Beneath the Resthome Marketing

By O’CONNOR, Teresa

The gagging of an elderly woman in an Auckland resthome turned the spotlight briefly on the care of the elderly in our country. We were all appropriately appalled at such an act; the person responsible has been sacked; the Ministry of Health has put in a manager; end of story. If only.

While it was an abhorrent act, it cannot be seen in isolation from the big picture of how we care for our elderly in New Zealand. While the advertisements show old people engaged in meaningful activities, relaxing in the retirement village spa, living out their twilight lives in secure comfort and contentment, the reality is often far from these marketing images.

The bottom line in elderly care in New Zealand is that it is almost entirely owned by large companies who are making a killing out of building and running ghettoes for the elderly; they may well be luxurious ghettoes – “marble tiled and flood-lit atrium” no less in the Ernest Rutherford complex just opened in Stoke – but they are still places where the elderly live in sometimes splendid, but more often sad, isolation from the communities in which they once lived.

The organisations for which profit was not the bottom line, the public health system and churches, have almost all got out of aged care, leaving the field open to large financial institutions to move in. And they’ve done that with alacrity.

Two major chains, ElderCare and QualCare, have just merged to form Oceania, the largest chain in the business in New Zealand. MacQuarie Bank is a major shareholder.

The British private hospital organisation, BUPA, has just bought out Guardian Healthcare, and Rymans Healthcare, formed by two former policemen, last week topped a list of New Zealand’s largest listed companies for being the fastest value-creator for shareholders, with a total shareholder return of 49 percent a year over the last five years. In May it recorded a record profit of $72.6 million. And you can rest assured that precious little of that will be going to its predominantly female workforce of caregivers.

The chief executive of HealthCare Providers New Zealand, the umbrella organisation for residential aged-care facilities, Martin Taylor, last week said the average hourly wage for caregivers nationally was now $13.15. And that’s before tax. This is the princessly sum paid to those who care for one of our most vulnerable groups of citizens.

Little wonder there is constant staff turnover and that occasionally some people are employed who shouldn’t be left looking after a dog. And last year when the Government tried to link its substantial annual funding to improving wages in the sector to ensure $12 an hour was the minimum, HCPNZ took a judicial review against the legality of that and won. So we’re not talking here of the most generous-spirited of employers.

Of the country’s 750 or so resthomes, well more than 200 have no collective employment agreements, which can offer some protection to both staff and residents, in that they guarantee a minimum wage and working conditions, and sometimes include minimal funding for staff education. And there is some outside body that staff can turn to for support, if they have concerns over their treatment or the treatment of those they care for. But fear and the need for wages, however mean, keeps most silenced.

While the Ministry of Health has acted swiftly in the case of the Auckland resthome, it takes a laissez-faire attitude to the sector generally.

There are no minimum staffing requirements in the sector, hence registered nurses, who command higher wages than caregivers, are spread very thinly and are expected to be responsible for the practice of untrained, unregulated caregivers who provide all the hands-on care.

Most caregivers do that hard physical work very well. But there’s not enough of them and they are not paid enough to feel valued and respected in their work. It is the genuine affection many feel for those they care for that keeps them going.

Anybody who has had more than a passing acquaintance with resthomes and their hospital wings knows only too well that while the extreme abuse of mouth gagging is thankfully rare, benign neglect occurs almost daily in too many places. Not deliberate neglect but the neglect that inevitably follows if there are simply not enough staff to do the work.

That neglect can take the form of bells unanswered for so long the person soils their bed or tries to get to the toilet themselves and falls and tears their skin or bruises their body, or worse, fractures their hip. Or it can take the form of too few showers, so an elderly person is left smelling of urine or stale body odour.

Or it can take the form of simple thoughtlessness, where food or drink is placed out of reach of the old person. Or it can be that untrained caregivers do not spot the early signs of a developing infection so treatment is not instigated in time and the old person suffers unnecessarily. Or it can be that money goes missing from the old person’s top drawer.

Or there is penny pinching on the part of management which places limits on the number of incontinence products or wound dressing products that can be used a person a shift.

Or the old person is left alone in their room for hours on end with no meaningful interaction.

Or the supposed physiotherapy, hyped in the prospectus, actually turns out to be an untrained physio assistant who occasionally walks the old person up the hall and back.

While retirement village complexes may provide the perfect solution for well-heeled elderly couples or singles, it is when people become dependent and need resthome or hospital care that the real quality of a residential facility can be assessed.

Don’t be fooled by the glossy marketing brochures or the expensive interior decor. Ask what’s the registered nurse to caregiver ratio, and the caregiver to resident ratio in the resthome and hospital; ask what’s the hourly rate for caregivers, cleaners and cooks; ask if the managers-owners encourage union involvement in the facility; ask how often physiotherapy is provided and if it is by qualified physiotherapists. It is those sorts of measures that will give a true indication of the quality of care, not the flash gardens, the stunning water features, the plushly carpeted public areas or the shareholder returns.

(c) 2008 Nelson Mail, The. Provided by ProQuest Information and Learning. All rights Reserved.