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Transforming Care Full Report 2024Page description to come. By: Rachel Mackintosh E tū: 13 November 2024 Transforming Care Report 2024 Contents
INTRODUCTION Transforming Care: A Call for Fairness and Dignity in Aotearoa’s Care and Support Sector. Care and support workers are some of the unsung heroes of our society. Every day, they show up with heart and dedication to care for some of the most vulnerable among us–our elderly, disabled people, and those living with complex health needs. Whether they work in specialised facilities, in the community, or in the homes of those they care for, they are there, ensuring that people can live meaningful and dignified lives. Their role isn’t limited to just tending to basic health needs. They offer comfort, companionship, and a human connection that is so essential to wellbeing. They are more than health workers, they become part of the lives of those they care for. Yet, despite the importance of their work, Aotearoa New Zealand’s care and support system is in crisis. This report, brought to you by E tū, the union representing care and support workers, shines a light on the deep challenges facing the sector. The very people who provide such critical services are underpaid, overworked, and undervalued. The system, fractured by low wages and poor working conditions, leaves care and support workers struggling to deliver the standard of care they want to provide – and the care that their clients deserve. At the heart of the issue is a system of funding that doesn’t put people first. With care and support sitting outside of the public health system, the Government’s approach to funding, combined with the commercial interests of private providers, leads to dysfunction. This dysfunction creates a ripple effect: workers are overstretched, services are compromised, and ultimately, the people who need care the most are E tū has been at the forefront of efforts to improve the care and support sector, and we’ve celebrated some significant achievements along the way. The historic 2017 equal pay settlement, led by E tū member Kristine Bartlett, resulted in huge pay increases for care and support workers. Since then, however, wages have stagnated and failed to keep pace with rising costs. Our members have secured the minimum wage for workers during ‘sleepovers’ who were paid a pittance for their time beforehand. Campaigns and collective bargaining have led to many other improvements to wages and conditions. Yet, despite these victories, the underlying problems within the system remain. That’s why we believe a radical overhaul is essential – which is the basis of our Transforming Care campaign. This report, which draws on insights from a survey of nearly 2,000 E tū members, as well as interviews with workers and perspectives from key stakeholders, paints a detailed picture of what needs to change. Dame Judy McGregor, a leading thinker and advocate for public services, contributes her expertise in bringing these issues into the light. It’s time for transformation to a system where both workers and those they care for are treated with the dignity, respect, and compassion they deserve. As a society, we owe it to these workers – and to ourselves – to ensure the care system is built on fairness, respect, and human decency. After all, we are all connected to someone who relies on care, and one day, many of us will need it ourselves. This report is not just a call for reform; it’s an appeal to shape a system that truly improves people’s lives, now and in the years to come. E tū Women's Committee "Healthcare in New Zealand isn’t always equitable, especially for Māori and Pacific women. There’s a feeling that our voices aren’t heard and our needs aren’t prioritised. It’s not just about treatment but building trust and understanding our unique challenges and cultural contexts." TRANSFORMING CARE – THE CASE FOR CHANGE Care and support workers know the issues-and the solutions. It’s time for decision-makers to listen. Aotearoa’s care system is broken. It doesn’t work well enough for the people receiving or delivering care. But it doesn’t have to be like that. We can have a care system that provides support to those who need it, while also E tū is enabling their voices to be heard by decision-makers by activating our members and working with other stakeholders, to shine a light on what is happening and talk about what should be done differently. // OUR CAMPAIGN FOCUS VALUE OF CARE STANDARDS OF CARE FUNDING OF CARE // WHO ARE CARE AND SUPPORT WORKERS RESIDENTIAL CARERS DISABILITY SUPPORT WORKERS E tū members in disability support work for large employers such as IDEA Services and CCS Disability Action, as well as smaller local and community-based providers. HOME SUPPORT WORKERS MENTAL HEALTH AND ADDICTIONS WORKERS WORKERS' VOICES Dame Judy McGregor has interviewed six E tū care and support members, to explore their experiences working in the system. There are some worrying reports from caregivers across the system. It is not the aim here to jeopardise workers’ jobs or to demonise decent and fair employers, but rather to highlight that these are systemic problems, felt widely by care and support workers. These stories show a different side to the system to what you might see on television ads for aged care facilities, or what you might read in the mission statements of care providers. This is the reality of a system in crisis. ANA FUNAKI “The money is so bad for the actual value of what we are doing. It is very heavy work and the cost of living is going up and up. But we are still paid the same." The undervaluation of her work upsets Ana Funaki, a level 4 qualified carer who has been working in a hospital at a South Auckland aged residential care facility for the past 13 years. Ana earns $29.10 cents an hour but believes the job is worth at least $35 an hour minimum, approximately a 20 per cent increase. She is angry at the lack of pay parity across the government-funded health sector between carers working in home support and residential facilities and health care assistants working in public hospitals. “We’re doing the same job. The difference is that the job of those working at a hospital is easier, they are paid better and there are more staff.” The lack of pay parity has been an enduring issue in the health sector for years. In 2012, the New Zealand Human Rights Commission’s Caring Counts inquiry into equal employment opportunities in aged care, strongly urged the development of a pay parity mechanism and for implementation to take place by 2016 at the latest. Ana says working conditions are not improving in the sector. While facilities are still hiring, carers’ hours are being cut. “Instead of seven-and-a-half-hour shifts, new hires have been cut to six hours." This makes it even harder for new entrants to survive given cost of living