Healthcare Assistants and Aged Residential Care: A Challenging Policy and Contractual Environment

IntroductionHealthcare assistants (HCAs) play a crucial role in the delivery of care and the well-being of older people living in aged residential care (ARC) facilities. In New Zealand (NZ) there are approximately 31,452 nursing support workers and personal care assistants working in nursing homes and in the community, with HCAs making up the majority of this workforce (Statistics New Zealand, 2013). Direct care in ARC is mainly provided by HCAs who are unregulated; a marginalized workforce, due to undervaluing of aged care services and low wages (McGregor, 2012). This aging, gendered and ethnically diverse workforce is expected to grow in response to the demands of the aging population (Kiata, Kerse, & Dixon, 2005; Ravenswood, Douglas, & Teo, 2014). There are concerns about recruitment and retention (Badkar, Callister, & Didham, 2009; Badkar & Manning, 2009; Grant Thornton New Zealand Limited, 2010; Ravenswood et al., 2014) but of equal concern is the landscape of care into which the HCA is recruited.Registered nurses (RNS) in aged care settings are responsible for the care delivered by HCAs and need to have an in-depth insight into the contemporary and evolving roles of HCAs, and the diverse challenges experienced by this workforce. Healthcare assistant responsibilities and workloads are expanding as they work with residents who have complex health conditions. Influential factors that shape the working environment of the NZ HCA were identified in a thorough review of the existing grey literature, current national policy, district health board (DHB) contract agreements and New Zealand Nursing Organization (NZNO) collective agreements. This article presents an overview of the role of HCAs in the current residential aged care environment. The authors argue that RNs need to be cognisant of the socio-political, economic and educational factors that influence HCA's ability to navigate the complexity of the aged care environment and the delivery of personcentred care in the New Zealand aged care context.Demand for aged caregivingThe demand for ARC is increasing, as are the associated costs for care and demands placed on the workforce. There were approximately 33,006 residents in aged care facilities for 2015-2016. This number is projected to increase to 40,619 for the period 2026-2027, and to 60,080 in 2031-2032 (Technical Advisory Services [TAS], n.d.-a). Currently there are 669 certified aged care facilities in NZ offering 38,742 beds (Ministry of Health [MOH], 2016a) with 90% overall occupancy rates for dedicated rest home beds, 88.8% occupancy for swing or dual beds which serve either rest home or hospital level care and 87.6% for specialist dementia beds (Kana, 2015). The DHB expenditure for the support of older people was $983 million with $590 million directed to ARC in 2016 (MOH, 2016b). The government weekly contribution for long term-residential care for individuals differs for each territorial district with the highest funding of $971.53 for Auckland City and the lowest $884.03 for Otorohanga, South Waikato, Buller, Grey, Waimate, Southland and Gore districts including Goods and Services Taxes (Chuach, 2016).The demand for ARC persists even with ageing-in-place initiatives aimed at reducing the need for rest home level care. The workforce that supports care in the home overlaps with the ARC workforce and shares similar issues. The 2002 Health of Older People Strategy (MOH, 2002) was created in response to ageing population projections and the need for a positive ageing strategy. Initiatives within the 2002 Health of Older People Strategy and the replacement Healthy Ageing Strategy (Associate Minister of Health, 2016) include improving community support so that older persons can stay in their homes longer and avoid costly ARC services. Care aimed to restore functional status is provided in the home or in the community by paid caregivers, delaying or preventing ARC admissions (Parsons et al. …