No time to care?
Home-care visits are a lifeline for elderly New Zealanders, so why are they being cut short? Bess Manson reports.
Mary Singleton is 82. The former pianist and teacher has outlived her family and many of her friends. She can go weeks without seeing anyone, apart from her home-care workers, for whom she has great affection.
But those precious visits are being slowly eroded by district health board home-care provider Nurse Maude. Just before Christmas, her carer’s twiceweekly 45-minute visits to shop, clean and cook were cut to 39 minutes. They had already been reduced by an hour a week last year.
‘‘These 39 minutes were to be broken down to 13 minutes vacuuming, washing floors, cleaning the kitchen, bathroom and toilet; 13 minutes preparing food; and 13 minutes shopping,’’ says Singleton, who lives on the Ka¯ piti Coast, north of Wellington.
‘‘It’s ludicrous and impossible to implement. I know of one customer who receives help in taking medication who has had her time cut from 15 minutes to 13 minutes.
‘‘There is no time for even minimal socialising with clients who may be isolated and lonely.’’
Sometimes she does not see another person for days, and her home-care support worker is a link to the outside world, she says.
‘‘I once didn’t see anyone for 17 days around Christmas and new year. When you’re old, your friends and family begin to die and many of my contacts are only by email. Nurse Maude doesn’t have any allowances for individual circumstances – it’s a rigid system. I would say inhumane and disrespectful.’’
John Shrapnell has been receiving care at home through Nurse Maude services for the past year.
Just before Christmas, he says he was told by his carers that his times had been reduced by between six and 10 minutes, though he had had no reassessment.
When he complained to Nurse Maude, he says he received a letter saying there had been no reduction to his visit time but that ‘‘minor adjustments to visit times may occur from time to time’’.
Shrapnell, of Wadestown in Wellington, says he is less concerned for his own situation, but feels for his carers, who talk of being overworked and having to complete too much in their allotted time.
‘‘Too often I have spoken with carers who’ve worked six hours or more without a break, no time for lunch and they’re exhausted.
‘‘Their schedule does not take into account the time taken travelling from one patient to another.
‘‘Nurse Maude is based in Christchurch, so they probably don’t understand the geography of Wellington and the time it takes to get from one client to another.’’
Too few doing too much
One former Nurse Maude homecare support worker says there are too few staff for too many clients.
A care worker for more than a decade, the woman, who did not want to be named, said one client’s care was cancelled after an assessment, despite the elderly woman being virtually housebound with mobility issues.
She had been caring for the client, well into her 90s, for years and was appalled that she was deemed ineligible for care.
She continued going to help the woman for free. She managed to get another assessment for her, and home care visits were restored. The support worker was not reimbursed for her care in the interim.
She was at the woman’s home when she called Nurse Maude to discuss the client’s needs, and says she was shouted at over the phone to leave the house.
She felt bullied, and left her position.
The former carer says she was fortunate enough to be able to afford to leave her job, but many colleagues had young families and rent or mortgages to pay, and had no choice but to continue working.
A Christchurch worker, who did not want to be named, says client times are determined by a computer program and appear on an app for staff.
The worker says times for different tasks performed during a visit were cut by two minutes each before Christmas.
‘‘Nobody told us our time was being reduced and, even worse, nobody told our clients. We had to break the news to them, which was very distressing.’’
Funding constraints
Nurse Maude is a registered charity and has been providing support care since 1896.
It has 942 support workers and 6741 clients in Canterbury, Wellington and Nelson/ Marlborough.
Since April last year, Nurse Maude has been jointly responsible for home care in home and community support services for people over 65 years in the Hutt Valley, Wellington
and Ka¯ piti Coast regions with Access Community Health.
According to Peter Guthrie, general manager of strategy planning and performance at the Hutt Valley and Capital & Coast DHBs, the number of complaints regarding services provided by Nurse Maude has decreased since the new service began.
Sue Bramwell, Nurse Maude general manager marketing, says client care times may be increased or decreased depending on the needs of the client, which are reviewed regularly, and that this did not affect the hours paid to the support worker.
She did not confirm whether time for tasks had been cut by two minutes per task before Christmas but said time allowed was ‘‘a guide, not a rigid rule’’.
