«Acknowledgements First of all, thank you to all who took the time to complete the survey. We would very much like to acknowledge the support of the ...»
THE NEW ZEALAND AGED CARE
WORKFORCE SURVEY 2014
A FUTURE OF WORK PROGRAMME REPORT
Katherine Ravenswood, Julie Douglas, Stephen Teo
‘Working a full day, 8 hours or longer but over a 12 hour day, receiving no compensation for working through
lunch and dinner times. Unreasonable travel pay does not recognise the costs of keeping a vehicle on the
road. When describing my job to people they are usually very surprised and amazed that anyone could work like this in a Westernised country. I do this job for love. I appreciate your survey, take the results to those who can make a difference’.
– home/community caregiver Acknowledgements First of all, thank you to all who took the time to complete the survey.
We would very much like to acknowledge the support of the New Zealand Work Research Institute and the AUT University Faculty of Business & Law which has supported this survey.
The survey was developed in consultation with an industry reference group and we would like to thank the following
organisations for their input (alphabetical order):
• BUPA Care New Zealand Limited
• Care Association of New Zealand
• Community and Home Health Association
• New Zealand Aged Care Association
• New Zealand Nurses’ Organisation
• New Zealand Service and Foodworkers’ Union
• Public Service Association We were also assisted by a number of students and researchers along the way and we would also like to acknowledge their
contribution, especially that of Diep Nguyen:
• Ailine Autufuga • Vea Mamanu
• Leah Brewster • Annie Ng
• Pranita Anand • Margrette Pulotu
• Cythnia Fernandez Roich • Sally Tran
• Hana Mose ISBN: 978-1-927184-28-8 Authored by Katherine Ravenswood, Julie Douglas and Stephen Teo Contents
1. Introduction 01
2. Background 02
3. Our Approach 06
4. Home Care Workers 07
5. Residential Aged Care 19
6. Conclusions 27 Executive Summary This report details findings from the New Zealand Aged Care Survey 2014, supported by the New Zealand Work Research Institute and the AUT University Faculty of Business and Law. The survey questioned both employees and managers in residential and home/community aged care about who is working, and what their experiences are. This report focuses on employee responses, and specifically those of non-nursing direct care workers, referred to throughout as ‘caregivers’. Close to 600 participants in home/community aged care returned surveys and nearly 300 residential aged care employees returned surveys.
There are a number of similarities across both residential and homecare aged caregivers’ work experiences. As expected, both home/community and residential care are highly feminised and an older workforce. For both, key sources of job dissatisfaction are low wages, high workload, abuse from clients/residents, and lack of support from managers. However, the issue of a high workload was raised more by residential caregivers than home/community caregivers as a negative issue for their job.
Interactions with, and care for clients/residents was positive and important for both groups of caregivers in the survey. Good and supportive workplace relationships with colleagues and managers are very important to residential and home/community caregivers. Home/community care workers also liked the flexibility of their work and hours.
Most participants perceived that they had the skills and knowledge to carry out their jobs, and had worked in aged care for some years. A significant proportion held national qualifications in aged care support. Residential based caregivers had more managerial support for completing qualifications than those based in home/community work. Participants want to engage in further training and career development.
While fewer in number, participants noted stress (from workload, negative workplace relationships, the emotional work of caring for the aged and ill, situations resulting in death) and fatigue as negative issues, and health and safety concerns. There was greater reporting of abuse from clients/residents among the residential based caregivers. Workload and stress was a more significant issue for the residential aged care participants.
1. Introduction The survey was inspired by the 2012 Australian Aged Care Census report. At that point there was no similar nationally based survey of the entire aged care workforce in New Zealand. There has been considerable research now into residential aged care work and the workforce in general, but still not as much in home/community caregivers in aged care.
We intended to capture the most complete data set as possible, given our resources, and knowing from discussions in developing the survey that high response rates are often difficult in the aged care sector. We do not report here on responses from managers as we feel there were too few responses to be able to report meaningful conclusions. However, there are sector-wide initiatives underway using census data and also working with providers to gain a more accurate overall headcount of caregivers. While we are not able to provide a ‘headcount’ of the sector, this first survey provides a realistic benchmark and sound information on aged care workers’ experience of work in this sector. This is particularly so for community and home health workers.
The release of this report is timely. It contributes to our knowledge of the sector at a time where we have seen Kristine Bartlett succeed in the Equal Pay Act case1 in 2013. The Equal Pay Act case followed on from the Human Rights Commission inquiry and Caring Counts report in 2012, and its associated aged care summits. There is now, perhaps enforced, recognition that the aged care sector can no longer remain ‘under the radar’. In 2013 legal action by PSA members regarding travel time between home care clients was the catalyst for negotiations between the Crown and unions, employers and funding agencies, with the resulting agreement due to be ratified by key stakeholers in 2015. There is also work with key stakeholders in the home and community health sector to develop more regularised work for employees. These all follow on from the Human Rights Commission inquiry, and subsequent summits, led by Professor Judy McGregor in 2012, highlighting ongoing issues for the workforce and its management. Another recent national initiative is that led by Careerforce and Health Workforce New Zealand into Workforce planning for the total (not just aged care) unregulated care workforce.
In the following report we provide some background information from international research that has been carried out in both residential and home/community aged care. We then present the findings from the survey. We focus on non-professional carers in home and community health and in residential aged care. These are grouped around responses to the nature of the work, who the respondents are, job satisfaction and retention, occupational health and safety, and skills, training and qualifications. We have refrained from including recommendations because the purpose of this report is to provide information that is publicly available to all interested parties to inform their planning and policy for the workforce. We hope it is used constructively.
