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.
Capacity and capability to meet
complexity of needs
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.
Workforce
sustainability
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.
Critical
partners
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.
Ēhara tāku toa i te toa takatahi,
engari he toa takitini
Our strength is not made
from us alone, but made from many, and we are stronger
together.
The issues I am seeing, must be addressed by
collective action across the health and disability
system.
Older people need, deserve, and should expect
no less than a joined up approach from health and disability
services.
Older people are precious and more
vulnerable now than ever. I’m calling on all of us in the
wider health and disability system to work collectively to
give older people a voice and greater confidence in the
quality and safety of health and disability
services.
I am committed to working with all the
critical partners and agencies in the broader aged care
sector and wider health and disability system so we can
leverage the powers and functions we have to collectively
advocate and effect positive outcomes for older
people.
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