pressures. It is also a disincentive for younger people. At her facility where there are 30 clients, there are five staff on the morning shift, four staff in the afternoon and only two in the evening. She believes the staff-patient ratio should be one staff member for every six clients, not seven or eight, given the physical and emotional demands of the job. While she often doesn’t feel safe at work she believes being a union delegate has given her strength in her relationship with management. “I am the union, so I can fight back.” Ana says she becomes tired from the heavy physical nature of the job. She wishes she could spend more time with her family. “I would be so happy and excited if we could eat meals together and share and plan family celebrations.” The scope of her job is also a worry. “Sometimes I have to do medication and care work and I am anxious about making a mistake. We shouldn’t be asked to handle medications, but we do it to help the client. The stress affects me - I often can’t sleep and it impacts on my family as well.” Like the vast majority of aged care, disability and home support workers, Ana does the job out of a sense of duty and compassion. She believes in helping others at the time they need care, just as she would look after family members. AMARJEET GAUTAM “Quality care means we need one and a half hours in the morning and at least 45 minutes in the afternoon so that clients get quality care.” If Amarjeet Gautam was a plumber, a builder, or a public servant who travelled in her job in her own car, she would be reimbursed at 95 cents a kilometre at the current IRD travel rates. But because she is a home and community support worker, Amarjeet suffers a double whammy. She receives only 63.5 cents a kilometre in travel reimbursement. She travels between eight to ten clients in a working day and travels between 80 to 100 kilometres in her own Kia Stonic. She is at least $31.50 worse off a week just in travel reimbursements as she travels to clients in the Mangere, Papatoetoe and Otara area. “I have to pay for my tyres, car repairs, registration and fuel. The cost of running a car has gone up like everything else.” Amarjeet, an E tū delegate, has also had to upgrade her car over the years. On top of that she does not have pay equity and earns only $29.10 an hour with a Level 4 qualification and six years of experience. She believes $35 an hour would be fair for the job she does. Amarjeet says the weekend differential hourly rate of $1.50 is far too low and just simply not enough for home and community support workers. “At the moment we can’t save, we can’t take holidays, we can’t eat out and we need to put food on the table. Even though we budget tightly we struggle to pay our debts.” If Amarjeet had more family time and was paid properly for her job she would do the things she loves but doesn’t have time for now. “I’d make sure I’d do a lot of cooking for the family and my boys. I would also go weekend shopping.” Peak hour traffic and roadworks also mean that home and community support workers on the road are always stressed about giving clients their proper time allocations. She says time with clients has been cut back, with an hour allocated in the mornings and half an hour in the afternoon, which isn’t enough for helping clients with food, medications and personal hygiene. “Quality care means we need one and a half hours in the morning and at least 45 minutes in the afternoon for our clients.” If there is a problem and staff need to work longer to cover, they do not receive overtime pay. Amarjeet says she has seen improvements in the service she works in with a recognition of the need to roster staff in one geographical area if possible and improved health and safety processes. But she says improvements are still needed. She would like to see hours rostered at least a week in advance, a designated troubleshooter available for weekend problem situations, and more opportunities for staff to be listened to. Both unions and employers acknowledge the unfairness of the underpayment in travel reimbursement. The unions state that low paid care and home support workers continue to subsidise the health system by paying for costs related to their travel over and above what they are compensated for through payments mandated by law. Increasing car-related costs means that some of the lowest paid women in the country doing critical work have suffered a reduction in take home pay. Employers have said that it is impossible, in equity, to sustain a position that it is “unaffordable” for the Crown to remedy the current under-payment. Both sides want urgent action on discriminatory travel underpayment. SUSHILA DEVI “I would really like to have a break in the weekend and be with the family. For ten years I have been working when they have had time off and when they are off I am working.” Prime Minister Chris Luxon has been challenged to do a day’s caring work so he can appreciate the real value of the job. The challenge comes from Sushila Devi, a Level 4 qualified carer, who has worked for 17 years in a South Auckland aged residential hospital facility. “My challenge is for the PM to do one day’s hands-on job. Then he would appreciate how much we are underpaid.” Sushila has nine people living in her extended family and while different family incomes pay for rates, food and the family’s mortgage, her account is often in overdraft. She notes that employers say they can’t afford pay rises for carers. “If they’re not making money how can they afford to open so many new facilities?” Sushila says she is a carer because she values every client and treats them like one of her own family members. But she says her work would be improved by more staff and better pay. Safety at work is a concern. "I don’t really feel safe and it is getting worse." While the hospital is not a dementia facility, many of the clients have dementia. "We are often punched or spat on, have hot porridge thrown at us, and one client runs naked around the facility. I have hidden in the toilets to avoid being punched." She says the acute needs of some clients mean they need one-on-one care. At the facility there is often no Registered Nurse (RN) present, and one senior care worker becomes a duty leader. But the role has extra responsibility. When there is a medical emergency and an ambulance has to be called, carers are often asked questions by paramedics that they can’t answer. “It is embarrassing, and we are doing a RN’s job but there is no extra money for it." The emotional labour of the job takes its toll. Sushila says when there are staff shortages the stress is high because carers can’t spend the right amount of time with patients. “I often can’t sleep through the night, and my kids have seen me cry after coming home from work." She was on ACC for three weeks after straining her back because of staff shortages. “I was hurrying to roll a