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More than 30,000 people are employed in aged care nationally, a workforce which will need to increase by at least half to cope with the ageing population. The Otago Daily Times series on ageing continues as health reporter Mike Houlahan looks at how New Zealand will find the workers to look after its older people.
They are the people without whom the aged-care sector could not function - the medical staff, the community care workers, carers and therapists.
They are also people proving increasingly hard to find - and hard to keep hold of.
"Aged care'' covers a wide spectrum of services, but statistics kept by the Aged Residential Care Industry offer ample evidence of sector-wide issues.
Staff turnover in all categories is 27% - it is 38% among registered nurses - and one in five staff is on a work visa.
The NZACA figures also show working in the aged-care sector is unlikely to afford you a rich and famous lifestyle - mean standard pay rates range from $16.40 an hour for laundry staff to $43 an hour for facility managers.
Add the fact that, along with the population in general, the medical workforce is ageing - in 2017 research found over the next five years, 27% of GPs intended to retire, and nursing faces a similar issue.
Unsurprisingly, with the rising number of New Zealanders over retirement age - more than a million New Zealanders will be aged 65-plus by 2036 - planners are seriously concerned about who will look after all those people.
In August last year NZ Aged Care Association member facilities had a record 10% vacancies - 500 out of nearly 5000 registered nursing positions were empty.
Chief executive Simon Wallace said those trends had accelerated, were exacerbated by the recent pay settlement for district health board nurses, and were simply not sustainable.
"My question would be, are we valuing the care of people in our hospitals more than the value of care for our people in rest-homes?'' he said.
"You would have to say yes, because nurses in public hospitals are paid more.''
Some operators were profitable and could afford to pay competitive rates for nurses, but the majority of aged-care beds were still run on the smell of an oily rag, by religious, welfare or not-for-profit operators, Mr Wallace said.
"They can only afford to pay their nurses what the Government funds them for, because they generally don't have a retirement village-type facility to cross-subsidise their care operation.
"That is a fundamental challenge we have to deal with''
Not only do staff have to be recruited, they need to be retained and trained.
Careerforce - the Industry Training Organisation for the health sector - has a key role to play in ensuring aged-care workers are competent.
Chief executive Jane Wenman said she agreed with Mr Wallace that many parts of New Zealand were in "crisis mode'' due to staff shortages, and added that registered nurses were the tip of the iceberg.
"When you look at the entire rest-home industry and support caregivers, that's looking like something more like 1000 required as well - with the ageing population we have coming through, I can only see that getting worse,'' she said.
For her, the recent pay equity had been a boon for the sector - it made it a more attractive career option.
But that message had likely not yet got through to the aged-care workforce of the future, Ms Wenman feared.
"Traditionally, a young person at school wouldn't necessarily think they would go straight into a rest-home to be a support worker ... the low pay previously was seen as a barrier,'' Ms Wenman said.
"We need to push the message out there that this can be a career of first choice - it takes a special kind of person to work in aged care, the demands can be very high, but the rewards are huge.''
However, the sector now finds itself in limbo, due to the Government's recently released proposed reforms to vocational training.
ITOs such as Careerforce were now in a holding pattern, waiting to see what the Government decided to do, stalling training programmes in the meantime.
"We don't know what's going to happen, but we do know it will have a huge impact,'' Ms Wenman said.
"Trainees will have to transition to the new arrangement and we can see an upheaval and perhaps a slow-down in skills training.''
A recent survey by unions the NZ Nurses Organisation and ETu suggests for those on the job, the shortage of staff and resourcing is already biting.
The survey of around 2000 aged-care nurses found 83% say care is often missed or delayed due to staff shortages, 73% say staffing levels at their workplaces are inadequate and 85% say it is difficult or very difficult to find replacement staff.
A look around any aged-care facility will reveal a united nations of employees, but a dependence on overseas staff has created its own issues - 63% of institutions have reported issues recruiting or retaining caregivers on visas.
NZACA's Simon Wallace hoped a review of temporary work visa conditions announced last year would help in that respect.
"Most of those people are on temporary three-year visas and have to go home, regardless of whether there is a New Zealander to do the job - the Government has now put some proposals out and our association is working through those.''
While the sector has its issues, there is a silver lining - job security.
"We have this ageing population,'' Jane Wenman said.
"The demand for staff is going to be bigger, not smaller, so there will be more security in a role there.''
- The Otago Daily Times is running a series of articles concerning ageing. If you have a story to share, please contact firstname.lastname@example.org