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Home care deserves more respect

Health Issues Healthcare

Abby Beswick18 November 2020

Napier-based carer Tamara Baddeley and I are due to speak at 1.45pm. At 1.38pm she texts: ‘Hi Abby. I’ve just got home. Can you give me 10 minutes to get some lunch?’ 

A home and community support worker for 21 years, Baddeley works on average 24 hours a week, for $23 per hour. She isn’t rostered for breaks, so is forced to grab a bite to eat while driving between clients or, like today, wait until she gets home.

Tamara Baddeley with client.

Today, her first client was at 8am — a 37-year-old woman who suffered a traumatic brain injury at birth, resulting in physical and intellectual disabilities. Baddeley’s allocated visit time is one hour and 15 minutes, during which she gave the woman a bed bath (time restrictions mean clients usually only have a shower three times a week, with a bed bath on alternate days), brushed her teeth, used a sling and hoist to get her into an electric wheelchair, tidied the bedroom, put the washing out, put the rubbish out, made a cup of tea, prepared lunch, put the wheelchair into the car, transferred the woman into the car, drove her to her day programme and returned her car home. 

Baddeley carried out similar tasks for her next two clients: a lady in her mid 60s who is recovering from a stroke and a man in his late 60s who is a paraplegic due to a car accident several years ago. She’ll see one further client later in the day.

As a carer, Baddeley and her colleagues are the front-line workers who ensure some of our most vulnerable members of society are happy, comfortable and well looked after. These workers are essential to the more than 2,600 senior clients in the region who they care for, enabling them to remain independent and at home as long as possible, relieving pressure on our hospitals and saving millions on aged-care costs. 

 

As we face the impact of an older population, the role of carers has become increasingly valuable. Yet they remain among our most undervalued workers in the country.

A daily challenge

New Zealand Health Group, which owns Geneva Healthcare and HealthCare NZ, is the country’s largest provider of home and community support services. Along with other private providers and not-for-profit organisations, they employ carers like Baddeley to look after our elderly citizens. 

Despite spending more than two decades in the industry, little has changed, says Baddeley. She describes a sector stuck in a time warp of poor pay, hours and conditions at the expense of carers and clients — “the very people they’re supposed to support”. 

Every day it’s a struggle to perform the required duties for her clients in the time allocated. In addition to household work, she helps clients with personal tasks like showering and dressing. It’s not something you can rush, says Baddeley. You need to take time to get to know a client, make sure they feel comfortable and learn to do things their way. Baddeley encourages her clients and gives them the confidence to do small tasks for themselves, while she fills in the gaps. It’s constant, demanding work that requires physical strength, adaptability and a gentle touch as she navigates the most intimate personal care.

The main private care providers for home support are Geneva, Health Care of New Zealand and Access Community Health (Green Cross). Along with some other medium size private providers and a number of not for profit organisations, they employ workers like Baddeley to care for our elderly citizens. 

As client demand has grown, Baddeley has watched care services that were already under pressure become dangerously overstretched. Time restrictions mean carers now spend less time with clients, some employers refuse to roster travel time between clients or breaks for carers, and work hours aren’t guaranteed, to allow employers the flexibility to cut workers’ hours as clients come and go.

“We’re not prepared for the amount of care that we’re going to need in the future because we can hardly cope with the level of need in the community now,” says Baddeley. If nothing changes, clients simply won’t get the care or carers will stay overtime to give them what they need and not get paid for it, she warns. 

Covid brought an additional set of challenges. During lockdown Baddeley worked seven weeks without a day off to ensure clients’ needs were met and visitors to their homes were kept to a minimum. To keep her and her clients safe, between each visit she went home, showered and changed. There was also a lack of PPE available through employers, so Baddeley sourced her own and sent it to workmates who needed it.

There’s another part of the job that’s not often talked about – dealing with the death of clients. During two of her worst years, Baddeley lost 16 clients and throughout her career, she’s lost more than 50. 

At times the emotional and financial stress has been overwhelming, says Baddeley, who admits being close to burnout more than once. “I haven’t chucked it in yet. I’ve been tempted a few times.”

“It’s women’s work”

To be frank, Baddeley and her colleagues do the work many of us wouldn’t want to do, yet we know our parents or ourselves, could one day desperately need her care. Why then have carers remained at the bottom of the pay scale, unappreciated and unrewarded for their work?

That’s simple, says Baddeley. “It’s women’s work. It’s what women do. They do it at home – they look after the kids, they look after the husband, they look after the in-laws or their parents and their grandparents. They’ve always done it; it’s part of their DNA. So they don’t need to be paid for it and if they are, let’s give them the bare minimum. That’s what it has always been.”

So why stay? “I love the variety of people I get to meet and support, and the fact that I’m always learning from them. I get to be a part of their life for however long the time is that I’m with them.” 