client over in bed when it needed two of us.” She also worked through Covid-19 but was infected in the early days of the pandemic by a client who she was testing. Sushila longs for more family time. “I would really like to have a break in the weekend and be with the family. For ten years I have been working when they have had time off and when they are off I am working.” JO-CHANELLE POUWHARE “Many of our carers have big families, especially Samoan whānau. Very often they have to work two jobs, caring and a cleaning job because of the high cost of living. There are health and safety aspects and burnout impacts on the quality of care work.” Wellington care and support worker Jo-Chanelle Pouwhare, has a former client who rings her twice a day to talk and hear her voice. “It is very hard to detach yourself completely. This client is autistic and suffers from high anxiety. Even though I haven’t been working with him since July he rings me twice a day, morning and night without fail. If I am very busy and don’t answer he will always ring back. 'Hello lovely, I say'. It gives him peace of mind.” Jo-Chanelle (52) says that when her client was transferring to a new residential care service his mother said, “please continue to be part of my son’s life”. While Jo-Chanelle has been to see the client’s new home she is careful not to intrude on his new care arrangements. But the client’s daily phone calls demonstrate the extraordinary commitment and support that carers like Jo-Chanelle provide the most vulnerable in society. She works for CCS Disability Action and provides home support. She believes that 90% of families she knows would support direct action, even strikes, by carers to ensure the implementation of pay equity. Some members of the public who don’t have a loved one in care assume that support workers “just wipe bottoms” without recognising the complexity, physical nature and emotional labour of the job. But those with a family member in care know that “those that work in the disability sector are special kind of people,” she says. Jo-Chanelle is active in union campaigns to transform care through pay equity and improved working conditions. She attended a recent online meeting between E tū members and the Minister of Health Dr Shane Reti. She is also adamant that guaranteed hours would improve carer job security and she is critical of Wellington aged care rest homes who have cut hours for care and support. She says it devalues both clients and carers. When organisations cut hours of work, carers are obliged to get two jobs to make ends meet. “Many of our carers have big families, especially Samoan whānau. Very often they have to work two jobs, caring and a cleaning job because of the high cost of living. There are health and safety aspects and burnout impacts on the quality of care work.” Cultural norms also mean that some care workers are not assertive about securing hours but Jo-Chanelle says she personally declined a contract that guaranteed her only five hours a week. “It just wasn’t liveable.” Jo-Chanelle says she considered becoming one of the record number of New Zealanders leaving to work in Australia. "When I looked for jobs online I found the lowest starting rate across the Tasman was $35 an hour. I can understand why carers are leaving." But she says Wellington CCS Disability Action, where she has been for the past four years, is the best organisation she has worked for and is part of the reason she stays. More money is crucial though. Jo-Chanelle says when she was broke she has had to borrow money for petrol for the 25km journey to Porirua. She lives with her mother paying board and for the amenities such as Wifi and Sky, while they share the costs of power. She has no savings for retirement. Jo-Chanelle copes with the emotional demands of her job. “I have my own stress relief. I like bingo, sketching and I am currently into Korean dramas.” PAVRITA PUNCHIHEWA “I believe there is an urgent need for bridging courses here when we desperately need more qualified nurses. Many migrant nurses have fundamental skills and overseas qualifications. Often they have more than 10 years' experience in their home countries. They are working all around the country.” Pavrita Punchihewa, a 50 year old residential support worker who looks after intellectually disabled clients, says caring is her passion, even though she is overqualified for her job. “I am really happy to help clients with their daily living, staying connected and having their families visit.” Originally from Sri Lanka, Pavrita was a Registered Nurse in her home country who had worked for 20 years in intensive care. She is one of hundreds of migrant carers in this country who are qualified nurses in their countries of origin. “I believe there is an urgent need for bridging courses here when we desperately need more qualified nurses. Many migrant nurses have fundamental skills and overseas qualifications. Often they have more than Pavrita says she chose not to requalify here as a nurse. She would have had to start nursing studies from the beginning because she had been absent from nursing work for more than five years. She also would not have qualified for a student loan if she was working full-time which she had to do. She needs the money she earns as a level 4 qualified carer to support her children’s education. Her eldest son is a talented musician. He is a prize-winning jazz drummer studying a Bachelor of Music degree at Victoria University and Pavrita is helping to pay for his accommodation and living costs. Her kids have nicknamed her the “Duty Mum”. Pavrita works over 100 hours a fortnight, 79 hours on roster and at least two sleepovers. She challenges the view that sleepovers are easy work. “It is not like sleeping at home. You are always expecting something to happen.” She says several of her clients suffer epileptic fits at night which may need an ambulance call out or suffer from continuous seizures. Other clients are bedridden 24/7 and have different needs. Her work can be physically demanding, especially hoisting bedridden patients, helping them to get into transport and changing incontinence pads. She recently spent four weeks not at work on ACC payments for a damaged shoulder. She says there are lingering psycho-social effects in her organisation after the Covid-19 pandemic. She says the pandemic has negatively impacted team bonding and the mental health of staff. “Some staff now feel they don’t belong and that no-one cares about us.” CALEB MAJOR “The low pay is another barrier. Unless caring was paid the equivalent or more than other jobs available, it will not attract men.” Why aren’t more men working as paid carers? “That’s a good question” says Caleb Major (36) a Paeroa-based disability support worker. Globally, the caregiver worker is overwhelmingly female. It is highly gendered in Aotearoa New Zealand with 84% women and 16% men.
