Opinion editorial: INsite looks at the Great Aged Care Debate between the New Zealand Aged Care Association (NZACA) and the New Zealand Nurses Organisation (NZNO).

With the election in just two weeks and the Beehive around the corner, the timing and venue for ‘The Great Aged-Care Debate’ felt significant.

The debate, which took place on Friday 11th November in Wellington, saw Martin Taylor, CEO of the NZACA, come head to head with Rob Haultain of the NZNO on the contentious issue of quality versus quantity in aged-care.

Chaired by Andrew Campbell – a last-minute substitute for Sean Plunket – the debate felt charged. Although sparsely attended, the audience were vocal in their support for NZNO; Taylor even referring to ‘Rob’s mob’.

It quickly became clear both sides were keen to push their agenda with political parties in the run-up to the election. While Haultain opted for emotive arguments, Taylor took a more evidence-based approach, which ultimately served the NZACA better.

The NZACA’s argument took an anticipatory beginning. Taylor began by refuting the notion that there was a crisis in terms of the quality of care provided and did so with facts, figures and findings at his fingertips. According to Taylor, 62 complaints regarding quality of care have been received for 2011 so far and only one investigated by the Health and Disability Commissioner, statistics Taylor pronounced “not bad” considering the 42,000 residents and 30,000 caregivers comprising the sector. Consumer advocacy groups like Grey Power, often vocal in other areas of healthcare, had apparently given no indication that the quality of aged care was deficient.

Predictably, Taylor went on to state the real crisis in aged-care was the insufficient number of beds required to meet the ‘grey tsunami’ set to overwhelm the sector in the next six years. With statistics serving to illustrate the extent of the projected aged population growth, few could dispute the need for building and replacing beds to meet demand. Taylor stressed the current level of government subsidy will not allow for the provision of the extra beds needed and therefore more funding is urgently needed.

The NZNO’s message was clear: they wanted what was fair and decent for the thousands of people comprising their membership. For the NZNO, fairness was fourfold, their charters requesting compulsory staffing levels with the right skill mix, fair pay in line with the public health sector to reduce turnover, a nationally recognised training programme, and a guarantee that government funding is only used for nursing and personal care of residents.

While Haultain’s argument was compelling, it appeared to hinge on isolated cases, anecdotes and emotive arguments. Certainly, few could fail to be moved by the smiling faces of health workers projected on the screen behind Haultain, or angered at the thought that some of these people have been on minimum wage for 15 years! Later in the debate, audience members added to the anecdotal heap, one describing instances of caregivers reusing continence products, catheterisation on a caregiver’s first day, and other shocking examples. But just as the Labour and Green’s travelling roadshow of horror stories boiled down to little more than giving people a chance to vent, the examples did little to halt Taylor . He acknowledged that while human error does occur, anecdotal evidence cannot override the facts that show there is no systemic failure of the aged-care sector as it currently stands.

The debate segued when Haultain turned the spotlight onto corporate aged-care providers, accusing them of shifting their focus from the quality of care to the level of returns for their shareholders. But Haultain’s comparison of meagre wages and poor employment conditions with the grand pianos and landscape gardens of corporate operators such as Ryman and Metlifecare did little to strengthen the NZNO’s quest for quality. Taylor was quick to rebut that such corporate operators profit predominantly from the retirement village sector of their businesses.

Taylor left the largely NZNO-friendly audience irritated – one questioner even declared herself so by way of introduction – perhaps because of his reliance on “robust research” and his approach to the problems facing staff at ground level, which, depending on your leaning, is either ‘blinkered’ or ‘focused’. And the frustration is understandable: the NZNO’s campaign for social justice and fair working conditions is clearly heartfelt and in many ways absolutely spot on. It’s hard to imagine an aged-care workforce not offering better care if caregivers and nurses were paid more and there were more of them at the coal-face. Few would begrudge hard-working caregivers the chance for better pay, training and conditions. Yet without proof embodied in research and statistics, it seems inevitable that claims the status quo isn’t working will continue to fall on sympathetic but unyielding ears. Certainly within the terms of this debate. The NZNO’s approach seemed to lack the oomph of supporting evidence clearly needed to make political ground.

It was the facts and figures that gave the NZACA’s case weight, if not gloss – no real solutions were proposed. While familiar, and perhaps even banal to the ears of those well-versed in the NZACA’s maxims, it was hard to dispute bald statistics and proven research.

Perhaps, the real cause for debate should be who sets the standards of care and how these standards should be quantified. For now, at least, the NZACA appeared to have the stronger hand.

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