Billy and the Health Care Assistant, a little understood occupation.

Billy inspiration for KalandraMy passion to improve care of the older person started with my mum.

My mum Billy was very much like her name, short, matter of fact and tough.  She entered an aged residential care facility when, like many others, her multiple health factors meant she could no longer stay at home, however she was still fiercely clinging to her limited independence and her dignity.  Over a two-year period, mum established close relationships in her facility which is the ‘norm’, with the staff becoming family, caring for her and about her. 

One Health Care Assistant (HCA) in particular absolutely adored mum and for this article I will call her Sally. To the casual observer Sally provided the recognised cares, the showering, support whilst walking, and later the care of the dying lady. It was watching Sally that prompted me to wonder ‘just what does the Health Care Assistant do?” and this would later become a question for my Doctorate. 

In answer to this question I already knew that they provided basic personal cares, helped to feed people, wash them, make beds, do laundry, clean up messes and so much more. They did this for usually eight or more clients and had extra work to do depending on the shift they were on. We think of them as low qualified with most at Level 3, but I will discuss that further, and yes many are not of the same ethnicity as their clients. 

Proceeding with the story as to why I wish to improve aged care:

Mum was dying and the family was gathered in her room, we had the usual banter and talk fest and now we were just seated quietly being with mum. During this time Sally entered her room and not speaking, gently stroked her face – why? Was she providing comfort to mum, to herself, to us. Was the gesture spiritual, religious, cultural? Was she checking skin condition or was the gesture simply saying ‘I am here’. 

After mum passed away Sally, although she too was grieving, still provided comfort to the family, organised the funeral director, notified the doctor and RN on call, comforted the other residents and proceeded to somehow fit in her normal duties. Later Sally found time to lay mum out, place a rose in her hands and entwine her rosary amongst her fingers. Sally exhibited skills, intuition, caring, love and knowledge way beyond her Level 3 training. The communication, problem solving and time management skills Sally employed were far in advance of this low level occupation.

Sally is one of 48,000 HCAs working in aged residential care in NZ. It is estimated that within the next ten years NZ will require a further 28,000 and Australia 200,000 more HCAs to cope with the aging population. 

We are not prepared for the huge increase in the aging population nor are we prepared for the intensity of care that this population requires, of which 90% of that care is administered by the HCA. This workforce, is poorly understood, with little comprehension as to the intricacies of the role. We undervalue the HCA. Sally and her colleagues are paid $27,000 less than the average NZ wage. She has no scope of practice, has no regulatory body, nor one defined organisation that supports her. 

We say the HCA role is low skilled or unskilled, that women have the innate compassion to do this work well, in fact our Ministry of Social Development reports that people can do this work with two days training and immigration personnel think that we can use apple pickers to care for our very vulnerable people. 

So let’s put some perspective on this. Level 3 on our NZQA framework equates with a reasonably intelligent school leaver, many of whom go onto University. Some of these low skilled HCAs are Level 4 which is the same as a qualified trades person. I would like to see any Government state that the qualified Plumber is low skilled and thus inform employers that they should be paid accordingly. Many of our HCAs are in fact Registered Nurses from overseas, highly qualified and competent however they do not, for various reasons get their qualifications recognised in NZ. So why do we persist in saying that these incredible ‘Sally’s” are low skilled and low qualified. It just does not make sense.

There is much discussion at present about using migrant labour to do jobs that our own people do not wish to do and the work of the HCA is one of those jobs. Without the HCA the organisation would not function. We rely on them and they bring knowledge and skill far higher than the apple picker brings and they work in this role because they absolutely love it and NZ.  How dare people say that our older persons can be looked after by itinerant, non-qualified people!! 

Remember that the population of our country and the world is ageing, that soon many other countries will be competing for HCA’s and that within 25 years over a third of the global population will be regarded as aged with the number of people able to provide care for them diminishing. Right now the world is already short of 4.5 million HCAs. 

However, aside from this should we not value and respect the people who provide the complex care, the love and the compassion for our older population, people just like my mum. Do we each need to have a parent experience end of life and needing support to fully appreciate just what the HCA does bring to that person. I hope not as this is not an easy lesson to endure. 

During the last few months with mum I also realised that there were huge gaps in her care, the allied health support that she needed was not easily available, the depression she was experiencing was not coped with and the little things that would have made her life so much better were not available. 

In response to these needs we have developed Kalandra and are now writing the qualifications and programmes to teach others the skills and knowledge to fill these gaps. Perhaps by the time I am considered an ‘older person’ we may have these occupations in place and appropriately value the people who most care for us the HCA’s.  

RIP mum 


Christine Clark

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