The father of two boys aged 8 and 10 years says he stumbled into disability support work when he was studying social work and he needed a part-time job. In the end he needed more hours and gave up social work studies for disability support work. He is currently at Level 3 earning $26.90 an hour and hopes to complete Level 4 by the end of the year. He now works across several facilities where most of the clients are middle-aged or older. His co-workers are generally male. Job satisfaction comes from “building relationships with the people we support.” “Even when a disabled person might not be able to speak or has communication difficulties, they often have big personalities. It’s rewarding to discover the different quirks of human nature. I have been supporting a man with behavioural challenges who is a different person today than he was 14 months ago. That’s very rewarding.” He acknowledges the job can be physically confronting such as when staff are assaulted, as well as emotionally draining. A recent incident involved Caleb having to calm down a man whon had picked up a rock to throw at him. He says healthn and safety is robust at his facility. Staff are offered counselling, paid time off and management makes sure they have support when needed. Caleb credits his employer with good, solid management and an example is the adherence to then agreed weekend rostering policy. In Paeroa he worksn one weekend in two, whereas when he was commutingn to Auckland to work, he was often rostered on everyn weekend. He agreed so he did not to lose hours and money. “It definitely impacts on family life.” Weekend pay rates definitely need to be improved, Caleb says. “In this industry, over the years, I have done tons of weekends. When I worked in Australia between 2008-9 there were much better penal rates for weekend work than here.” There is no extra pay for weekend work just a “high five from the manager.” A fair differential rate need not be massive in dollar terms but would be an acknowledgement that carers are giving up weekend time. Over a fortnight Caleb works a total of 106 hours comprising 70 rostered hours and four sleepovers. A carer who is asleep during sleepover is paid at minimum wage for the time. Awake hours when clients may need help or there are incidents are paid at the carer’s normal hourly rate. Caleb says if he was paid more and had more time off he would spend it on “quality time with family.” “The public has no idea of what goes on. They see television advertising with bowling greens, swimming pools and rainbow pictures with healthy, happy older people. It all looks fabulous, even if there are actors playing residents with little old ladies having cups of tea. But the reality is very different.” CARE AND SUPPORT MEMBER SURVEY INTRODUCTION From low wages, inequitable treatment, a lack of safe staffing levels, to the challenges of violence and harassment at work, care workers share their views and want to be heard. As one survey respondent said, care workers want to be valued by the government and employers for the integral role they play in the care and support of the most vulnerable. Transforming care will require the combined efforts of government, providers, residents, and their communities. It will also take hearing and acting on the voices of workers and their union representatives. At a critical time in this political and economic debate, the care and support workers’ survey report contributes to that discussion. The care and support sector in New Zealand is a diverse and vital part of the country’s healthcare system, designed to assist individuals who require aid due to age, disability, or health conditions. There are different ways of accessing the care and support that people need, and individuals can access more than one of these services throughout their lifetime. Overview of Sector RESIDENTIAL CARE FACILITIES COMMUNITY SUPPORT SERVICES IN-HOME CARE SERVICES NON-GOVERNMENTAL ORGANISATIONS (NGOS) LISTENING TO THE CARE AND SUPPORT WORKFORCE The care and support workforce in New Zealand is predominantly female, reflecting a global pattern where women represent approximately 70% of the workforcee1.This sector is characterised by workers who are older (45+) and ethnically diverse, reflecting the multicultural nature of the country and our union. It is this diversity the enables that sector to assist with providing culturally competent care to the diverse population it serves. 1 https://www.who.int/activities/value-gender-and-equity-in-the-global-health-workforce [CHARTS] Summary of findings
// PILLARS OF CARE Value of care A system that values the workers and the recipients of care equally so that everyone feels respected and cared for. Standard of care A system that ensures a standard of care that protects both the workers and clients/residents so that everyone thrives and feels supported. Funding of care A system that ensures that everyone has access to the services/facilities they need, no matter what their economic circumstances are and one that ensures that they get the care they need from a well-trained, well resourced, and well supported workforce. 1. VALUE OF CARELOW AND INEQUITABLE WAGESThe value we place on carers is a direct reflection of the value we place on vulnerable and dependent members of our society. Low and inequitable wages is globally a driver of poor sector performance and in New Zealand most carers are slipping to pay rates close to the statutory minimum wage, despite a landmark equal pay settlement in 2017. Workers surveyed were asked what pay equity would mean for them. Overwhelmingly, they said it was about being valued for the work they do and being paid enough not to just survive on, but to thrive on. As the quote below says, it is recognition that the value place on the worker is integral to the value we place on the support and care provided. I need to work 130 hours a fortnight to survive. It would be better for my family if my work hours could be reduced to an 80 hour fortnight.” “A sense of value from the government and our employers in doing a role that is an integral part of someone’s support and care. Walking along side to help maintain mental health and wellbeing. It would recognise the commitment and passion for a role that I give my all to, whilst working alongside some of your most valuable people.” “Being paid an amount that reflects the level of risk, emotional distress, experience and expectations