Ngā Hononga

The fourth principle is Ngā Hononga | Relationships.

For older people in New Zealand, this may include the impact of changes in relationships with loved ones as well as the community, and the importance of a robust and talented workforce to support them.

Relationships

There are several key issues affecting the relationships of older people in New Zealand:

Isolation and loneliness

Many older people live alone or have limited social connections, which can lead to feelings of isolation and loneliness. This can be especially true for those who live in rural areas, have low incomes, have been widowed, or have limited mobility. Research is clear that long-term feelings of loneliness can affect someone’s physical health as well as their mental wellbeing.

Financial concerns

Financial issues can place a strain on partner relationships, particularly if one partner is dependent on the other for financial support. This can also be a concern if one partner needs expensive medical care or if there are issues with retirement savings. Financial concerns can also be a barrier to older people continuing to go out into the community to develop and maintain friendships, for example to be able to meet a friend at a local café.

Health needs

As people age, they may experience a range of health needs, which can affect their relationships. This may include physical disabilities or chronic health conditions, which can require care and support from partners or family members. The additional complexities of cognitive decline in dementia mate wareware also present specific challenges to relationship maintenance.

Changes in family dynamics

As family structures change, relationships can also be affected. This may include changes in caregiving roles or changes in living arrangements.

Bereavement

Losing a partner, close whānau members and friendships can be a significant challenge for older people, both emotionally and practically. This can lead to feelings of grief and loss, and may also require significant changes to living arrangements or caregiving responsibilities.

GAPS in support for isolation

There are several gaps in support for older people in New Zealand regarding isolation:

• Access to services: Many older people may not be aware of the services that are available to them or may have difficulty affording them and/or accessing them, especially if they live in rural areas or have limited mobility.
• Lack of transportation: Older people who no longer drive or have limited access to transportation may find it difficult to maintain social connections or access support services. Even where transport options are available, the cost can be very expensive.
• Limited social connections: Older people who live alone or have limited social connections may be at higher risk of social isolation. This can be particularly true for those who have lost a partner or close family member.
• Digital divide: Some older people may not be comfortable with or have access to digital technology, which can limit their ability to connect with others online. It’s important to note that even where training is available, some people may not have the desire to learn how to communicate online, preferring to use the methods they’ve used throughout their lives.
• Limited funding: Many community organisations that provide services to older people may have limited funding, which can limit the availability and scope of their programs. Day care programmes are normally only funded through carer support payments, meaning those without an eligible carer cannot access these without out-of-pocket payment.
• Loss of the Second Place and Third Place: Leading urban sociologist Ray Oldenburg talked of the three key places where most of us spend our time: home (the first place) and work (the second place), alongside the third place, which is a public place where we can relax and socialise. This will be different to everyone, but some examples are regular activity groups, parks, churches, gyms, cafes. The second place (work) is lost in retirement and many third places may be less available, accessible, affordable or truly welcoming to older people.

Elder Abuse in New Zealand

Elder abuse is a problem in Aotearoa. This report from the Office for Seniors, based on data from the New Zealand Longitudinal Study of Ageing shows that at least 10% of people over 65 have experienced abuse.

Researchers believe that the actual number of people impacted is higher – due to fear of reporting and the study not including people in hospitals or care homes.

Elder abuse can take many forms, including physical, psychological, sexual, financial, and neglect. Most of the time abusers are known to the victim, often leading to fears of reporting the abuse. These fears may be due to dependency on the person, fear of retaliation, or shame that a family member is treating them this way. It is important to acknowledge that elder abuse can be an example of family violence.

GAPS in support for those experiencing elder abuse

There are gaps in the support available for those experiencing elder abuse in New Zealand.

