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Aged care providers warn the shortage of rest home beds is leading to longer wait times for elective surgery, over-crowded emergency departments and other pressures on the health system.
Figures obtained by RNZ under the Official Information Act show on 26 March, there were 138 hospital patients waiting to be transferred to other care facilities, including rest homes and dementia or rehabilitation units.
Sixty of them - more than 40 percent - had been waiting longer than two weeks.
Aged Care Association deputy chair Warwick Dunn said 138 patients "may not sound like many", but it was more than 1 percent of public hospital capacity.
"And any bed that's occupied by someone who could or should be in a residential care facility is one less bed that's available for someone waiting for a hip operation or a new knee joint or some other form of elective surgery.
"So our view would be, any number of beds is one bed too many, frankly."
It was also bad for elderly patients to be marooned in hospital, stuck in bed and bored, he said.
"They often end up going into residential care in a far worse state."
Dunn, also Masonic Villages Trust chief executive, said the rest home sector was currently short about 1000 nurses from a total workforce of over 5000.
"As a consequence there are 1200 beds across the sector that have had to be closed, that's either total closures or partial closures that providers have had to put in place to keep staff and residents safe.
"And that's a significant loss of capacity up and down the country."
Figures provided to RNZ by Manatū Hauora the Health Ministry show rest homes have made 4795 "section 31 notifications" - advising they did not have enough nurses to ensure patient safety - since the category was introduced last April 2022.
The worst month on record was November 2022, when there were 690 safety alerts.
A Ministry of Health spokesperson said the number of notifications fluctuated each month due to lags in reporting and communication, and the speed at which the notifications were processed internally.
Once the data was collected, it was provided to relevant teams in Te Whatu Ora "who can use the information to improve services".
"Reporting has, and continues to, provide an important role in supplying providers and the health system with knowledge which helps provide safe and quality services for everyone."
'A significant warning sign'
The government has added nurses to its fast-tracked pathway to residency, and was boosting pay rates to close the gap with hospital salaries.
However, Nurses Organisation kaiwhakahaere Kerri Nuku said conditions were still "dire" with some rest home staff regularly working double shifts to fill the gaps.
"This is our most vulnerable population and when our nurses are triggering and writing incident forms because they are understaffed, that's a significant warning sign."
Fiona Brown - whose intellectually disabled brother Arthur spent six months in Middlemore Hospital - said family and friends had to stay with him around the clock.
"We did throw that option around about just getting him out, I quit my job and bring him here to look after him. But someone said to me, 'If you do that, you'll never get help from anybody. They'll just expect you to do it all and keep doing it'."
During her brother's time in hospital, his weight nearly halved to just 38kg and he developed a pressure wound requiring surgery, she said.
He was finally transferred to a private hospital on 18 April after Te Whatu Ora agreed to split costs with the provider.
New Zealand Health Group head Veronica Manion, who leads the country's largest home care and support service, said her sector could help relieve the pressure on hospitals if the government changed its funding model.
"If you've someone who's in hospital waiting to go into aged care but there's no beds, if they actually increased their funding a bit more, we could care for them in the home."
She estimated there could be hundreds of other people in hospital waiting for home care to be put in place so they could be looked after safely in their own houses.
RNZ has asked Te Whatu Ora for those figures.
