Palliative care can’t survive on ‘cakes and electronics stores’

By Alex Perrottet of RNZ

According to leaders in the palliative care field, the industry can no longer survive on “cakes and tents.”

Dr Aileen Collier, President of Palliative Care Nurses of New Zealand, said that nurses’ pay was just the beginning of major problems facing a sector that cares for increasing numbers of patients as the population continues to age. .

“It is urgent, if we do not do something now, we are going to have serious problems.”

Collier said hospice and nursing home nurses receive about 20 percent less than their DHB peers, and that was endorsed by Dr. Brian Ensor, Hospice Waikato’s medical director.

“That is a real fight,” Ensor said.

“Funding the nursing staff and associated healthcare staff, trying to keep them within the reach of the DHB, which is a major competitor for experienced staff, is a real problem.”

And the concerns are shared by the elderly care industry, which now cares for most of the people in their final months and days.

Rhonda Sherriff, a clinical advisor to the New Zealand Association for Senior Care, has worked for 35 years in the industry and is a co-owner of a retirement village in Christchurch.

She said 38 percent of people who receive hospice care die in nursing homes, and the other 62 percent is divided fairly evenly among people who die at home or in hospitals.

He said that registered nurses in elderly care were not being paid enough for all that work increase.

“Our registered nurses are the same caliber as any other registered nurse who works in DHB, hospices or anyone else in the country in primary care,” he said.

“And I think they should pay their peers in other sectors fairly.”

He said there needed to be more nurses, not fewer, but the sector depended dangerously more and more on foreign nurses in the Covid era.

“I think it’s hard work; it’s physically and mentally exhausting,” he said.

“We are a 24-hour service and it may well be that acute care settings are more attractive for young nurses to come, want and work. I guess we are not seen as an attractive sector.”

Dr Rachel Wiseman, who works in specialty palliative medicine at the Canterbury DHB, said the payment problem also affected palliative services in hospitals.

“We are really struggling to train enough new specialists to meet the anticipated demand,” he said.

“So we have a fairly significant proportion of our workforce that is older and will be retiring in the next five to 10 years and we are not training enough people to replace them.”

Wiseman said hospitals need to attract those new doctors, but in the end it all comes down to money.

“Who’s going to pay for it?” she asked.

“Because the funding that comes centrally only pays for part of the position, and the rest must be covered by the district health boards, which are all in the red at the moment.”

Aging population

New Zealand’s death rate is projected to increase by 50 percent in the next 20 years as our population ages.

New Zealand hospices are not equipped to care for so many dying patients, and neither are hospitals.

Mary Schumacher, CEO of Hospice NZ, said it was not about the future, but about now.

“I think we are really behind,” he said.

“We need to have a clear focus that everyone in New Zealand, regardless of setting, deserves the best palliative care and end-of-life care.”

Every year the New Zealand government provides around $ 78 million, and the last suitable increase in funding was the 2015 budget, under Jonathan Coleman.

There is $ 155 million a year in costs, which means the $ 77 million shortfall is made up for through fundraising.

Collier said it was ridiculous.

“If someone said, right, their maternity services will now be funded by bakeries and electronics stores, we would laugh, we would just laugh,” she said.

“So why do we accept that this is okay at the other end of life?”

She said palliative care always seems to be an afterthought for those who provide the funds and strategies.

“Big new cancer control agencies with funded staff, but palliative care is always left as an adjunct, in part because we don’t like to talk about it.”

Wiseman said he agreed, and since palliative care had changed a lot, the funding model had to change as well.

“Palliative care is the only specialized service that has to rely on charitable fundraising for essential services,” he said.

“I mean it’s crazy. That doesn’t apply to any other specialty in New Zealand, as far as I know. Because it’s a health service that we’re providing. This is no longer a community hospice where people are going to die, these they are specialized services “.

Mary Schumacher said hospices make themselves feel invisible.

“If you did a search on some of the documents and strategies, we are not even mentioned,” he said.

“Palliative care is not even mentioned, it’s like people don’t die in New Zealand. We talk about all kinds of things, but what we don’t talk about is the fact that people who are dying have palliative care needs.”

A close look at the health policies of each of the parties revealed little for the elderly and dying.

Only the New Conservative Party and the Green Party even mention palliative care, while Labor would appoint a Senior Care Commissioner and have a dementia action plan.

New Zealand First policy said it would shift funding to reflect population changes, such as age, and increase services in rural areas, as did the new conservatives.

And it is the people in those rural areas who are of greatest concern to front-line personnel.

Dr. Salina Iupati, who had 10 years of experience as a GP before moving into palliative medicine, is researching world standards of care for her PhD at the University of Otago.

He said what patients want most is to be cared for at home, even to death, if possible. And he said it could be done with adequate funding and support services.

He said there should be a personalized and streamlined service, with a single port of call for the patient and their family.

“They should not call multiple numbers depending on the situation and there are not too many providers entering their homes,” he said.

“And continuity in that care is very, very important, because patients and their families don’t have the energy and time to repeat the stories multiple times.”

Iupati also brought up the comparison with motherhood, saying that mothers have dedicated professionals to care for them and their babies early in life.

“And it’s also freely available to all mothers, as it should be,” she said.

“But, on the contrary, there is no standardized pathway for end-of-life care, for the patient in their last year of life.”

Iupati said that whānau would have the best resources to care for the sick and frail at home, with just a little training, but there was no funding model that would allow them to take time off.

“What worries me is that the families are under so much pressure, they have to pay the bills and they cannot spend the time, the last weeks and months, with the dying relative, even if they want to,” he said.

“They have to pay the bills, they have to pay the mortgage, they still have to go to work. I mean, we have paternity leave or maternity leave.”

These professionals say that now is the crucial time to rethink and restructure, and palliative care must be properly integrated into the healthcare system and budget, or the nation runs the risk of marginalizing people, particularly in rural settings.

Schumacher said having so many different systems across the country was making it worse.

“There is no transparent funding model, there is no funding model for hospices, for palliative care that says ‘this is what we are buying, this is what we are paying for,'” he said.

“Each DHB and each hospice is funded differently, so some hospices are funded higher than others.”

Experts said in the crucial conversation on health financing after the elections, the elderly need to be heard.

Collier said that in all of this, the voices of the elderly and frail were lost, and that was the real concern.

“The way we’re treating people on this is really shocking,” he said.

“You know, do they have something to say? Where is their opinion on all of this?”

– RNZ