“You build up relationships with these people. We’re not supposed to, but we’re not robots. You cannot go into someone’s house and undress them, shower them, dry them and redress them and not develop some sort of a mutual respect and friendship.” 

A win, but it’s not enough

Carers have been fighting for change for years. Alongside her role as a carer, Baddeley is convenor of the community support services council in NZ trade union, E tū, which represents workers in residential and community aged care, disability, and mental health. Baddeley and a team of representatives spent five years campaigning for equal pay for workers in carer roles, arguing that their low rates of pay were the result of systemic gender-based pay discrimination. 

On 18 April 2017 more than 50,000 workers in the sector celebrated victory, with the Care and Support Workers (Pay Equity) Settlement Agreement. This resulted in pay increases of up to 45% for care and support workers, who can currently earn up to $25.50 per hour, at the highest pay rate (Level 4 qualification). This top rate will peak at $27 per hour next year, the final year of the settlement. 

The pay settlement is great, but there are other significant issues in the industry that need addressing, says E tū director of health, Sam Jones. Top of the list are ensuring employers stick to their commitment under the legislation to put people through training, particularly at the higher levels, and provide them with enough hours to have income security. Currently they’re falling short on both fronts, he says. 

“What we do see is employers really reluctant to train people in Level 4 in particular and that’s because people will end up on $25.50 at the moment, and $27 from next July.” Employers aren’t rewarded for having a workforce trained to the highest level, says Jones. “The funding model incentivises these employers to not train everyone up to that level and that’s the opposite of what the Government wanted to achieve when they set it up.”

Work hours are also going in the wrong direction, says Jones. In-home carers are typically guaranteed 15-18 hours a week. There aren’t enough carers, yet employers don’t guarantee workers anywhere near the hours they deliver, says Jones. In fact, statistics show as little as 20% of the total hours delivered are guaranteed to workers. The main reason for this is despite consistent volumes of work, providers pass the risk of losing clients onto the workers, to avoid paying them if they don’t have replacement hours available. 

Adding to this is a system set up to provide clients with care during two main blocks of time — morning and night. While some care needs to be done at set times, such as medication and health needs, other tasks like domestic duties could be done at other times. However, extra travel time and costs remain a barrier. “At every level, not enough has been done to spread some of this work across the day to facilitate decent jobs with enough hours”, says Jones. The fragmented nature of funding, split between the Ministry of Health, DHBs and ACC and multitude of private providers has compounded the issue, leaving workers in a constant state of financial uncertainty. 

“The stress that it adds to your life, every week, hoping you’ll get rostered for enough hours is unbearable. What it does is it stops young people coming into the industry and it drives people out of the industry. It’s diabolical,” says Jones.

The union is also campaigning for paid travel time between clients as this is currently often not rostered, even when client visits are back-to-back, making it impossible for workers to meet their schedule. 

Home care is meant to be the Government’s answer to supporting our ageing population in an affordable way, but the sector isn’t being treated in a way that makes it a viable answer, says Jones.

Care on Call, which employs more than 90 carers in Hawke’s Bay, refutes the claims. Spokesperson Kristina Fleming says the company rosters and pays staff for travel time and breaks, and supports them to upskill. Patterns of work are reviewed every few months and guaranteed hours vary between carers, she says. “It’s a dynamic environment and demand for services moves around a lot.” 

New Zealand Health Group chief executive Josephine Gagan also says guaranteed hours vary between staff depending on their role, training, availability and client needs. Workers are provided training, upskilling and professional development opportunities. Break and travel times are managed as part of rostering, she says. “We work closely with staff and the unions regarding the terms of employment and pay.”

Our ageing population

Like everywhere in New Zealand, the population of Hawke’s Bay is ageing. There are 30,390 people aged 65 or older in the region, according to Statistics NZ. Ten years ago the figure was 20,490. The bottom line is, this growing number of elderly citizens is putting increasing pressure on an already stretched health system.

A recent DHB board report on Ageing Well in Hawke’s Bay highlighted a number of risks impacting our ageing population. These include the need to attract and retain a skilled workforce, limited capacity with growing demand, service gaps and an increase in complex cases. 

As the number of seniors goes up, so does the cost of care. There are three funding streams for senior home care: the Ministry of Health, ACC and the District Health Board. In the 2019/20 year, Hawke’s Bay DHB spent $19,810,278 (excluding GST) on home support. Compare that to the two previous years, 2018/2019 and 2017/2018, when it spent $18,321,095 and $16,956,900 respectively. The money is used to provide bulk funding to private companies that employ carers and community organisations that fund home care support services.

In response to our ageing population, the DHB is following guidelines set out in the national Healthy Ageing Strategy — a 10-year plan aimed at improving the health of older people. As part of this the DHB is undertaking a number of strategic approaches, underpinned by increased home care and community support. This is aimed at keeping people well at home and able to return home safely from hospital as soon as possible. 

