Dr Jackie Blue: Caring Counts and Beyond

Dr Jackie Blue: Caring Counts and Beyond

May 11, 2014

SFWU Central Region Women’s Conference, Wednesday, 5th November 2014 

The number of people aged 65 and over has doubled since 1980 and passed over 600,000 in the latest Census.

This number is likely to double again by 2036. Our older people are also living for longer.

For many older people, these older years are also active years.

A 65-year-old today can expect to live independently and without assistance for another 11–12 years.

These older people are also working longer and staying involved in their local communities.

Having said that, the increasing number of people aged 65 and over – and particularly the increasing number of people aged 85 and over – do have health problems that need support.

This has major implications for our health and disability sector, including aged care, in the years ahead.

Consequently, our aged care workforce will be critical if we are to meet the health challenges of our ageing population.

Poor pay is destabilising this crucial workforce and the reality is that the aged care sector relies on a minimum wage workforce.

The high staff turnover means that there is a constant loss of skills and experience.

This work is not seen as a career path.

Workforce development is critical as we know that training and education bring about widespread benefits.

Trained staff are better at their job and there is greater job satisfaction and job retention.

The workforce supporting older people living in their own home or in community residential facilities is critically important.

These workers not only support the health and well-being of the older members of our community, they also enable the family of older people to stay in the workforce or remain connected to their communities.

The work of carers is physically, mentally and emotionally demanding.

We know that as our population ages, older people are living at home for longer before entering residential or hospital care.

When they enter a care facility they are generally sicker with multiple needs.

More and more will require rehabilitative support at home or in residential care following a hospital admission following stroke, heart attack, fall or some other event.

There are greater numbers of people needing dementia level care is increasing.

We cannot continue to be in denial of what is coming our way.

Caring Counts recommendations update:

It’s over two years on from the Human Rights Commission’s publication Caring Counts, the report of the Inquiry into the Aged Care Workforce.

When this work started people outside the industry, including the Commission, did not appreciate the skills and demands we all ask of care workers.

The Commission came to the conclusion that the value we as a country place on older people is linked to the value we place on those who care for them.

That is: not enough.

For that reason, the report was dedicated to all older New Zealanders, including our mums and dads and our grandmothers and granddads.

As well as reflecting the value placed on older people, the aged care workforce also reflects the value that is placed on women’s work – as this workforce is overwhelmingly female.

The Commission has continued the work of Caring Counts.

We are providing legal expertise as an intervener in the Pay Equality case currently before the court and providing ongoing leadership and facilitation of the work of the Caring Counts Coalition.

As a residential home carer in my University holidays, a former GP who looked after rest homes and as the daughter in law of an ageing and very sick father in law, I know from personal experience how critical it is for the well-being of older New Zealanders that aged care services are the best they can be.

And like all social services including health sector, the quality of services stand and fall on the skills, capability and capacity of the workforce.

The Caring Counts report has been the catalyst for some quite remarkable achievements.

The consensus the Commission identified in the report has resulted in the Caring Counts Coalition, an alliance of stakeholders meeting regularly to advance the implementation of the Inquiry.

It’s an informal grouping of consumers, providers, care workers, peak bodies and the sector ITO Careerforce.

It includes the CTU and the three unions covering the sector – Service and Food Workers, the Nurses and PSA.

We have some major providers represented from both the for profit and not for profit sector, residential and home support and consumer representatives such as Grey Power and Age Concern.

Our strength is that while the organisations are diverse we are united around a common cause.

As well as the formation of the Coalition, the inquiry has been used as leverage to test the Equal Pay Act, a process still in the courts.

This union has been the driving force for this action. This case has the potential to improve pay and conditions for all women in work in female-dominated occupations whose work is undervalued. You should all be immensely proud.

Behind the scenes your union and the PSA have been working away at improving conditions for home support workers especially around travel and less casualisation of work hours.

Just before the election, the Health Minister announced significant money was being earmarked to address those issues and announced a time frame for implementation.

Health Workforce NZ and Careerforce have set up working groups for a long term and comprehensive plan to develop the kaiawhina (care) workforce.

The Commission is chairing the “Workforce Recognition” stream. Key principles are that recognition is fair, equitable and valued.

But as pleased as I am about the achievements since 2012, we are not there yet.

There were ten recommendations that came out of Caring Counts.

