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Collective action needed says Aged Care Commissioner

Elderly patient and caregiver spending time together

Aged Care Commissioner Carolyn Cooper has been in the role since March this year. In this op-ed, she talks about the current problems facing the aged care sector and the need for an urgent response to ensure older people receive the support they require. She says they need and deserve to have access to appropriate health and disability services whenever and wherever they need them.

Events over the past four months, since I took on my role in the Office of the Health and Disability Commissioner (HDC) have reinforced the important contribution I have to make as Aged Care Commissioner. I am here to protect older people’s rights, advocate for change and make sure they get the best, most appropriate health and disability services.

I begin by acknowledging the conscientious effort of so many people working in health to protect and safeguard the well-being of our older population. Their selfless dedication in challenging circumstances, should be applauded.

However, I am conscious the health and disability system is under significant pressure with limited capacity to respond to the demands placed upon it. I have observed a range of issues across the system affecting the quality of care and quality of life for older people.

COVID-19 continues to place older people at risk and the recent surge has seen this group make up a high proportion of current new daily COVID case numbers, and sadly, a high number of deaths.

We are facing major challenges across the health system and there is a need for urgent government intervention and a collaborative response from across the aged care and health and disability sectors to address these challenges.

Equitable access to health and disability services for vulnerable older people either in their homes or in aged residential care is key to maintaining their health and well-being. The priority is avoiding unnecessary hospital admission, maintaining the independence of older people, and delaying the need for aged residential care support for as long as possible.

Robust mechanisms must be in place for monitoring what is happening to older people. At a time where health and disability services are being disrupted we have a collective responsibility to measure the impact this disruption is having on older people. We must ensure older people are being supported and continue to receive the support they require in their day-to-day lives. Their rights under the Code of Health and Disability Services Consumers’ Rights apply notwithstanding these current challenges.

People are living longer, but people age differently – their needs are diverse, and the nature of the support they require varies. We must adapt services to best meet the needs of the individual, whether this be in their own home or in an aged residential care setting. In aged residential care, where people’s acuity and support needs are evolving, and their health can rapidly change, it is vital there is sufficient staff with the right skills and expertise to keep vulnerable people safe and respond to their deteriorating conditions. We need to ensure service providers have access to tools that allow them to match capacity and capability of staff to the needs of people in their care.

A sustainable workforce means a sustainable health and disability sector and better choices for older people.

The aged care workforce is under significant pressure especially in Home and Community Support Services (HCSS) and Aged Residential Care (ARC). Older people are high users of the health system and each part of the system needs to function effectively to respond to demand and ensure there is patient flow. The challenges of limited access to HCSS and ARC means there is potentially a longer length of stay for older people in public hospitals. This means that hospital services are diverted from providing services to other population groups.

Urgent intervention is required to address the current workforce shortages facing the system. The priority must be the retention and recruitment of nurses and support staff in HCSS and ARC facilities. Alongside this we also urgently need a comprehensive longer term strategy to ensure a sustainable aged care workforce to care for the growing ageing population.

It is not a level playing field for HCSS and ARC with the public hospital system and they struggle to retain and recruit registered nurses and suitably skilled support staff. More needs to be done to ensure there is a clear national “home grown” training strategy, coupled with better access for nurses wanting to work in Aotearoa New Zealand, through immigration settings and pay equity with public sector nurses.

HCSS are an enabler of the Government’s ‘ageing in place’ strategy. Supporting people to live well at home whilst accessing a range of health services and enabling them to remain connected with their communities helps ease the pressure on aged residential care and public hospitals.

HCSS and ARC are critical partners in the success of the health reforms, as is primary care who maintain oversight of increasingly frail people in their homes. We need to unblock the health system to enable older people to age in a place of their choice or in supported care environments.

Aged residential care is a nurse led service supported by visiting General Practitioners/Nurse Practitioners and dedicated support staff such as caregivers, cleaners and cooks. The quality of care and quality of life for older New Zealanders is being compromised with many care homes needing to close beds due to limited workforce availability to provide safe and effective services to residents in their care.

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