Making inroads

In spite of an often-bleak picture, there are also bright spots. Community organisations are a huge source of care, support and social connection for our senior citizens. 

Enliven, run by Presbyterian Support East Coast, offers intensive home support and day programmes. These are funded by the HBDHB, Ministry of Health and ACC and provide physical, mental and social wellbeing to elderly people. Home support clients receive specialised care from a team of experts that maximises their independence and helps them achieve their goals, with an overall aim of keeping people safely at home along as possible. 

Currently, 250 local seniors use the service and demand is increasing, says Presbyterian Support East Coast social services general manager, Mary Wills. Their services are continually evolving to meet changing needs. One such area is increased diversity of older people. “In the next 20 years we’d expect to see more Māori and Pasifika people in that older age group, so our services need to respond to that,” says Wills.

Age Concern seniors afternoon tea. Photo supplied.

Age Concern seniors afternoon tea.
Photo supplied.

Charitable organisation, Age Concern, is dedicated solely to supporting people over 65 and provides a range of government and non-government funded services. These include, intervention services for people who need social support or community care, ageing well services to keep people healthy and active, and social connection. 

Last year they supported 8,000 Hawke’s Bay members, and Covid has triggered increased demand particularly due to social isolation, says Age Concern Havelock North manager Carol Winters. Their services are a lifeline, says Winters. For some elderly people, their carer will be the only person they see. After 10 years in the organisation, she’s watched the level of need for aged care and our response as a society, change dramatically. Carers play a “hugely valuable” role, says Winters. 

In December last year, Hawke’s Bay District Health Board launched home support service Hoki ki te Kāinga. Targeted at older people, the service supports medically stable hospital patients who prefer to be at home, to return earlier than they otherwise would. The short-term intensive programme funded by ACC and the DHB helps clients regain their wellbeing and physical abilities, with therapist visits up to four times a day to help with things like exercise, dressing, showering and cooking meals. 

Hoki ki te Kāinga team leader Amy Williamson says the aim of the service is to get people back to being as independent as possible and building their confidence so they can continue to live in their own home as long as they want to. Māori and Pasifika clients have particularly responded to the service positively as whānau support is such a strong part of their wellbeing. 

Being at home surrounded by loved ones rather than isolated in a hospital plays a significant role in their rehabilitation, says Williamson. “People have been incredibly positive about the service. It’s all about making it work for the person and what they want,” says Williamson. There’s been huge demand for the service, which has supported 150 people to-date, and they’re already looking at ways to increase the number of people they can support.

What needs to change?

In spite of best efforts, we’re in no way prepared to meet the growing need for senior care as we head towards the bell curve of an older population. The demand it is already putting on our health system, front-line care staff and families is unsustainable. 

Private care employers say they’re regularly meeting with funding agencies and reviewing their services to clients as part of future planning, but it’s not enough. 

“We’ve got more older people needing help, we’ve got no more money and we’ve got the services needing to go around,” says Winters. As a result, the allocated amount of time a carer spends with a client has to be shortened. She’s seeing carer fatigue “big time” – both in paid carers and family members, often elderly themselves, who take on a carer role. “It’s unbelievable and none of this is going to get any better,” she says.

Jones advocates for better treatment of carers across the sector, including guaranteed hours, delivery of training, and support for workers. He would also like to see carers employed directly by district health boards, rather than private companies. This would ensure workers are treated fairly and allow our trained care workforce to be utilised in the best possible way, particularly during situations like a pandemic, he says.

The pay equity legislation expires in June 2022, when the union will be re-engaging with the Government. Slipping back to the minimum wage is not an acceptable outcome, says Jones. They will continue to fight for workers’ rights and take individual employers to the Employment Relations Authority who fail to comply with the legislation. 

Finally, and possibly most importantly, attitudes towards carers need to change. If there was a greater level of respect from managers, employers and the community, everything else will follow, says Baddeley. “How can looking after someone not be considered a real job?” 

Photos by Florence Charvin

Abby Beswick18 November 2020

2 responses to “Home care deserves more respect”

  1. Rosemary Marriott says:

    Home support workers are a godsend to those who receive their services and deserve better recognition and working conditions. It’s a no-brainer that better funding is economically beneficial as well through being able to maintain elderly and disabled people in their own homes. However their is confusion in calling them carers – carers are those 10s of thousands of people who are caring for their loved ones 24/7 and who are largely unpaid and who give up their work, their life to care for those who need it. They are grateful for the few hours support a week they receive from support workers. Home support workers are called as such in their employment contracts – there is no such confusion from the agencies.

  2. Mother says:

    I am the mother of this young lady and I would like it to be known her carers are always allocated ample time to perform tasks safely and throughly… all of her carers are aware that if they need more all they have to do is ask me. This is an exception not a rule that I am very aware of, as I do know most carers don’t have that luxury

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