They work in an industry predicted to grow massively in coming years. They save the health system huge sums of money by keeping people out of hospital beds and rest homes. They’ve had wage hikes of up to 50 percent and been promised a structured career path. Yet workers who care for the frail, elderly and disabled in their homes report burnout, stress, poverty wages and bullying. Some have been striking, others are suing. What is going on in the home care support sector? Rebecca Macfie reports.
They are called an ‘invisible army’ – thousands of mostly middle aged women who move about in their private unmarked cars, going into the bedrooms and bathrooms of the most vulnerable members of the community to provide the personal support that keeps them in their own homes.
They take off the nightie of the Alzheimer's sufferer, coax her to the shower, wash her naked body, dry her papery skin, put on her bra and underpants and pantyhose, and choose a dress for her to wear that day. They clean the stained toilet of the elderly widower, and scrub his kitchen floor. They clean a catheter, they hoist a severely disabled man out of his bed in the morning and back into it at night. They do what is delicately referred to as ‘bowel care’. They prepare meals and shop and chat. They care.
Last week some members of the army made themselves highly visible by picketing the offices of Lifewise Trust on Mt Eden Road, Auckland, and going on strike for part of each day. They were prepared to keep it up for two weeks despite earlier facing three lockout threats from the Methodist Church-owned trust.
A settlement of sorts
But on Tuesday this week they settled their two year dispute, winning improvements on some of the issues that were critical to them: a $16,000 bereavement leave fund available to union members, which will give more flexibility for women who are often leaders in their whānau and carry a heavy load when there is a death; a one-off payment in lieu of extra sick leave; a commitment to long service pay. A process has been established to deal with how workers can keep their guaranteed paid hours if a person they care for dies or goes into hospital.
But Lifewise’s so-called ‘bucket’ system of work, which effectively requires workers to be available to the employer from early in the morning until evening, but which guarantees them paid work for only a fraction of those hours, remains outstanding.
There will be more talks between worker delegates and the employer, but if no agreement is reached Lifewise is likely to be taken to court by E tū union. Legislation introduced in 2016 in response to a campaign against zero hours contracts stipulates that workers can’t be made to be available for work without the payment of “reasonable compensation”.
Although systems of work allocation differ among the privately-owned and NGO providers that operate in the home care support sector, an overwhelming complaint from workers is that they have to be available to their employers for long stretches of time, for which they are not paid.
A promise unfulfilled
This is a key issue in a law suit being taken by home care workers against Access Community Health, a division of publicly-listed Green Cross Health and one of the biggest operators in the sector.
The Public Service Association filed the proceedings in the Employment Relations Authority last year and has since been joined by E tū. It is alleged that Access is in breach of its collective employment agreement with the two unions by failing to provide regular and guaranteed hours, failing to provide ten minute rest breaks, and failing to pay wages owed to workers after clients have cancelled scheduled services. They are seeking certainty of hours, wages in arrears (plus interest) for workers who have been short-paid, and legal determinations on the underlying issues. One round of mediation has failed to produce an agreement, and the parties are back in mediation next week.*
Many workers were pleased in 2017 when agreement was reached requiring employers to bring in guaranteed hours. Each worker’s guaranteed hours were to be based on 80 percent of the hours they had worked over a previous three month period.
For a workforce that had effectively been on zero hours contracts, the promise of stability was welcome. But that promise remains unfulfilled.
“We’ve effectively ended up with a slightly prettier version of zero hours,” says Melissa Woolley, PSA assistant national secretary.
Access workers spoken to by Newsroom say they are stressed and burned out, are bullied by management, and that conflict has developed between front line care workers and administration staff because the employer has failed to invest in training and management systems to support the implementation of guaranteed hours and other changes.
One worker, who has been with Access for 12 years, says she has been battling since 2019 over her guaranteed hours. She previously worked 115 hours a fortnight in the hope she would secure a steady 80 guaranteed hours, but that has never happened. Currently she works two blocks of hours every day, from 7.30am until 2.30pm, has two unpaid hours off, and then is back on the job from 4.30pm until about 8.30pm.
At one point in her negotiations with the company she was told that in order to get 80 hours of guaranteed work she would have to be available to the company for 126 hours a fortnight – with the additional 46 hours of availability unpaid.
She says her health is suffering because of the stress, and she is nursing injuries to both arms caused by lifting and showering high-needs clients. “I am a level 3 qualified care giver, but I am also very distressed and very burnt out,” she says. Rosters are changed without notification, and she and her co-workers are liable to be called by co-ordinators anytime from early morning until late at night asking them to attend to a client. “Some support workers are over-worked and others get nowhere near enough work…We are so disposable to this company.”
Another Access worker who has progressively lost guaranteed hours told Newsroom the workforce has been “beating our heads against a brick wall for years trying to get this home support industry sorted out. Without us workers they don’t have a business. It always feels like it’s them and us, like we are pushing shit uphill…
“Their idea of consultation is you get a phone call saying your hours are down because Mr Brown went into [rest home] care on Tuesday, and then a week later they ring to say we have to reduce your hours. But they never say, ‘there is a Mr Yellow who needs care on another day or another time, would that suit?’. There’s no consultation and there have been times when they’ve just taken on a new worker instead…We need some sort of stability in this work. I think their idea is to keep us vulnerable because when they need us they have us, because we are desperate.
“Yet the clients and hours are there. It’s an ageing population. They are staying at home. So why on earth don’t we get to the point where we are actually employed for 30 hours or 40 hours. People would then look at the industry like it was a proper job.”
