School of Business

Course code ITST7.400

Special Topic

Management related problems in the rest homes in New Zealand

Supervision -Alison clear

Author -Hardeep Singh Maan
Student ID . 2017001863
Executive summary

This report provides the analysis and evaluation on the rest home care related management issues and
problems of financial and human resources. The areas of improvement in quality of care are also main
subject of analysis. The methods of analysis include interviewing the manager and by secondary research
findings; health care of New Zealand offers a diverse range of services to enhance the betterment in the
health lifestyle of the New Zealanders. The disability and support services include the long-term care
facility services given to the old people. New Zealand rest homes are main service provider of long term
care facilities. Rest homes play vital role in contribution to common goal of ministry of health i.e. giving a
better health care services to the New Zealanders. Managing the rest home care facilities, the managers of
the rest home is to give quality of services towards the consumers(residents) by managing the resources in
the rest home. They face challenges about human and financial resources and provides the services
according to standards set by the health of ministry for rest homes. District health boards gives funding to
the certified rest homes. In this report, the managers face issues about the output of the services not matching
the cost of funding and quality standards. After deep analysis of the observation, the shortage of staff and
poor training provided to staff is the main factor that is decreasing the quality of the services, it is also a
great challenge for a manager to deliver the care-assistance according to the standards. This report also
reflects the factors that related to quality of care giving to residents. The staffs main demand of the rest
home is to give quality services. DHBs (District Health Board) is responsible to check the quality of care
provided to residents by evaluative auditing process. In this report, the data taken from the New Zealand
complaint website gives the clear illustration of the poor polices, management, training and lacking areas
which are the barriers for quality of services (QOS) to the residents in the rest homes. This report gives the
understanding about the incidents happened in the rest homes due to distinct reasons. The proper strategies
are required to be implemented in staffing process to hire better staff. In this entire process, the quality of
staff and the cost of caring staff in the rest homes is important for managers to evaluate a quality of the
services.
Table of contents

........................................................................................................................ 1
Management related problems in the rest homes in New Zealand ............................................................... 1
Executive Summary ...................................................................................................................................... 2
Management challenges faced by managers at rest home in ........................................................................ 4
New Zealand ................................................................................................................................................. 4
Introduction ................................................................................................................................................... 4
Research questions ........................................................................................................................................ 4
Methodology ................................................................................................................................................. 5
Literature Review- ........................................................................................................................................ 5
Findings and discussion ................................................................................................................................ 7
Conclusions ................................................................................................................................................... 8
Recommendations ......................................................................................................................................... 9
References .................................................................................................................................................... 9
Appendix ..................................................................................................................................................... 10
Management challenges faced by managers at rest home
In New Zealand

Introduction

The health care society of New Zealand offers wide range of services such as health and disability support
services to improve, promote, and protect health of new Zealanders (Govtnz, 2017). This report
emphasizes on the issues and problems about the management of long-term care facilities like rest homes
in New Zealand. Healthcare management is becoming a big challenge due to the focus on increasing
productivity, quality and lower the cost of giving care.
Rest home care industry plays a key role in healthcare of the nation to give disability services to person
with disability due to age related or disability for support for their independence. The rest home care
facilitates the main resident care and continue providing hospitality services. An independent agency
(contracted by the District Health Board) accesses the patient information and offers the required level
and type of services. There are several types of service portfolios such as rest home comes as single type
and the combination of services consists of two types of services as rest home combining with continuing
care hospital.
The managers have a pressure to keep the balance between the external environment and internal
environment demands. Skills and knowledge needed to manage the management of the rest homes. It has
been changing due to regulatory, demographic, technological and social changes. Increasing the
expectations of the customer for high standard quality of care and the stake holder expectations for profit.
The main challenges of manager to create equilibrium in the shortage of resources with increase in
demand and expectation of quality of care and its key role in elderly care. (Madas & North, 2000)
A government conducts audits to check the standards and quality of the services given by the rest home to
the residents. So, manager is answerable about the limitations and improvements about the spotted areas
during audit in rest home.