that come with my work. Feeling valued by my employer and society.” Over 17% of the respondents had not had a pay rise for over two years, 20% had a pay rise in the last two years, and just over 38% received a rise in the last year. One in 4 were unsure whether they had had a pay rise or not. TRAINING AND CAREER PROGRESSIONOpportunities for training and career progression within the sector are limited, which impacts job satisfaction, recruitment and retention, and the quality of care. Even with a legislated requirement for employers to provide training, nearly 20% of the respondents felt that they were not sufficiently trained to undertake their job fully. The Sapere Report recommended increased training opportunities and pathways and greater regularisation of the workforce. This is crucial for the sustainability of the workforce ensuring we do not lose carers to other industries or countries. HOURS OF WORKJust over 90% of the surveyed workers have regular hours, and for 85%, this was the same as their guaranteed hours. These hours vary anywhere from less than 10 hours per week to more than 40 hours per week, especially those undertaking sleepovers where their regular hours can almost be doubled, depending on how many sleepovers they are required to do in any one week. “54 hands-on and 36 sleepover hours a fortnight” Most of the respondents tend to work between 30 and 40 hours per week. [CHART] When asked if they were able, would they change their hours, nearly half would continue to work the hours they worked now, whilst 40% said they would increase their hours. 10% would decrease their hours if they could. 2. STANDARDS OF CAREMAINTAINING SAFE STAFFING LEVELSMaintaining safe and sustainable staffing levels is fundamental to delivering high-quality care. According to the UniGlobal report into the Care Sector “extensive research over the years has consistently demonstrated that higher numbers of nurses and carers lead to better care quality, more lives saved, and fewer medical complications. Moreover, unsafe staffing levels contribute to increased illness and injury among nurses and carers, fuelling a destructive cycle of high turnover within the sector” [2] This destructive cycle is prevalent in New Zealand, as the standard of care is at a critical point, with cuts in workers’ hours and ongoing staff shortages impacting the level of service and care provided to clients and residents. Nearly 50% of respondents to our survey felt there were not enough staff at their workplace, and slightly fewer felt they did not have enough time to fully care for their clients and residents. New Zealand has a voluntary guideline of 1.14-2.0 hours of care per resident per day for high level care compared with Australia where guidelines are 3.58 hours of care per resident per day and the US with guidelines of 3.48 hours. [CHART] 2. Winning Rights: the path to empowering care workers worldwide, UniGlobal Care, May 2024, pg 9. EMOTIONAL AND PHYSICAL DEMANDSAs well as these reductions, the nature of care work can be physically and emotionally demanding. Workers often face high workloads, with the responsibility of caring for multiple individuals with varying needs. This can lead to stress and burnout, and without adequate support and resources to manage their well-being effectively, workers are susceptible to leaving the sector, taking their training and expertise with them. When asked whether the workers felt that they were sufficiently trained, over 20% answered no, whilst nearly 10% were unsure whether they were sufficiently trained or not. The same number of respondents had issues with getting the time to attend training (just under 20% had an issue and just over 10% were unsure). One respondent linked delivery of pay equity to training and upskilling, which they described as impacting on the quality-of-service provision. "What pay equity means for me: Supports improved training & upskilling. Improves the quality of service provision.” Good health and safety practices play a vital role in supporting workers to help mitigate the situations that can lead to stress and burnout. The survey und ertaken by E tū revealed slightly less than half of the respondents felt that their workplace had good health and safety processes at the workplace. One measure of good health and safety practices is the ease with which a worker can get leave when they need it, and whether they are replaced while off, so that they don’t come back to a back log of work. One in five workers said it was either difficult or very difficult to get time off, whilst 40% felt it was easy or very easy. However, only a quarter were always replaced when they were on leave. [CHART] Three-quarters of the workers who responded to the survey felt safe at work most or all of the time. However, nearly 40% of them had experienced violence and harassment at the workplace, with nearly 70% of those who answered yes having experienced it more than once. “I believe the work I do is comparable to a prison guard. We do personal cares, and there is a risk of assault. We do stuff others won’t.” “The type work we do, the kind of environment we do, … the risk involved is especially highly prone to injuries.” ‘Residents/clients’ or ‘family/friends of the residents/clients’ were most likely to be the one inflicting the violence and harassment (over 60%). A work colleague was the next most likely at 25% with a manager being the least at 12%. Nearly all the respondents reported the incident, but half of these felt that the employer did not take it seriously. The figure was slightly lower when asked if they had observed someone else experiencing violence and harassment (just over 30%) but still half of these respondents said that the employer did not take it seriously. FORMAL HEALTH AND SAFETY PROCESSESThe picture improved significantly when respondents talked about formal health and safety practices in the workplace. Over 90% said that their employer had health and safety policies, and 70% felt that there were accessible health and safety processes. Most respondents (over 60%) said that there was a health and safety committee in their workplace. However, only 30% had seen any minutes from these meetings but 40% were either unsure or left the question blank. Most had a health and safety representative in their workplace (65%) and knew who they were (70% of those who responded yes). 3. FUNDING OF CAREThe survey represented workers in for-profit and NGO or charity providers. The majority of respondents worked for employers who operated nationally. [CHART] Government agencies oversee and regulate the care and support sector, being responsible for