‘‘As health needs change, we make the adjustments necessary to support them.’’
The charity is aware of the funding constraints of the health sector as a whole, and its impact on an ageing population, Bramwell says.
‘‘Our priority will always be attending to their care, which may mean activities such as putting shopping away become secondary to making sure their health needs are being met.
‘‘Nurse Maude certainly acknowledges that some clients and support workers would like to see increased care time. Our job is to make sure everyone is provided with the right amount of care.’’
Canterbury District Health Board (CDHB) contracts three providers for home-care services across the region – Nurse Maude, Access Community Health and Healthcare New Zealand.
CDHB plannning and funding manager Carolyn Guthrie says the DHB received one formal complaint in 2019 and 2018 in relation to home-based support services.
Contracts with providers do not specify the number of clients to receive services but are based on the complexity of client needs, she says.
The DHB increased the funding for home-care contracts by $613,000 for the current financial year, from $29.1m in 2018-19 to $29.6m for 2019-20.
Deluge of complaints
PSA national secretary Kerry Davies says the union has been deluged by complaints from home-care workers of DHBcontracted providers.
The union received more than 100 complaints from Nurse Maude staff, primarily from Christchurch and Wellington, in the past six months.
‘‘When they started cutting back the hours, the clients were getting less time than they had been assessed for. [Nurse Maude] gave no reasons for the cutbacks in hours for the client or the worker.
‘‘Certainly one of the complaints has been people frantically racing to get to all their clients on time and feeling like clients are being shortchanged. One thing seems to be consistent, and that is a reduction in service for clients.
‘‘It’s been a few minutes here and a few minutes there, but it all adds up. And it’s the elderly client and the support worker who are paying for it.
‘‘Workers are worried about the quality of work they are able to provide.
‘‘Cutting back hours means cutting back the support for the client and their needs. The problem is Nurse Maude is calculating the visit of a care worker down to the nth degree – 13 minutes to shop for someone?
‘‘You can’t calculate a shower down to [specific] minutes when you are dealing with someone who is frail and fragile. There’s no humanity in rushing in and rushing out. It needs to be done with dignity.’’
A wider problem
But the problem is far from unique to one provider.
The PSA receives dozens of complaints a week from homecare workers for DHB-contracted providers, including Access Community Health, Healthcare NZ, Geneva and Nurse Maude.
Their concerns include reduced hours, not getting paid breaks, incorrect pay and having to use their own phones.
‘‘We have complaints about providers scheduling client visits back-to-back or crossover of time, so no time to travel or complete a visit without being forced to leave early to get to the next client,’’ says Davies. ‘‘This seems to happen often to people.’’
The Government needs to put more money into home-care workers and change the funding model so people are paid for doing a job, not just for an hour here and an hour there, she says.
The PSA and the E tu¯ union are working together on a campaign to address issues of a lack of adequate funding for care workers. It is a work in progress.
Sam Jones, a director of E tu¯ , says the home-care sector is systemically underfunded.
‘‘The demographic of our Baby Boomer population has different expectations of how they want to live in their retirement. The only way to afford life in old age is to have a well-funded and effective homecare workforce.
‘‘It’s a false economy to underfund home-care services because, if an elderly person presents at hospital having not got the service they needed at home, it’s going to cost the taxpayer a hell of a lot more to treat them than it would be to pay a home-care worker.
‘‘We will need an army of home-care workers going forward . . . It’s going to take a real investment by our government to fix these problems.’’
The Ministry of Health says it is ‘‘aware of funding pressures in this sector arising from a growing older population and increased operating costs for provider’’.
But a spokeswoman says funding is the responsibility of DHBs, not the ministry. ‘‘DHBs have the role of weighing up all health priorities to ensure their investment is directed to the highest-priority populations and needs in their districts.’’
Meanwhile, people like Mary Singleton will continue to fight their corner for a better deal.
She says she’d love nothing more than to be able to organise a hikoi of the old and disabled, but feels too old and weak to even contemplate this.
‘‘We are all too frail for that and, because of our frailty, we feel powerless.’’ – Additional reporting: Cate Broughton