I'VE BEEN THINKING

 Aged care is more of an issue than ever before with the population bubble known as the Baby Boomers coming of an age where rest home living is a reality for many and with average longevity increasing.

There are many problems in this with there not being enough rest homes and care facilities to cater to this new boom (or echo of the original one), not enough qualified care workers in an industry of chronic underpayment and the rise of unscrupulous chancers who are taking advaNtage of thEse situations.

Yes there have been horror stories:

NZ HEALTH GROUP

Retirement villages are booming, while aged care homes face a staffing crisis over nurses’ pay, forcing the closure of more than 400 beds.
A wave of baby boomer pensioners, combined with the global pandemic, is firing up the retirement industry.
Every week about 40 new villas and apartments are completed, and every week 100 seniors move into retirement villages to enjoy the secure carefree lifestyle pictured in glossy advertising brochures.
Over the next five years, 87 new villages and 21,400 units are planned, but behind this seemingly rosy outlook lie some rather less palatable facts about the aged care sector.
Over the past six months 461 rest home beds have closed, largely due to the shortage of 1000 registered nurses lured by the promise of earning up to $30,0000 a year more in public hospitals, and operators warn more closures are pending unless the Government addresses pay parity and work force issues.

SPECIAL REPORT ; REST HOMES ON VERGE OF COLLAPSING

Obviously not all rest homes are suspect but, with staff shortages, facility shortages and a pandemic to deal with there are many that are operating at sub-standard levels as the report above shows.

Aged care nurses are working double and even triple shifts — 24 hours straight — to plug gaps, writes Nicholas Jones.
It took only a few nursing vacancies to close Wharekaka rest home and upend the lives of its elderly residents.
Aged care homes across the country are grappling with a severe nursing shortage that in recent months has forced 20 facilities like Wharekaka in the South Wairarapa to close all or some of their hospital-level beds.
The sector is short 1000 registered nurses out of a workforce that should number about 5000.
Covid-19 shut borders and created fierce competition for nurses, who can earn much more in public hospitals or working in other DHB roles, including as vaccinators.

Even aged care homes that manage to stay open can do so with unsafe staffing levels.
Authorities were notified of 851 incidents last year when a facility didn't have enough nurses to ensure the safety of residents - a 227 per cent increase from 2020.
Nurses have worked triple shifts - 24 hours straight - because there's nobody to relieve them and they won't leave residents without cover.
Simon Wallace, the chief executive of the Aged Care Association, which represents most companies and owners, says staffing shortages are worsening by the day.
"I don't use the language that I am about to use very lightly at all. Quite frankly, we are on a precipice in aged care right now. We are on the verge of collapse."

And  here are some of the horror stories.

Staffing pressure has been linked to substandard care in complaint decisions released by the Health & Disability Commissioner, the Government's health watchdog.

The Weekend Herald has read reports released since 2018 and found staffing and training problems identified in 27 cases when a resident died after substandard care. Investigators generally couldn't say whether or how that contributed to the deaths, given residents were often unwell with a range of health conditions and near the end of life.

In one example, proper checks weren't made on a dementia patient who fell repeatedly, and died soon afterwards. A nurse told investigators staffing levels meant "it was very difficult for the registered nurses to be as vigilant in attending to the needs of all 50+ residents as they ought to have been."

Fourteen residents died with infected bedsores and wounds that weren't treated or monitored properly, with investigators finding staffing issues including high turnover, heavy workloads for nurses and lack of training. In one case, nurses claimed they were ordered to complete care plans and other assessments in their own time if necessary.

A man had maggots hatch in his wounds after dressings were changed infrequently, and a nurse told investigators her workload was "impossible".

A woman died after her 6cm deep ulcer wasn't treated properly, and a nurse working as the clinical manager revealed she was on call 24 hours, seven days a week and the "fulcrum point of the natural tension between the owners' interests and their financial constraints, and maintaining nursing standards".

Another home was ordered to review nursing levels after no action was taken when a man complained of stomach pain. He died the next day from a perforated intestine.

The HDC investigates only a fraction of complaints, and can take more than a year to do so, meaning there is a significant lag-time before events turn up in reports.

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So, where to from here?

I think that some lateral thinking is needed.

In the past, in our society, the care for the aged was undertaken within families and, if finances were secure a 'granny flat' or similar was built on the quarter acre section or farm or an extension was added to the family house. This was funded by sale of the elderly parents' house.

In recent decades the elderly were packed off to rest homes and other care facilities that had medical services. Residence in these could be secured by renting accommodation or by buying a unit or villa within the compounds. As demand has risen so have the costs of care in rental, monthly fees and the real estate value of the units and villas to the point where it is becoming prohibitive.

Now, as seen in the above reports, these facilities themselves are struggling to provide adequate staff regardless of the cost increases and the standards of care are slipping. Those are the measurable things. The harder to measure things are the sense of isolation, helplessness despair and loneliness that comes from third hand and impersonal care especially if the caregivers are overworked and underpaid. There is a crisis looming.

Building big and expensive facilities that need to run at high profits is never going to work properly. There will be slippage. Some return to basics is required.

My proposal is that instead of furthering the rest home industry, thought is given to how care for the elderly can be given in their own homes. I'm not talking about Nurse Maud-type daily calls but live-in support. This will be at a cost to the elderly patients and their families but will, without the crippling overheads of building new facilities, be cheaper than in-rest home care.  Some alteration to living areas of houses will be required to provide live-in accommodation for care givers. Major rest home and care facilities will still need to be available for patients requiring more extensive care and who have critical health issues but there will not be as many needed. Some increase in ambulance facilities for ferrying at-home residents to hospitals and clinics will need to be instituted.

The upside of his, in the long run will be more affordable care for the elderly and their families in a more comfortable and friendly setting.

The current downside is that there simply aren't enough qualified carers in the market. Also, of these most are woefully underpaid. If however, costs can be taken out of the industry by simply not building as many megalithic facilities then a well-paid and well-trained workforce is possible. This workforce can also be properly overseen and regulated to ensure the safety of the residents.

Most elderly people, when making the shift to rest home care, have to sell their family homes to pay for accommodation in rest home care centres. Most do not get a fair swap of equity or housing standard in doing this. Proper, government secured and underwritten reverse mortgaging facilities can and should be provided. This is no more impossible for future governments to create and manage than Kiwi Saver schemes and government run services. For those who don't own their own houses to reverse mortgage, but who live in rental accommodation, then government allowances for in-house care should be provided. Overall this should not cost more than the current government subsidies that go into facility care for these people.

There are some very big challenges facing the care industry, the ageing population and government. Immigration rules need to be changed (they are under review now) and fast-track training needs to be put in place along with expansion pf nursing training schools. Underlying this is the need to pay more to care workers to ensure a higher level of care.

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I'm not suggesting an easy quick-fix to the problems here but what I am putting forward are some thought starters. We all need to think about the issues and affordable solutions now and not leave it to corporations who are eying up the 'industry' in order to make a lot of money.

I'm just the ideas guy. Other more qualified experts will have to come up with the action plans.