• Limited awareness: Many people, including health professionals and community workers, may not be aware of the signs and risk factors for elder abuse, and may not know how to respond appropriately. This can lead to under-reporting of cases and limited access to support for those who need it
• Limited funding: Services that support victims of elder abuse are often under-resourced and over-subscribed, so may struggle to meet demand. This can lead to long wait times for assistance, and limited capacity to provide ongoing support to victims and their families.
• Lack of specialist training: Many health professionals and community workers may not have received specialist training in identifying and responding to cases of elder abuse. This can limit their ability to provide effective support and may mean that cases go unnoticed or are not responded to appropriately.
• Limited services for specific groups: There are a lack of targeted support services for specific groups, such as Māori and Pacific Island older people (including support delivered in various languages), who may experience higher rates of elder abuse. This can make it difficult for these groups to access culturally appropriate support and assistance in a language they understand.

These gaps highlight the need for greater awareness and resources to support victims of elder abuse in New Zealand. However, there is ongoing work in New Zealand to address elder abuse and prevent it from happening in the first place.

There are a range of services and support available, including:

Awareness campaigns such as Elder Abuse Awareness Week which surrounds the UN World Elder Abuse Awareness Day in June each year. This campaign works to educate the wider public about what elder abuse is and how to report it. It aims to help people recognise the signs of elder abuse and understand what they can do if they suspect someone is being abused. The Office for Seniors also raises awareness across the motu and have a range of resources available.

The Protection of Personal and Property Rights Act 1988 provides a framework for protecting the rights and interests of people who are unable to manage their own affairs. This legislation includes provisions for investigating suspected cases of elder abuse and taking action to protect vulnerable people. It also allows for appointing an Enduring Power of Attorney (EPA), but as reviewed on page 19, there is little awareness about this legal right, which can also be too expensive to access. Sadly, there have been some cases where EPAs have exploited their power and used this as a way to abuse the person they are meant to be advocating for. In this instance, action can be taken by family and/or support workers to have the arrangement changed through the Family Court. A review of this legislation and framework is currently being done by the Law Commission so there may be changes to it decided soon.

Looking more holistically, the other things which will help minimise elder abuse will also improve quality of life for older people in general, e.g. valuing older people, person-centred care, access to safe housing, age friendly communities.

Workforce

The workforce that supports older people in New Zealand includes a diverse range of roles, each with its own unique responsibilities and challenges.

These range from those working in aged care provision such as kaiāwhina, healthcare assistants, nurses, doctors, diversional therapists, care and support workers, pathfinders and occupational therapists through to housing case workers, tenancy managers, navigators, social workers and foodbank/kai support workers. You can find detailed information on these roles and more in The Workforce Guide.

According to research by Toitu te Waiora, over a third of people who currently do this type of work in New Zealand are due to retire by 2023. At the same time, Aotearoa has an ageing and increasing population (by 2050, it’s estimated there will be 1.5 million older people, who will make up a quarter of the entire population). This increase in the population of older people at the same time as a decrease in the people able to care for and support them will have a significant impact on workforce planning and training, as well as on the delivery of services to older people.

In order to ensure that the workforce is able to meet the needs of older people in the years to come, there will need to be a focus on attracting and retaining workers in these fields, as well as on providing ongoing training and support to help them meet the evolving needs of older people.

Available training to work with Older People

There is a variety of education options within New Zealand for those wanting to work within the community, health or social sectors. Unfortunately, the majority of these do not provide specific papers on working alongside older people.

Certificate in Health and Wellbeing (Levels 2 – 4):

Many people who wish to work as Healthcare Assistants, Support Workers, Pathfinders or Navigators complete one of these certificates. They can take between 6 – 24 months full-time study to complete, and most have part-time study as an option.

Students can choose to focus their study on certain aspects of healthcare which are more likely to affect older people, such as dementia care and palliative care. In addition, some providers look specifically at caring for older people and/or the ageing process as part of the course. These qualifications are offered by several providers including private training schools such as Kalandra (which specialises in aged care) and across the vocational education providers that now make-up Te Pūkenga. This also now includes what were previously known as industry training organisations, including Careerforce, who provide in-work training of the workforce engaging with care and support of older people.

Apprenticeships:

These provide an alternative pathway to qualification which is based around paid on-the-job training with some additional study. Te Pukenga Careerforce offers a range of community and social apprenticeships. Specific to working with older people are the Apprenticeship in Advanced Care and Support and the Apprenticeship in Diversional Therapy. Both of these are usually offered to expand and formalise the knowledge of experienced staff.

