Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Current Role Challenges in New Zealand Aged Residential Care: The Potential Consequences for Healthcare Assistant Role Expansion

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Current Role Challenges in New Zealand Aged Residential Care: The Potential Consequences for Healthcare Assistant Role Expansion

Article excerpt


In the context of the ageing population and the current international debate about the educational preparedness of healthcare assistants, it is timely and important to continue to review the roles and scopes of practice for nurses and healthcare assistants who work in New Zealand (NZ) aged residential care and review the international debate about regulation, standardised education and qualifications for healthcare assistants and its relevance for aged residential care in NZ.

Population ageing is a worldwide phenomenon, with two billion people expected to be aged 60 or over by the year 2050, representing a three-fold increase since 2000 (World Health Organisation, 2011). InNZ "the number of people aged 65+doubled between 1984 and 2014 to reach 650,000. It is highly likely that there will be 1.28-1.37 million people aged 65+in 2041, and 1.57-1.81 million in 2068" (Statistics NZ, 2016, "Population aged 65+", para. 1). While there are increasing numbers of older people in NZ, there has not been a corresponding rise in the numbers of people entering aged residential care (Boyd et al., 2011). Older people report a preference to live in their own homes and communities rather than aged residential care (Grant Thornton NZ Limited, 2010; Jorgensen, Arksey, Parsons, Senior, & Thomas, 2009; New Zealand Labour, Green Party of Aotearoa NZ, Grey Power, New Zealand, 2010). Additionally government policy is directed towards supporting ageing at home with services, and to delay or minimise aged residential care admissions (Davey, de Joux, Nana, & Arcus, 2004). In spite of government support for community care, there is evidence that, compared with other countries, a high proportion of older New Zealanders is predicted to live in aged residential care at the end of their lives (Broad et al., 2013). In 2013, 31,899 people lived in NZ aged residential care. The percent of people aged 80 and above living in aged residential care varies from 17.5 to 20.5 depending on region of residence (Statistics NZ, 2015). As residents in aged residential care are likely to have more complex care needs than has previously been the case (Boyd et al., 2011), it follows that a skilled and knowledgeable workforce in greater numbers will be required (Grant Thornton NZ Limited, 2010).

The NZ aged residential care workforce statistics illustrates the relative numbers of regulated and unregulated staff. Grant Thornton NZ Limited (2010) estimated that there were approximately 18,150 unregulated healthcare workers employed in NZ aged residential care. The Nursing Council of NZ statistics reported that 794 enrolled nurses (ENs) and 4469 registered nurses (RNs) were employed in residential care settings in 2015 (Nursing Council of New Zealand, 2015). These figures demonstrate that the majority of direct care in NZ aged residential care is provided by unregulated healthcare workers in line with international figures from Australia, Canada, the United States and the United Kingdom for the equivalent workforce (Badkar & Manning, 2009; Grant Thornton NZ Limited, 2010; McCloskey, Donovan, Stewart, & Donovan, 2015; National Institute of Labour Studies, 2012; New Zealand Labour et al., 2010; Willis Commission, 2012) which leads to the question of appropriate skill mix and staff support to best meet the changing level of resident care need.

The argument presented in this paper spans the current work, education and remuneration situation for healthcare assistants in aged residential care and includes educational levels and supervisory relationships between RNs, ENs and healthcare assistants together with the interplay between organisation and practice in aged residential care. Included in this argument is the consideration that developing and improving the work of the healthcare assistant has the potential for change in all clinical roles in aged residential care.

What this paper adds to the debate

1. The current role expansion (RN, EN and healthcare assistant) has led to confusion between role expectations and regulatory requirements. …

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