Research questions
What type of challenges faced by the managers during management resources like finance and staff in rest
home?
What kind of problems and issues arise during managing the quality of care to the residents in rest
homes?
Methodology
After analyzing and evaluating the research methodology process, I choose qualitative method in which I,
interviewed rest home manager and tried to find the research questions about management problems in
elderly rest home. I interviewed the manager at a public rest home. The mangers in the rest home
addressed the problems they face during the management of the resources (services they provide) and the
issues related to the finance. The manager of rest home discussed the entire information about the finance
sources, like who is providing funding to run this rest home and other inputs like residents pension and
charity. The problems related during managing the quality of care given to the residents as the output.
With the help of the data available on the internet try to find issues related to the management of the
finance in the rest, cost effective methods, the various funding sources. The online research helped me a
lot to know the relationship between the cost, staff and the services. These three are inter-linked with each
other. The review of the articles focuses upon the management prospective of the managers, their action
plan and problems faced in the rest homes-

Finance (cost of caring, funding, financial sources)

Staff (nurses, healthcare assistants, Physicians)
Quality of care (standards set by Ministry of Health)
The method of finding the key issues are related to the management of rest home by interviewing
methods and funding for resident care services.

Literature Review-

Finance support in rest home

According to Vincent Mor (2014),There is the agreement between the health of ministry and 20 district
health boards for the homebased support services for the old people . Aged care services have given free
to the public until year 1993 after it transferred to disability support services. There is a residency care
subsidy for old people paid by district health boards. The government gives subsidy to 64 percent of
people in resident care. IN year 205 the associated social security increased the exclusions of assets.
People could hold NZD $150,000 before pay to the full cost to the rest home. In 2012 government
decrease the budget for asset threshold. The fundamental issues related to the funds are Increased cost of
the care giving not matched with the present funding. Increase in demand of high quality standards not
meet the funds
Ministry of health issues a list of certified rest homes and audit report on ministry of health website. A
basic rest home cost over $40,000 per annual for a single person.
The 60 percent of the cost for the long-term care services given by the district health board. According to
Grant Thorntons Review (2010) 68 percent of resident care facilities owned by profit seeker owners in
New Zealand.
According to author goldsmith, (Goldsmith, 1993)Manager is the main person who represents and knows
the rest homes insufficiencies, the areas required for improvement and challenges. An interaction
between the staff that duty on the daily to talk with the older and sicker people. The rest home manager is
the administrator have an impact on the organization. Staffing is the sensitive management function It is
very difficult to get right(deserve) people for the job and training them after recruitment. The cost of
hiring is very high for any organization this cost includes the recruitment and training expenses. Planning
gives the positive result as output.

Quality standards and staff

Care depends upon the no of staff members and the cost its 3 types
1. functional, team and primary care
Rest home management the availability of the registered nurse need in the continuing hospital with rest
home. The requirement of registered nurse is depending upon the no resident in the rest home.
Health care assistants responsible for the care of the resident after registered nurse. Care planning include
therapists and social worker. Health and disability services act 2001 standards to deliver safe, consistent,
and suitable levels
The manager has responsibility to enforce the safety and health regulations. Hiring of the staff and
managing the management between nurses and the working teams is also a challenge.
According to (Bowers, Esmond, & Jacobson, 2000)There is the connection between the quality and the
staffing in the rest homes
The standards are set by the ministry of health (Govtnz, 2017) for a rest homes to provide support and safe
services to the consumers. It helps to improve the quality of the services these services include consumer
rights, service governess and management and infection prevention and control

For the better resident outcome, a good management is in the care home. in care homes, most of staff is
inexpert or semiskilled (Bowers et al., 2000)
According to the (Esmond & Jacobson) higher number of experienced staff like registered nurses increase the
positive outcomes residents, lower level of registered staff (RN) illustrate poor care to the residents. An
excellent quality ensures the good outcomes of the resident. Inadequate no of staff fails to develop and
demonstrate relation with the resident which is a barrier to provide the high quality of care. shortage of staff
put burden on the each of the member due to high no of procedure and the task activities to complete in the
given time .so, short staff is also a barrier to give a quality of care. working with the untrained staff is like the
shortage of staff. The process of developing relationships between staff and residents has connection between
the staffing and the quality.
The quality of the care depends upon the performance of care giver in the rest home, the measurement tools
and quality standards are important.

According to Duffield (Duffield, Roche, O'Brien-Pallas, & Catling, 2009) it is seen the performance of the
nurses in team without any absent puts positive impact on the patient care.
 The data finds from reports given on consumer website most of rest homes did not deliver the quality of
services due to given responsibility to unexperienced staff without supervision the main
(Consumer.org.nz, 2017).

