In five years working in aged care, Heather has seen demand for residential care consistently put pressure on available capacity across Nelson and Marlborough.
As Facility Nurse Manager at Coastal View in Nelson, she sees that pressure first-hand.
Coastal View has 59 beds, dual registered for hospital and rest home level care and a separate 20 dementia bed facility, and Heather says the facility is almost always full. Enquiries are constant, particularly from families looking for dementia care.
“There has always been a lack of beds in Nelson and Marlborough. Our beds are basically occupied all the time, and since we opened our dementia care, that has been full as well.”
But for Heather, the issue is not simply whether there is a residential care bed available. It is whether there is a bed providing the right level of care for that person’s needs.
She says many residents who enter rest-home-level care are also living with some degree of dementia. As their needs change, getting them reassessed and moved into more appropriate specialist care can be difficult.
Heather says part of the challenge is the pressure on Needs Assessment and Service Coordination (NASC) teams, which are short staffed and managing significant workloads, meaning reassessments can take time to happen.
At the time Heather spoke to the Association, she estimated there were around six residents whose needs may be more appropriately met in dementia care but who had not been approved for that level of care.
“The majority of people coming into rest-home care have some element of dementia. As their needs increase, it can be really difficult to get someone reassessed and then find the appropriate care for them.”
That creates challenges for residents, their families and the people caring for them.
A standard rest home is not a secure dementia facility. Heather says staff will always prioritise residents’ safety, but when someone living with dementia begins wandering or trying to leave, the environment may no longer be appropriate for their needs.
“We want people to be cared for at the right level and in the right environment. The difficulty is that even when someone’s needs change, the appropriate bed isn’t necessarily there for them to move into.”
Heather recalls one resident whose needs were reassessed as requiring hospital-level dementia care, but there was no suitable bed immediately available.
She says the facilities involved ultimately had to find a practical way to move the resident into the appropriate level of care, including arranging for Coastal View to accept another resident in return.
“It shouldn’t have to come down to moving people around to find a way to get somebody into the care they need. Families are already dealing with an incredibly difficult situation. They need to know the right care will be there when their loved one needs it.”
Heather says increasing capacity is part of the answer, but beds alone cannot solve the problem. Facilities also need enough appropriately skilled people to provide increasingly complex care.
Coastal View chooses to staff above recommended levels, but Heather says adequate funding would give providers greater ability to invest not only in safe staffing, but in the additional care, activities and support that contribute to residents’ quality of life.
“More beds are important, but those beds need people. We need to be able to employ enough staff, support them properly and give them the training they need to provide good care.”
Workforce education is another area Heather would like to see strengthened. She says facilities invest significantly in training their teams, but greater access to funded education would help build capability across the sector, particularly for healthcare assistants and registered nurses.
For Heather, the pressures she sees every day come back to a straightforward issue: having a bed somewhere in the system is not enough if it isn’t the right bed, with the right staff and the right level of care for the person who needs it.