At the completion of the qualification, the apprentice receives a Certificate in Health and Wellbeing (Level 4). Those with an apprenticeship in Diversional Therapy become eligible for membership in the Diversional and Recreational Therapy body. This professional body is actively seeking a Bachelor-level qualification for Diversional Therapy.

Diploma:

These courses usually take approximately 18 months to complete full-time and are usually the same as the first half of a Bachelor’s degree course. A Diploma in Enrolled Nursing is one of the two main pathways to become a nurse in New Zealand.

Bachelor degrees:

These courses usually take 3 or 4 years to complete full-time. Degree courses that often lead to careers working with older people include Nursing, Social Work, Physiotherapy, Occupational Therapy, Health Sciences, Psychology, Counselling, Medicine (doctor). More details on the education pathways for all of these roles can be found in The Workforce Guide.

Further study for working with older people

There are several postgraduate courses which focus on working with older people. The main barrier to accessing this type of specialist knowledge is that you must have a degree in order to apply, which rules out many people.

For those with degrees, these courses expand and improve knowledge of working to support older people. Some of these courses are available to anyone with a health sciences degree, while others are specifically to one discipline (e.g. nursing). There does not appear to be any similar post-graduate study option available for those not working within health science (e.g. Social Workers).

• Postgraduate Certificate in Gerontology (in person learning at University of Auckland)
• Postgraduate Certificate in Health Science (Older Adult Health and Wellness): (in person learning at Auckland University of Technology)
• Postgraduate Certificate in Specialty Care – Gerontology (Distance learning through Whitirea/Weltec)
• Postgraduate Certificate in Health Sciences in Nursing – Gerontology (Distance learning through University of Otago).

When provided extra support from their employers, people doing further training can more fully embed their learning in their practice and make best use of their new knowledge.

One example of this is the Gerontology Acceleration Programme in Canterbury, which has been upskilling registered nurses for the last decade. As part of a year-long programme, nurses receive mentoring, peer support and complete two clinical rotations working specifically with older people, as well as complete the Postgraduate Certificate offered by the University of Otago. Although the number of people going through this programme has been relatively small (28 people since 2018), it has had a very positive impact on these nurses and the older people they will care for throughout their career.

Courses available to anyone

There are other courses that anyone caring for or working with older people (including family members) could take:

• Dementia Friends is a short and accessible online course from Alzheimers New Zealand which aims to increase community understanding of dementia mate wareware and simple ways anyone can support those living with it.
• Dementia STARS are short webinar courses from the New Zealand Dementia Foundation which are aimed at the caring workforce but could be helpful and are available for home carers as well.
• Preventing Dementia and Understanding Dementia are an in-depth courses from the University of Tasmania which are completely free and available online for anyone to study, regardless of their background.
• Understanding Ageing is a free course from Charles Sturt University which is also available online for anyone to study.
• Working with Older People is a paper offered by the Open Polytechnic that anyone could study as a standalone paper to further their knowledge. It does have some eligibility criteria but seems to be more accessible to the public than other papers offered as part of postgraduate study.

Migrant workers

In addition to encouraging New Zealanders to work with older people for their career, immigration is likely to continue to be a significant factor in addressing the workforce shortages in the aged care sector in Aotearoa New Zealand. Many aged care facilities rely on migrant workers to fill vacancies, particularly in regions with lower population densities, and these workers bring a range of skills and experiences to the aged care sector.

The process for converting overseas qualifications can be lengthy, time-consuming and expensive. This can be frustrating for both the worker and the potential employer who is suffering workforce shortages. Of course, it is important to ensure that people are qualified to work in the sector and once this is confirmed, it is just as important to ensure that migrant workers are provided with opportunities to learn about aged care in New Zealand (including cultural competency to best equip them to support Māori and Pacific peoples) and improve language skills if needed.

One of the key issues affecting both migrant workers and non-Pākehā New Zealanders is racism. This can be experienced on many levels, from structural and institutional (e.g. unable to progress because effects of colonialism or visa limitations mean they cannot afford further study) to being subject to racial abuse from patients or clients. It’s important that employers are aware of this and able to mitigate and support their staff.