FUNDING MODEL FAILURESGovernment funding of care is insufficient to meet current needs, which are expected to increase as New Zealand’s ageing population grows. This very point was made in the Sapere report commissioned by Te Whatu Ora into the Aged Sector. “Our cost modelling indicates that aged care services are under financial stress and ARC and HCSS providers may not be able to recover their efficient costs at current pricing and funding levels” [3]. Survey respondents were asked whether their employers received funding from sources other than the government. Of those who answered yes, 45% said the money was raised via donations/fundraising/bequests, just over 25% said money was received through the employers’ property/assets, and 20% said shortfalls were made up by charging clients/residents for services/premium beds. Sapere reported the need to substantially increase funding to these sectors, and highlighted that rest home level care was the most underfunded area. Sapere also raised concern around the disparity of funding between rural and urban areas, mainly due to the inability for providers to charge premium room rates to offset shortfalls in rural areas resulting in increased wait time for a bed. Large providers are also finding other ways to raise capital through Right to Occupy agreements whereby people pay for a room in advance of needing one. Respondents working in the aged care Sector were asked whether their employer charged for Premium Rooms. 20% of respondents were aware of this practice and reported 50% or more of their facility was taken up by premium beds. [CHART]
One large provider, Rhymans Healthcare, is also offering a Refundable Accommodation Deposit (RAD) to pay the ongoing costs for a premium room (usually around $300,000 to $400,000 upfront) that is returned to the individual if they leave or to their estate should they die whilst at the facility [4]. In the report, Sapere identified that there was substantial variation across the regions around the hours and levels of care in the Home and Community Support Sector and reported serious issues in residential care with insufficient beds available – a situation that will get worse in the future without a change in the funding model. IN-BETWEEN TRAVEL BUDGET IMPACTSSapere highlighted the struggles to attract and retain workers in the sector. This lack of staff in the home and community support has caused travel time to increase and the In-Between Travel budget grow substantially to the point it is now 17% of the overall home and community support sector budget [5] Home support respondents were asked whether their travel had increased or decreased over the last year. 40% had seen an increase in their travel, with 25% of those who responded now doing at least 20 km more a week than this time last year. [CHART] Respondents were also asked how many hours they would travel on average in a week. Most respondents traveled less than 100 km per week, but over 10% traveled more than 300 km. Asked about what type of vehicle they drove, the majority of participants drove car/small SUV diesel/petrol (54%) or medium SUV/Ute petrol/diesel vehicles (22%), 15% drove either electric or hybrid vehicles.
// CARE AND SUPPORT IN A GLOBAL SETTING The need to transform care is not limited to New Zealand alone. The crisis of care and support is a global issue, with some of our major trading partners also undertaking or implementing changes in all or parts of the care and support sector. Australia commissioned a report into the aged care sector, and the taskforce released their findings in 2023. They found that not only did it need a system that is “sustainable, or financially sound, … to attract additional investment and ensure the sector is set up to deliver quality care” but also that the system must “provide quality care when it is needed” and must “ensure equitable access for people with low means” [6]. The UK Labour Party went into the last election with a proposal to create a National Care System (NCS) for England. A 2023 Labour/Unison joint report identified that “since 2010 care and support in England has gone downhill fast and we now face an adult social care emergency” [7]. There needed to be a properly funded system as “adult social care spending quantifiably increases the wellbeing of recipients [and] reduces pressures on the NHS” [8]. Scotland is more advanced in introducing a National Care Service. Equity is at the forefront of their policy with the premise that everyone should have “access to consistent, high quality services wherever they live, and whenever they need them” 9. The National Care Service has a strong focus on co-design10. The NCS Board will provide national oversight and governance to ensure consistency, fairness, and a rights-based system and includes representatives from the central government, local government, NHS, people with experience of accessing services, unpaid carers, and from the workforce. This is a work in progress with unions in the UK expressing real concern that the voices of workers are being systematically removed from the care and support sector transformation, especially in England. Scotland currently has the voice of workers included at some levels and the unions are continuing to lobby to include the workers’ voice at every level of the design of // TRANSFORMING CARE IN NEW ZEALAND New Zealand has the benefit of a Sapere report into the state of care and support. The crisis of care in this country is backed up by this survey and the stories of our members across all types of care provision. The current mixed-funding financialised model based on incentivising providers to manage care and not addressing the needs of those providing the care or those being cared for, does not work. Transforming care will take all the voices of the sector, from the providers to the residents/clients, from the workers and their unions to the communities that wrap support around the elderly and vulnerable. Establishing an autonomous fully funded National Care Service which is co-designed by stakeholders and governed through a tripartite model that unites providers, unions, Māori, and government, will place the value of care at the centre of the transformation.
