Healthcare assistants and aged residential care: A challenging policy and contractual environment

Abstract
Healthcare assistants provide the majority of direct care to the residents living in aged residential care. In New Zealand, the delivery of care is under the supervision of the registered nurse. The purpose of this article is to examine the New Zealand policy landscape and care demands in aged residential care. Within the current care environments, registered nurses are challenged by the responsibility of ensuring quality care delivered under supervision by healthcare assistants in an increasingly complex and contract driven environment. The complexity and acuity of a client population requiring specialised care challenges the constraints of care contract expectations and creates significant difficulties for both registered nurses and healthcare assistants. Variability in role identification and scope is a significant barrier to understanding the healthcare assistant workforce as a whole. Individual employment contracts between the employers and healthcare assistants promote further variability with differing role and certification requirements for hourly rates of pay. National contracts used by District Health Boards do not address the acuity creep that is occurring at all levels in aged residential care and the workload increases that directly impact registered nurse supervision of care. The overall funding of aged residential care is caught between a client population predominately funded by the State and the sweeping economic reforms that depend on privatization. Registered nurses need to have an understanding of the socio-political, economic and educational factors that influence care delivery in aged residential care.

Ngā ariā matua
Hora ai tēnei mea te kaiāwhina manaakitanga hauora i te nuinga o ngā mahi tiaki hāngai tonu mā ngā kuia koroua i ngā whare kaumātua. I Aotearoa, ka noho te horanga o te mahi manaaki i raro i te maru o tētahi tapuhi rēhita. I tuhia ai tēnei pānui hei tūhura i te ao kaupapa here i Aotearoa me ngā kawenga o te mahi manaaki i ngā whare kaumātua. I roto i ngā horopaki manaaki o nāianei he uaua te kawe a ngā tapuhi rēhita i te haepapa kia whakaūngia te mahi manaaki kounga tiketike, e tukua ana e ngā kaiāwhina manaaki hauora i raro i te mana o ngā tapuhi i tētahi horopaki matatini, mahi kirimana hoki. I runga i te matatini o ngā āhuatanga me te taumaha o ngā māuiui o ngā kiritaki o roto, me ngā mahi mātanga, uaua hoki e tika ana mō aua kaumātua, ka werohia ngā whakaaro manaaki ā-kirimana, ā, ka ara ake ētahi uauatanga nui mā ngā tapuhi rēhita me ngā kaiāwhina manaaki hauora. Kua noho ko te rerekētanga o te tohutanga o ngā tūranga mahi, me te ahunga o ngā mahi o roto hei maioro nui mō te mārama o te tangata ki te kapa kaimahi hauora nui tonu. Nā ngā kirimana takitahi i waenga i te hunga whakawhiwhi mahi me ngā kaiāwhina manaaki hauora kua ara ake ētahi āhuatanga matahuhua, nā ngā ritenga tūranga, nā ngā tohu mātauranga hoki e hiahiatia ana mō ngā utunga ā-haora. Kāore ngā kirimana ā-motu e whakamahia nei e ngā Poari Hauora ā-Rohe e tino hāngai ana ki te pikinga ake o te taumaha o ngā māuiui i ngā taumata katoa i ngā whare kaumātua me ngā whakapikinga utanga mahi e tino pā ana ki te pai o te tirotiro o ngā tapuhi rēhita ki te pai o ngā mahi manaaki. Kua mau te whāingainga pūtea mō te ao tiaki kaumatua i ngā whare kaumātua i waenga i tētahi hunga e āwhinatia ā-monitia ana, te nuinga me kī, e te Kāwanatanga, me ngā tikanga toro-whānui hou o te wā e anga kē ana ki te tuku i ngā mahi nei ki te ao arumoni. E tika ana kia mārama ngā tapuhi rēhita ki ngā āhuatanga ā-pāpori, ā-tōrangapū, ā-ōhanga, ā-mātauranga hoki e pā ana ki te horanga o te manaakitanga i ngā whare kaumātua.

Keywords / Ngā kupu matua
Healthcare assistants/Ngā kaiāwhina manaaki hauora, aged care/te manaaki kaumātua, registered nurses/ ngā tapuhi rēhita, supervision/ te tirotiro, education/ te mātauranga, retention/ te pupuri kaimahi