Changes to policy and legislation for the migrant workforce is common. For those interested in this area, it would be best to ensure that the information that you are accessing is current and reliable. We recommend going directly to the source, such as the Government’s Employment New Zealand website.

GAPS affecting the workforce who work with Older People

There are a few key issues and gaps in the workforce who work with older people in New Zealand.

These can have significant implications for the quality of care provided to older people, as well as the job satisfaction and wellbeing of the workers themselves. Addressing these gaps and issues is important for improving the overall quality of aged care in New Zealand.

Workforce shortages:

There is a shortage of workers in the aged care sector in New Zealand. This shortage is partly due to the ageing population and the increasing demand for aged care services, as well as the relatively low wages in the sector.

Training and qualifications:

A review of the courses offered in New Zealand shows that very few of the diploma and bachelor courses included modules focused entirely on working with older people. Students may learn a little about older people as part of another paper (e.g. Human Development may cover the whole lifespan) but this won’t be in-depth. There are a few exceptions within some nursing and social work degree courses, especially among providers who provide training grounded in te ao Māori and Pacific approaches. However, all of these providers have recently been amalgamated under the Te Pūkenga umbrella which is looking to streamline courses available around the motu.

This means courses are currently under review and it is not yet clear if any papers focused on aged care will be included in the updated courses. Most of these courses will include a placement in a healthcare setting so students may learn about aged through these experiences, but this is not guaranteed.

In addition, there is a very limited pathway from Certificate level qualifications into Bachelor and
Post Graduate qualifications. This limits not only the workforce, but also the research produced on different approaches to supporting this age stage. Many with certificate or apprenticeship level qualifications would find a higher-level qualification useful, but do not want to train as a nurse, occupational therapist, social worker or similar, and so remain practicing at the level in which they are qualified but doing increasingly complex work. This also creates challenges in multidisciplinary teams, where hierarchies based on qualification levels can create challenges, and power imbalances.

Staff turnover:

Staff turnover is high, which can disrupt the continuity and quality of care provided to older
people. This turnover is partly due to the low wages in the sector, as well as the high emotional and physical demands of the work.

Cultural competency and safety:

Many workers in the aged care sector come from diverse cultural or international backgrounds, and it is important that they have the necessary cultural competency to work safely and effectively with older people from different cultures, especially Māori and Pacific peoples.

Integration with other healthcare services:

There is a need for better integration and coordination between the aged care sector and other healthcare services, to ensure that older people receive the right care at the right time. This is particularly important as older people often have complex healthcare needs and may require care from multiple providers.

Weaving in the strands

Mana Whenua | Belonging

A sense of connection to where you are

Being cared for, supported by and socialising with those who have a genuine understanding
of who you are contributes to a sense of belonging.

Mana Atua | Wellbeing

Spiritual, physical and mental wellbeing

To maintain overall wellbeing, older people need trusted relationships with a knowledgeable
and competent workforce, be able to rely on those making decisions on their behalf (or supporting them to make decisions) and have opportunities to connect with others in ways they enjoy.

Mana Tangata | Contribution

Feeling a sense of purpose and being of value to your community

Continuing to nurture friendships and access the community is a vital part of being able to contribute. When this isn’t fulfilled, it is human nature to try to recreate this feeling, which could be one of the reasons why older people don’t report financial abuse, as they believe they are “helping out” the person taking advantage of them.

Mana Reo | Communication

Understanding others and being understood

Those working and caring for older people must understand enough about the person, their language/s, and their cultural and health backgrounds to be able to communicate
in a way that ensures the older person understands what is being said, as well as the worker or carer genuinely hearing and understanding what the older person is saying (or sometimes not saying).

Mana Aotūroa | Exploration

Continuously learning to discover new possibilities

When older people are isolated from their communities and support circles, they are less likely
to continue trying new things, which leads to more isolation. It’s also important that those working with and supporting older people continue learning – about the individuals they are supporting, aged care in general, different cultural norms, and specific topics such as dementia mate wareware. Strengthening the availability and accessibility of courses focused on gerontology would significantly contribute to this.