E Tu believes the following principles should inform our three pillars of care. VALUE OF CARE
STANDARD OF CARE
FUNDING OF CARE
CONCLUSION Transforming care depends on valuing care: valuing those who give and those who receive the care. It depends on establishing agreed standards that are monitored and enforceable because quality care is based on the inseparable relationship between the care worker and the person they care for. Ultimately, this depends on addressing the funding model for care and ensuring those funds are distributed to ensure adequacy, equity, and quality. All the evidence suggests we need to address the failure of our care service with urgency and that takes all stakeholders making a commitment to participation in the change process, including unions as the voice of the workers who are passionate about their vocation and grossly undervalued. Together, we can build a properly funded National Care Service that is world-leading and one that everyone can be proud of. But we need to start now and it needs to be grounded in principles of co-design, decent work, and the value of care. The current system is broken and continually adding band aids to fix the problem, will not change the outcome. The sooner we start the change the better the outcomes will be for our most vulnerable. We never know when it will be us or one of our loved ones that needs to use the system, and we need to know that we, or them, will be well-cared for. That is not something that can be guaranteed now, no matter how committed the workforce is caring for their clients/residents. 04 RECOMMENDATIONS The changes needed to transform care will be significant and comprehensive. With the experience E tū has from our work in the sector and the input from our members and community stakeholders, we have developed the following simple recommendations in line with our identified pillars of care. VALUE OF CARE
STANDARD OF CARE
FUNDING OF CARE
07 OUR COMMUNITY VOICE We know that transforming care will require a coordinated effort from many different stakeholders in civil society. Our Transforming Care campaign invites participation from a wide range of key players and organisations. Here are what some of them have to say about the importance of this kaupapa. Dame JUDY MCGREGOR and Dame DIANA CROSSAN [PICTURES] Aotearoa New Zealand is in a care crisis impacting older people, people with disabilities, those needing home support, whānau, and communities. This crisis will likely affect us all and worsens each day it goes unaddressed. Every day, an unseen yet essential workforce of women, around 65,000 strong, provide crucial care. They travel to homes, aged care facilities, and community residences, supporting vulnerable New Zealanders. These carers are undervalued, performing challenging and vital work often dismissed as “women’s work,” yet without them, lives would be at risk. Their roles demand strength, skills, patience, cultural understanding, compassion, and empathy. Many New Zealanders believe the 2017 Kristine Bartlett case fixed low pay for carers. However, that pay deal, while beneficial, also blocked further pay equity claims to determine the true value of their work. The lack of pay parity and equity for women in mental health, disability support, aged care, and home support is a fundamental human rights issue. New Zealand once championed human rights, promoting equal pay and ratifying the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) 45 years ago. The United Nations has repeatedly urged our government to expedite pay equity. Most carers are women, often Māori, Pacific, or migrants, supporting our most vulnerable through tasks like feeding, toileting, emotional care, and medication management. New Zealand has also cut back on pay equity initiatives, notably disbanding the Pay Equity Advice and Assurance Taskforce in 2024. Carers’ claims remain unresolved, impacting over 200,000 women nationwide. Judy was New Zealand’s first Equal Employment Opportunities Commissioner with the New Zealand Human Rights Commission and is an Emeritus Professor of AUT. Diana was the first manager of the Equal Employment Opportunities Unit at the State Services Commission and served as Retirement Commissioner between 2003-13. LEN COOK The care industry in New Zealand is poised for significant transformation over the next two decades, primarily driven by the aging population. With 45% of population growth projected to occur among those aged 75 and older, the demand for care will increase dramatically. Currently, around 43,000 people require care, with 12,000 professionals supporting them. However, this number doesn't fully capture the care provided informally at home, often by family members—an arrangement that is becoming less common due to smaller family sizes and increased demands on potential caregivers, particularly women. The commercialisation of care has resulted in varied standards based on wealth, but the sector faces a shortage of young workers to meet the growing demand unless immigration policies change. Looking ahead, solutions must focus on enhancing the physical and mental well-being of aging individuals to delay the need for intensive care. Policies should move away from rigid retirement ages, instead encouraging continued contributions from older citizens, whether in paid work or community service. New Zealand must also address how housing stock and support services will meet the needs of both older individuals and working families. Each locality will experience varied demographic shifts, requiring tailored approaches. Ultimately, the care industry must evolve to respond not only to medical needs but also to broader community and social support. By leveraging available information and planning with equity in mind, New Zealand can create a more sustainable and inclusive care system for future generations. NEW ZEALAND PUBLIC SERVICES ASSOCIATION etc etc 08 A MOVEMENT FOR DIGNITY IN AGED CARE AGED CARE PROTEST MOVEMENT A new protest movement has emerged in the aged care sector among older residents and their families, driven by anger over staffing cuts. They have joined forces with care staff, nurses, and unions in a campaign advocating for fair treatment of both staff and residents. In August 2024, a protest took place outside Arvida’s Village at the Park in Wellington, sparked by a proposal to reduce weekly care hours by 400. The facility, home to approximately 220 independent residents, also accommodates 45 people in secure dementia care and another 45 in rest home and hospital-level care. The proposal outraged residents and families due to inadequate consultation, unanswered questions, and assurances that care quality wouldn’t be affected. Although registered nurse