1. Leadership: The Prime Minister ensures that the minister with responsibility for older people has a top ten Cabinet ranking to deliver better services and to provide leadership and co-ordination across ministerial portfolios. This has been progressed. Amber. 

The current Minister for Aged Care is now in Cabinet but at number 20.

2. Pay Parity: Between health care assistants working in DHBs and carers working in home support and residential facilities within the next 3 years. This has not been achieved but progress on pay is happening. Amber. 

For nurses there is basic hourly rate parity with DHB nurses, but private providers can’t compete with penal rates and bonuses.

For care workers parity and ultimately pay equity is still a dream but a dream looking increasingly possible.

If the Equal Pay Case is successful there will undoubtedly be a domino effect with other workers who work in the aged care sector such as cleaners and chefs and in other sectors where there is a predominance of women working in low-paid work.

It is important to remember that pay equity is not the same as pay parity and that is why the Equal Pay Case is such a landmark case.

As Kristine Bartlett said in her speech to the Caring Counts Forum in July this year:

“Parity is surely the deposit on equity. It’s the start of a journey so let’s not confuse it with the end.”

3. Fair Travel: The Ministry of Health and DHBs develop a sustainable and consistent fair travel policy which is annually reviewed and adjusted, and which covers the real and actual costs of travelling including vehicle costs and time spent travelling.

The prolonged Inaction on pay inequality and inadequate compensation for travel have been discriminatory breaches of fundamental human rights.

In September this year the Government’s announced that community support workers would be paid for travel time and for petrol costs when travelling between clients.

The Government also announced that a reference group will be looking at making this crucial workforce more regularised, with guaranteed hours and workloads. So that’s a green or almost green!

4. Qualifications: Providers in the aged care sector and the ITO (Careerforce) commit to ensuring all new staff achieves a Level 2 Foundation Skills qualification within six months of starting and that all existing staff achieve this qualification in the next two years.

Within five years, Level 3 should become the normal level of qualification.

This has not achieved but there have been significant gains. Amber.

Under the new Home and Community Support Sector Standard, all home support workers must also receive ongoing training to ensure they are competent and meet the Standard’s requirements to ensure the safety of the people they care for.

An increasing number of funders such as DHBs are requiring care staff to have at least Level 2 qualifications in their contract with providers.

The workforce planning Kaiawhina work also includes learning and development. Watch this space.

5. Safety Standards: The voluntary standard “Indicators for safe aged-care and dementia-care for consumers should become compulsory to ensure the protection of both carers and older people. The Home and Community Support Sector standard must also be compulsory. This has been partially achieved. Amber.

The Home and Community Support Sector standard is now in place but staffing numbers/ratios are not part of it. Set staffing ratios remains controversial.

Private residential providers state that mandatory staff levels will stifle flexibility. For instance, if someone is off unexpectedly for an hour they will have to be replaced.

This would mean their argument goes they would be watching rosters minute by minute.

The Government responded in the recent Caring Counts Political Forum:

"All aged residential care providers must comply with the Health and Disability Services Standards 2008 (the Standards) which are based on meeting the needs of residents, and do not specify minimum staffing numbers."

The Government considers it more important to focus on positive outcomes rather than measures like minimum staffing ratio.

Minimum staffing ratios risk locking in particular types of service delivery, stifling innovation, and creating barriers to more effective ways of caring for older people and improving their experiences.”

The comment from the other political panelists was that the standards need to be reviewed because of the changing acuity and complexity of patients.

6. Consumer Information: A five-star system of quality assurance comparing residential facilities with the aim of improving consumer choice and public accountability is developed and adopted for use in New Zealand by the Ministry of Health and DHBs with input from the Auditor-General. This has been partially achieved. Amber.

While a five-star system has not been instigated there are now full audit reports of care facilities made available to the public.

But the full audits are difficult for the lay person to navigate and there is a call that they are made more user-friendly.

7. Transparency: District Health Boards provide disclosure in their annual reports that makes explicit expectations about ‘passing through’ annual funding increases and details their fair travel and equal pay provisions in aged care service delivery contracts. This has not been achieved: Red.

Private residential providers also say that DHBs should be required to pass through the annual inflation adjustment that Government provides for this purpose.

They comment that funding increases to home support services over the last 5 years have been top sliced by DHBs with only small amount passed on to providers.