We will be running the New Zealand Aged Care Workforce survey again in 2016 and look forward to your participation in it.
Service and Food workers Union Nga Ringa Tota Inc v Terranova Homes and Care Limited  NZEmpC 157 ARC 63/12
2. Background It is widely accepted that our population, and those of other OECD countries, is aging in proportions we have not seen before. The aging population has led to us thinking about the relationship between work and the reality of an aging workforce2. It has also led to discussions about how we will care for the increasing number of older people, and who in an aging workforce will do that care. Projections indicate that we could face a significant labour shortage in aged care in the short, medium and long term future. Some of those shortages may be met with increased migrant workers, but how we manage the workforce will be important in order to be able to upskill them to meet future demands and requirements, but also to retain quality workers and keep them in the aged care workforce3. We focus here on the non-professional direct care workers, which we will refer to as caregivers (the role is also known as healthcare assistant or personal care assistant among other variations).
We therefore need to have a good picture of not only the numbers and demographics of workers in the aged care workforce, but also what their perceptions and experiences of the work are. This ‘picture’ needs to be updated regularly so that we can adjust and plan accordingly. The New Zealand Aged Care Workforce Survey 2014 provides the first, or benchmark, in what we hope will be a series of surveys that will update what we know about the aged care workforce – across both residential and home/community care settings.
There are several areas that are important to a positive work experience that have an impact on the retention of valuable and
• what work are they doing
• how the work is organised into shifts and regular hours of work
• work conditions and the work environment
• qualifications, skills and training
• occupational health and safety
• job satisfaction and quitting intentions Who is in the workforce?
Exact numbers are hard to identify, although we can get a good indication through Census data. There are also national initiatives underway to provide data on total numbers in the aged care workforce. Callister et al. (2014) give an overall picture
of the New Zealand aged care workforce in residential services4 :
• the majority are women
• aged over 45
• approximately 31% born overseas (residential)
• original countries of birth most common among migrant workers in residential aged care: Pacific Islands, Asia and the UK/Ireland
• of all caregivers, 68% European, 15% Maori, 14% Asian, 9% Pacific Peoples For example, McLeod, L. and Bentley, T. (2015), Managing an Aging Workforce. Auckland: EEO Trust and the New Zealand Work Research
Nana, G. (2014) Health & Disability Kaiawhina workforce 2013 profile. Presented at the Careerforce Workforce Development Conference 2014, Wellington, New Zealand: Careerforce New Zealand. Retrieved 14 December from http://www.careerforce.org.nz/wordpress/wpcontent/uploads/Presentation-Dr-Ganesh-Nana.pdf Callister, P., Didham, R., & Badkar, J. (2014). Reliance on migrant caregivers, a 2014 update (Wellington, New Zealand). Callister & 2 Associates. Retrieved from www.callister.co.nz What work is the aged care workforce doing?
We have some indication that direct care employees (non-nurses) have experienced an increase in workload over several years – client/staff ratios have increased5. The work has also got physically and emotionally harder as older people are frailer now than previous decades when they enter care6. Some evidence points to tasks that were once carried out by registered nurses now being delegated to caregivers7. There is also anecdotal evidence that many workers in residential and home/community aged care do not have guaranteed hours per week, even when they are permanent employees. How work is organised – the kinds of shifts, availability of hours, travel time between clients, for example – is important for employees’ job satisfaction8.
Carryer, J., Hansen, C., & Blakey, J. (2010). Experiences of nursing in older care facilities in New Zealand. Australian Health Review, 34, 11–17;
Haultain, R. (2011). Take a stand - sign the charter for quality aged care. Kai Tiaki. Nursing New Zealand, 17(3), 23; Kiata, L., Kerse, N., & Dixon, R. (2005). Residential care workers and residents: the New Zealand story. The New Zealand Medical Journal, 118(1214), 1–11.
Boyd, M., Kerse, N., von Randow, M., Chelimo, C., Whitehead, N., Connolly, M., Walters-Puttick, S. (2008). Changes in aged care residents’ characteristics and dependency in Auckland 1988 to 2008. Findings from OPAL 10/9/08 older persons’ ability level census. Auckland, New Zealand: The University of Auckland.
Networkers. (2005). A snapshot of staffing levels in aged care services. A report to the New Zealand Nurses Organisation. September 2005.
Wellington, New Zealand: New Zealand Nurses Organisation. Retrieved from www.nzno.org.nz Clarke, M. A. (2015). To what extent a ‘bad’ job? Employee perceptions of job quality in community aged care. Employee Relations, 37(2), 192–208.
What are the work conditions like in aged care?
We can no longer dispute that wages are low in aged care in both residential and home/community care. Wages average little more than the minimum wage which in 2014 was set at $14.25 per hour. As a comparison point, the New Zealand Living Wage for 2014 was set at $18.809. In residential aged care, many caregivers are paid less compared to other occupations within residential aged care. Indeed, this argument was made in the landmark case under the Equal Pay Act 1972, won by Kristine Bartlett and the Service and Food Workers’ Union against her employer. Some describe the low wages in care work compared to other occupations as ‘wage penalties’ 10.
The work environment and relationships between employees and managers is very important for aged care workers to feel valued and appreciated. This includes managerial support, but also managers consulting with their aged care employees and keeping them informed on what is happening in the workplace. Keeping workload at a reasonable level is also important – a high workload and the resulting stress can influence employees to quit11.
One aspect of the work environment is the autonomy or freedom to make decisions about their work, with appropriate managerial support, that employees have. Greater autonomy leads to greater satisfaction and retention among aged care employees12.