They are expected to administer potent drugs to New Zealand's most vulnerable, but disability caregivers say they are lacking the qualifications and confidence needed for their demanding roles.
Bill Lewis* of Wellington is fearful residents will die on his watch. He became a caregiver 20 years ago and enjoys working with the "blokes" in his care. "They are like family."
He works for a large national disability provider, caring for six high-needs patients for up to 17 hours at a time, including an overnight shift that he works alone.
"Two of the people I care for are prone to seizures, I sleep with one eye open all the time."
Lewis, in his 60s, works 56 hours a week, even though he's technically employed part-time. No nurses are employed on site.
His main concern is the powerful sedative he is expected to administer to a patient suffering a seizure.
"I have a first aid certificate renewed every two years after a six-hour refresher course. With that I am required to administer potent medications, including psychotropic drugs and stesolid."
Stesolid is administered to patients in major epileptic seizure to calm the muscles, so as to minimise damage. The drug is administered anally while the patient is seizuring.
"My training consisted of watching a half-hour video. I was shocked, the tube used to administer the mediciation is sharp and can perforate the bowel," he told the Sunday Star-Times. "When someone's in a seizure, they're jerking in all sorts of directions. It's not fair, I won't administer it unless someone's dying."
Lewis said he complained to managment but felt like he was not listened to.
Patients were living longer and had more complex needs, but companies were keeping costs low by employing unqualified staff, he said.
"I'm retiring soon because it's physically demanding. It's mainly women who run the house, and I am concerned."
A nurse adviser was employed to take charge of more complex medical scenarios, but there was just one in charge of nearly 20 units, with up to 120 residents. "I don't think it's safe, management have pushed the boundaries."
A recently released report into aged care by Equal Opportunities Commissioner Judy McGregor found wages and treatment of caregivers were in many cases exploitative.
The disability sector was no different, workers and union representatives say.
Lewis earns an average $11.39 an hour – a daytime hourly wage of $16, and an overnight wage of $6, after a court decision to allow carers to continue to be paid for sleepovers.
The average rest home carer earned $14.50 an hour, $1 above minimum wage. A number of those were qualified nurses who turned to caregiving after the economic recession.
But unlike aged care, which was run by private companies with the help of state funding, disability providers were not seeking returns on investment, Service and Food Workers Union co-ordinator Alistair Duncan said. "To be fair, most disability support providers are like the IHC, a state-funded multimillion-dollar provider and well-organised. But the workforce is not fully regulated."
The Public Service Association says disability carers have been undervalued and are still among the lowest paid in the country.
Last month the Government committed $144 million over four-years for the disability support budget, including $132m in new spending.
The money will go towards addressing pay equality, but is realistically a "small catch up" on years of underfunding, PSA national secretary Richard Wagstaff said after the budget announcement. "These workers are almost all women, and their low wages reflect the pay gap between men and women."
Auckland University of Technology management lecturer Katherine Ravenswood says the issue of equality goes beyond pay and society was starting to realise traditional views of care work were based on gender sterotypes.
*Name changed to protect his job.
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