E tū’s director of organising, Kirsty McCully, says the stresses on workers in the sector are reaching crisis point. “Why would you work your guts out and be treated like shit and see no pathway?” She says there are also serious health and safety risks. “The providers often don’t have offices to drop into to talk to a health and safety officer, and workers barely know who their health and safety rep is...We’re waiting for a disaster to happen.”
Winning the battle, but losing the war?
A 2019 AUT study of the care sector cast some light on the causes of this crisis. Between 2014 and 2017 a suite of changes was rolled out, arising from successful litigation by the unions and by the recommendations of a working group appointed by then-Director General of Health, Chai Chua. These included:
The landmark 2017 pay equity settlement that delivered government-funded hourly wage increases of up to 50 percent in the aged care and disability support sector over five years. It included a four-level pay and qualifications career structure for workers. Those who had long years of service but didn’t have formal qualifications were put on the top tiers as a transitional measure.
A government-funded regime under which home care support workers for the first time received payment for travelling between clients, including a modest rate for mileage and minimum wage for travel time.
A requirement for workers to be given guaranteed hours, arising from law reform that ostensibly banned zero hours contracts, and from the recommendations of the director general’s working group in 2015.
In addition many district health boards, who contract organisations such as Access and Lifewise to deliver government-funded in-home care and support, have also been moving to a new assessment tool, interRAI to grade the needs of clients.
The AUT study showed some managers in the sector believed this cascade of change made it much harder to match the qualifications (and pay rates) of workers with the needs of clients and their attached level of funding. Some managers said there had been a “deliberate shift” to employ workers with lower qualifications, and to reduce the hours of workers on Level 3 and 4 (the top two tiers of pay and expertise). Some managers said workers had been deliberately put on reduced guaranteed hours so the organisation had more flexibility to deal with client changes.
Graeme Titcombe, chief executive of the Home and Community Health Association, agreed that the challenge of matching client needs and funding with worker qualifications and wages was significant. “Providers are not going to use someone who they pay at Level 4 [wages] to care for someone needing Level 1 care because they are only funded at Level 1…[T]hey would make a loss on every one of those clients.”
In the past, when care workers were systematically discriminated against because they are women , this was less of a problem. None of them were paid what they were worth, and therefore the mismatch between their value as skilled workers and the funding linked to the needs of clients was not crystalised.
But now that the courts and government have addressed this historical inequity, the upshot is that more long-serving and expensive workers are losing out on guaranteed hours of work and in some cases are worse off than before.
Conditions tighten
Workers interviewed for the AUT study said they had been pressured to sign guaranteed hours agreements, and were told that if they didn’t they would be put on casual hours. Extremely long days were common, and rostered breaks were virtually unheard of.
The burden was also falling on rostering and co-ordination workers, who were charged with making the system work. The study reported a culture of bullying and abuse in the sector, with care workers fearful that they would be denied sufficient hours of work in retaliation for speaking up. Staff meetings and opportunities to meet with other care workers had reduced, adding to a sense of isolation among workers who operate primarily from their cars and in clients’ homes. Many felt the level of care for their vulnerable clients was suffering as a result of these stresses.
Although the AUT study is two years old, an unpublished pre-Covid survey carried out by the researchers is understood to show that little has changed for workers. “ [The] pay equity and in-between hours settlements had yet to result in decent work for those in home and community support,” associate professor Katherine Ravenswood told Newsroom in a statement. More than half of the workers surveyed said they wouldn’t recommend working in the sector to friends and family – which may partly explain why recruitment remains difficult in some parts of the country.
Titcombe says a lack of a clear and consistent definition of guaranteed hours accounts for much of the difficulty. But the underlying problem is the cherry-picking of the 2015 report on the home care sector commissioned by Chua. Because of these frustrations, a raft of ‘Settlement Party Action Groups’ (SPAGs) have been trying to make progress on the issues, but none of this work has yet been released.
In the meantime Titcombe says there is significant financial stress on home care providers, for whom wages account for about 88 percent of their costs. “They do need some significant margin above support wages to keep going.”
Hanging on by fingernails
While Access is profitable – making $2.5 million last year off revenue of $156 million – Titcombe says the NGOs in the sector are generally running at a loss. But there are fewer not-for-profits in the sector these days, as ownership has consolidated into the hands of Access and New Zealand Health Group (which owns Geneva Healthcare and Healthcare New Zealand). Combined, these shareholder-owned operators deliver about 65 percent of home care support services under tender to DHBs, ACC and the Ministry of Health. All up, about 100,000 New Zealanders are provided care in their homes under these contracts.
“It’s got to the stage where only the very biggest [providers] are hanging on by their fingernails, and that won’t last either,” says Titcombe. He says in the past two years the process of consolidation of ownership has stopped, “as even the larger businesses can no longer make it work profitably”.
But union leaders are sceptical of the claim that a lack of margin in home care contracts is the problem, or that public funding of care for the elderly and disabled ought to include a slab of profit for private shareholders. E tū lawyer Rob Haultain says it “beggars belief that they are prepared to ask the taxpayer to fund their profit”.
She says much of the problem stems from the providers failing to invest in the systems needed to manage the needs of an ever-changing client base as well as looking after the workforce and providing decent and reliable hours.
“I don’t think it’s anywhere near as complicated as they say it is. Every provider has their own bespoke system. I think it’s mainly because of inadequate management systems, and because it’s easier for them if they hire in heaps of people on small hours of work. And because [those workers] are so desperate for work and because they have to have their own car and pay for its maintenance and so on, when the boss says ‘do it’ you do it.”
*Access’s CEO Alison van Wyk declined to be interviewed, but a PR company sent a statement including this: "As one of New Zealand’s largest employers, we take our responsibilities to all of our colleagues incredibly seriously, ensuring all of our teams are able to work in a safe and supportive environment, and are fairly compensated."
