practices or new models of care.
Yet the opportunity is huge. Long-term care in rest homes is proven to deliver better health outcomes and is highly cost-effective for the Government because it is provided at a significantly lower cost overall than DHB hospital care.
There are also opportunities for rest home providers to work with the DHBs and the Ministry of Health to deliver improved quality of care and to increase efficiency by providing additional or enhanced services such as short-term, post-operative care and rehabilitation.
The funding model review of the sector carried out in 2019 is now progressing again after Covid-19 delays. But the final model must create a framework and funding approach that addresses these issues and secures a future of equitable access for Kiwis to care, within their communities and with a choice of facility type.
The Government must be lauded for putting a value on the lives of older New Zealanders with its Covid-19 response. But old habits die hard and ageism can too easily become pervasive.
It serves none of us well if we ignore the health and wellbeing of precious older Kiwis and the many thousands of dedicated Kiwis who care for them.
• Simon Wallace is the chief executive of the New Zealand Aged Care Association, which represents the interests of more than 90 per cent of the country's 665 rest homes and 40,000 residents.