hours weren’t reduced, all 12-hour shifts were shortened to 8 hours, significantly impacting hours for enrolled nurses and caregivers, now called ‘wellness partners'. Nearly 70 staff members had to reapply for their positions, resulting in two redundancies and one resignation over unsuitable shifts. Remaining staff now face varied contracted hours and new shift patterns. In a group interview, residents and their families expressed concerns about health and safety risks, citing personal experiences in dementia and hospital care. Three independent residents and three partners of individuals with dementia, aged in their late 70s and 80s, shared their views. Leaders of this protest group are encouraging other residents and families nationwide to join them in a broader aged care consumer movement. They aim to collaborate with the Retirement Village Residents Association to strengthen the consumer voice and increase resident agency in care issues. IMPACT OF THE PROTEST The protest has fostered a sense of solidarity between some residents and care staff. One resident noted, "From my perspective, some staff feel very supported by residents. There’s a new, personal connection—asking each other how we are. This reciprocity in the café is meaningful and something to build on." Another resident added, "An allianc e with unions, especially E tū, and independent residents is a powerful new factor in this movement. As younger people enter retirement villages, they’ll bring energy and commitment to improving this space." Residents believe Arvida management’s response to their protests has been slow. "They thought they’d do it quietly," one resident remarked. "Cuts are happening everywhere, yet we’re the only ones protesting." The protestors have made waves through notices, petitions, rallies, and media appearances, aiming to raise care standards across all retirement villages. COST CUTTING E tū has been unable to obtain the updated staff rosters at Village at the Park; however, residents confirm that 12-hour shifts were shortened to 8 hours. Staff feedback was largely ignored, with workers needing to reapply for jobs, and most requests for specific shifts going unaddressed. While some staff members left, a minor concession was made to retain a dementia care activities coordinator, though with reduced hours. Residents and their families suspect that Arvida’s cost-cutting measures were implemented prior to its sale to the US private equity firm Stonepeak. Despite Arvida’s claims that the cuts aren’t linked to the sale, residents fear the impacts of foreign ownership, expressing concerns over a lack of accountability. “How can we expect improvement under foreign ownership, with no way to hold them accountable?” MOTIVATIONS FOR PROTEST Residents and families involved in the protest cite a mix of altruism and self-interest as their motivation. “This issue has gone on too long, worsening each year. We came here expecting quality care—our blood is in this now.” One interviewee recalled a 2019 United Nations report criticising New Zealand’s care for older people. “From what I’ve seen, that report was accurate. You can’t have four staff for 24 people in a dementia ward and call that safe. It’s a health and safety risk for everyone.” The interview took place two weeks after the new rosters were implemented, with specific incidents noted that highlighted staff shortages in the dementia unit. STAFFING RATIOS AND POLICY The interviewees strongly advocated for staff-to-resident ratios in Ministry/Te Whatu Ora guidelines. “Australian guidelines have ratios. If New Zealand’s standards included staffing ratios, it would provide clarity and support for proper staffing.” They fear the impact if carers were to strike, expressing that a walkout would be catastrophic for resident care. Arvida recently introduced five wellness principles: “living, eating, moving, engaging, resting, and thinking well.” However, residents argue that these principles don’t reflect the reality they experience. A spokesperson for Arvida told Radio New Zealand that staffing levels have been adjusted to slightly above pre-COVID levels. DEFINING DECENT HEALTH CARE Residents insist that quality care requires adequate staffing, respect, and the involvement of residents in decision-making. “Retirement villages profit from elderly residents. It’s high time management understands the importance of treating residents with respect and enabling our agency.” They further pointed out that if issues like these affect wealthy residents, the experience could be even worse for those with fewer resources. “We aren't merely passive dependents. We have perspectives and can contribute to solutions. We just need the chance.” E tū conducted a survey of 1,562 of our union members working in care and support, looking at their experience working in the sector. The full survey report is available in the complete Transforming Care Report, visit www.etu.nz/tcr24 to check it out. Below are some of the key findings from the survey. Over 40% of respondents would increase their hours of work if they could. If you were able to, you would..
Less than 40% of respondents have had a pay rise in the last year. When was your last pay rise?
Over half of respondents felt there were not enough staff at their work to give quality care. Do you feel that there are enough staff at your workplace to give quality care to your residents/clients?
Over 40% of respondents said they needed more time to do their jobs properly. Do you feel that you are allocated enough time to give quality care to your residents/clients?
Nealy 40% of respondents experienced violence and/or harassment in the last year. Have you experienced violence or harassment in the workplace in last year?
Over half of respondents didn’t think their employer was taking incidents of violence and harassment seriously enough. Do you feel that compliant about violence and harassment are taken seriously and dealt with accordingly?
RECOMMENDATIONS The changes needed to transform care will be significant and comprehensive. With the experience E tū has from our work in the sector and the input from our mem bers and community stakeholders, we have developed the following simple recommendations in line with our identified pillars of care. Value of care
Standard of care
Funding of care
We know that transforming care will require a coordinated effor t from many different stakeholders in civil society. Our Transforming Care campaign invites participation from a wide range of key players and organisations. Check out the full Transforming Care Report at www.etu.nz/tcr24 to read contributions from people and organisations who support this kaupapa, including:
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