They add that since 2008 there has been no increase in funding to cover minimum wage increases and Kiwisaver contributions.

They also say that some DHBs are funding services better than others and as a result these DHBs are subsidising other DHBs

8. Migrant workers: Immigration New Zealand ensures information about qualifications and registration requirements is available in countries of origin and develops best practice for migrant workers in aged care. This has been achieved. Green.

Immigration New Zealand has developed guidance for migrant workers and their employers to be published and distributed in the New Year.

The Human Rights Commission and other members of the Coalition have assisted Immigration New Zealand with this work

9. Diversity of Carers: Health Workforce New Zealand provides leadership on the recruitment of men as paid carers, the promotion of encore careers in aged care, and the development of strategies that encourage part-time carers to increase their hours of work.

Health Workforce New Zealand in combination with Careerforce New Zealand is now leading work on the Kaiawhina Workforce – work streams include quality and safety, workforce intelligence, sustainability, access (which includes learning and development) career development, workforce recognition and consumer focus.

It’s a comprehensive action plan. So another recommendation in which progress is being made. Amber.

10. Valuing carers: The Human Rights Commission hosts a stakeholder summit with government agencies, peak bodies, Age Concern and Grey Power, trade unions and community groups to enhance sector cooperation and to promote and celebrate the paid aged care workforce. This has been achieved. Green.

This summit was held in late 2012 and the outcome was to form the Coalition for Caring Counts.

Out of ten recommendations four have been achieved, three, progress has been made, and one not achieved.

There is more work to be done to get all ten over the line.

Equal Pay Case:

You will be aware the Equal Pay Case is currently been heard.

Testing the interpretation of the Equal Pay Act has been welcomed by the Human Rights Commission. This Act has never been properly tested before.

The implications of winning this case are huge for women workers in New Zealand, because it centres on equal pay for work of equal value.

There are many occupations in New Zealand mainly done by women. Many of these jobs are low paid and they are low paid because they are seen as women’s work and therefore less valued.

International treaty bodies including the CEDAW committee, the ILO and ICESCR have all been critical of the apparent lack of legislation addressing equal pay for work of equal value.

It has been assumed that the Equal Pay Act did not cover equal value work.

However, a closer look at the purpose of the Act, and statements from Government over the years that assert New Zealand’s compliance with international conventions on this issue suggest that this assumption may be incorrect

I would like to acknowledge the leadership of the Service and Food workers Union in taking this case on behalf of Kristine Bartlett. It is a landmark case.

The case began in 2012 when Kristine lodged an application with the Employment Relations Authority or ERA that she was not receiving equal pay as per Equal Pay Act 1972.

In Nov 2012 the ERA agreed it should go direct to the Employment Court. All the stakeholders agreed that important questions of law should be examined before substantive case was heard.

These points of law were considered in June 2013 in the Employment Court.

In August 2013 the Employment Court supported Kristine’s argument that centered on section 3(1) (b) of the Equal Pay Act which says that:

For work which is predominantly done by females, the remuneration should match that paid to males who have similar skills, working in jobs requiring similar responsibility, effort and work conditions.

Because male care givers are also paid poorly the Court indicated that the male comparator would have to found in another industry.

In making its decision the Court took into account New Zealand’s international obligations and the relevant domestic human rights legislation; and carried out an analysis of the legislative history of the Equal Pay Act.

The Commission felt the decision was a good one. We consider that the purpose of section 3(1) (b) is clearly to provide for the equal pay of women in situations where there is no male comparator within the workplace.

In this situation, the only clear alternative is to look at industries with similar lines of work to find an appropriate comparator.

In Jan 2014 the aged care provider, Kristine’s employer Terranova appealed the August decision.

The appeal was heard in Feb 2014 in the Court of Appeal.

We found out just last week that the Court of Appeal supports the original Employment Court decision.

The case could well be further appealed to the Supreme Court or it could be accepted and the substantive case can be heard.

I would like to leave the last word to Kristine when she spoke at the Caring Counts Forum in July. She said:

On September 21st we’ll have the results of the election. And the residents will be a day older. Every day we delay respect for the carers is a day less respect for the men and women in care. And that needs to be sorted out once and for all.

EEO Commissioner Dr Jackie Blue

Dr Blue is committed to progressing human rights and issues of equity, particularly those that affect equal employment opportunities.

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