Paul Barber, Policy Advisor, NZCCSS
Demand for home and community support services will continue to grow over the coming decades, largely driven by population changes including an ageing population. Alongside this increasing demand is the fact that more than half of the support workers in the sector are aged 55 or over.
These are some of the multiple challenges and opportunities are before the home based support sector in this country in responding to three broad trends in our society:
- urban centres growing and provincial parts shrinking
- growing number of older people compared with younger people with associated health provision implications
- increase in migration leading to more ethnic diversity.
The number of older people of Asian ethnicity will nearly treble from 59,500 to 164,100 in the next 15 years (to 2033) while older European ethnicity will grow by nearly half as well, meaning an increase of 276,300. This population change will bring with it increased support needs. So the challenge is to recruit and train more support workers to help meet this need.
Comparatively little is known about the current state of the home and community support workforce. This is despite it being a 16,000-strong workforce, responsible for providing home support services for approximately 75,000 people aged over 65, numerous New Zealanders recovering from injury, and 7900 people living with disability in 2017.
Careerforce, the Industry Training Organisation for the health and disability sector, commissioned the report Spreading our Wings – A Report into the Training and Development Needs of the Health & Disability Home and Community Workforce to help understand the emerging health and wellbeing needs of people living at home and how that translates into developing the support workforce. The report was compiled by the Home and Community Health Association, peak body for the sector.
Andrea McLeod, HCHA Chairperson, commented that “The report confirmed concerns we have about our workforce, in terms of aging and supply. The home support workforce is generally older than other health workforces, and there is not an obvious pool of replacements. This is a big challenge. Training is also an issue – both in terms of funding and in having qualifications that are a good fit and are flexible for clients and services.”
Like many health services, home and community support services are financially stretched. According to the HCHA, this represents a significant problem as the services being provided need to grow to be responsive to increasing needs, more client choice, more integrated health care, and the impacts of technology.
Training resources are needed to develop a fit for purpose culturally responsive workforce that reflects the changing population demographics. Among other challenges, a significant proportion of the workforce struggle with literacy, or have English as a second language, and there is also a growing need for better IT skills.
Training has to recognise the growing complexity of client needs and that the best responses are holistic service delivery responses. There are also significant levels of unmet needs relating to disability, with around 10% of people with disability reporting unmet need. This requires a workforce with skills in reflective practice, collaboration orientation and care-oriented towards fostering informed and active clients.
Organisational Development in A System Under Huge Pressure
Reading the report brings the question whether the investment in organisational development that is needed for the learning and development needs of staff, and their pastoral support is recognised in the way services are funded and commissioned?
The report identifies some specific workforce training needs based on client demand, including:
- specific chronic conditions
- medication support
- cognitive decline/dementia
- palliative care
- mental health and addiction
- challenging behaviours
- impact of social isolation on people’s wellbeing
Organisations often have multiple funding streams, but the frontline staff interact with a wide range of clients not knowing where funding is coming from. There are also some questions about whether younger people have the maturity and life skills for the support worker role.
The report identifies the numerous system-related change pressures, including the financial constraints with costs rising faster than funding. Other issues identified include the changing skill mix with more personal care, less household support, and increasing use of restorative and rehabilitative services. Socioeconomic deprivation is an issue with workers not trained to see client needs in wider social context. Other challenges arise from the need for more integrated service provision that requires working across boundaries of teams/organisations, the use of case-mix funding model will continue to grow, and the trend to more self-directed care with support workers employed as independent contractors. More training is needed to meet the requirements of the Pay Equity Settlement to support workers through their training, while some questions remain about the role of Level 4 support workers in the services.
A total of 22 recommendations for service providers, funders and service commissioners, as well as for Careerforce itself provide an outline of appropriate responses to the many challenges and opportunities ahead.