The staff did not keep and create the record. This shows poor documentation and the ignorance
by the staff, they give poor standard of care to patient not checking properly. the care provided to
old person was below to the standards as per given by ministry of health shows the poor training.
The manager failed in giving the assurance for the quality of the services this shows
unexperienced manager.
It was found inaccurate and uncomplete assessment about the residents and management did not
have any training to work for elderly care.
Plans were not clear to staff of the rest home. The staff was less in number, poor in the
management and measures of pain and infection prevention and control, untrained staff needed
training. The care plans and the complaint management was not done properly.
Shortage of the staff and deprived infection control process. Incomplete caregiver training and
insecure medicine management.
these areas need improvement to provide a quality of the care services to the home care residents.
The nursing is the key role to give the best service output to the patients. The quality of care to the
resident given by the nurse staff (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002)
The staff at rest home unable to give the quality of the care that creates a major problem in the health.
Sometimes treatment given to residents is not proper treatment and medical care all this happened due to
poor staffing and training (Oupcom, 2017)

Findings and discussion

After analysis interviewed manager at rest home. I found the entire process of funding for the rest home it
begins with the central government appoints minister of health then minister offers annual purchase
agreement to the ministry of health for giving funding to the district health board. The disability support
services come under the district health board. So, the financial support for the rest homes given by the
regional district health board. According to the regions there are 20 district health boards in the New
Zealand which they are offering the disability support services. Sometimes offered funds to the rest home
is not enough so that time manager must control on the other costs. While any new policy made by the
district health board that put burden on the costs. Because the manager must perform better for the rest
home. As the funding sources, they are not getting enough funds from donations. some time
The fundamental issues related to management of the resources they face shortage of the staff like care
giver, nurses and financial like maintain the cost of care and the other expenses at rest homes.
The problems related to staff like assurance, throughput, source of workforce (agencies which provide
staff)
Nursing staff like RN (registered nurses), LVN (licensed vocational nurses) or LPNs (practical nurses
with license). nursing assistants with certification and therapists like physical must have skills and
experience.
For a manager bring the best performance in the rest home the challenges are productivity, efficiency, and
the quality. for manager, It is difficult to keep equilibrium between the cost and the productivity by giving
the quality of services. The quality of care directly proportional to the dealing of nurses with the residents.
The manager with the non- management background faces many problems in distributing the financial
resources because some managers in the rest homes are the nurse managers so they unable to control the
cost and the funds of rest homes. Accurate Budget presentation is essential to obtain the financial support
for the rest home.
Managers must regular check on the updates related to changes in the polices by district health board
I found there is subsidy given by the government for the older people for the resident care. in this subsidy
pension $34.81 for week and $246.91 for clothing payment its the indirect funding source from the
government the rest home. its contract between the rest home and district health board.
Communication is also main barrier to staff members, overseas staff unable face the cross-culture issues
while giving the services to the residents.
After analysis, the finding in the reports the main problem is human resources a shortage of staff like
nurses and caregivers. Untrained staff is also a main issue for not giving better services. For a manager
hiring a deserving staff recruitment is essential.

Conclusions

After deep analysis, it concluded, manager is accountable for the output of the rest home like managing
the cost for the use of the resources and delivering the quality of services to the resident of the rest home
is the main problem. manager performance is depending upon the output of the rest home like services
given to the residents. Staff (nurses, caregivers, health assistants, dietitian) is also responsible for the
quality of care as output. fresh staff or untrained staff creates an issue for manager not provide the
excellence of care to the consumer. The more experienced and skilled staff in the rest home give the
positive output for the services. The coordination between the nursing, non-nursing and management is
essential to work for common goal. In the rest home nursing staff has to work accordingly to the health
practices and given directions by the manager. The positive services output gives satisfaction to resident,
ultimately the profit comes to the owner of the rest homes.
Recommendations
As manager, the services should be proper and well planned. for continuous improvements for the quality
a documentation about quality and risk management is needed. The complaint system should be proper
accessible prepare under the facility management
Human resource management -should arrange a best practice for employment with meet judicial
requirements. should hire the staff have relevant qualification, skills, and experience in health care.
the district board should give more funds to financial support it will help to Managers of the rest home
should keep check all the standards given by the ministry of health. proper documentation, policy should
have implementation on the plans in as strategy management. For meeting the quality standard there
should be proper coordination with the staff. The fulfillment of shortage staff and hire only trained and
experienced staff is essential to give the quality of the care.
Managers should have a management qualification or financial training given to manager it will help to
manage the finance in the rest home. the combination of qualification like nursing and management is the
helpful for the rest home. manager could easily coordinate between the nursing staff it would be easy to
know the issues faced by staff during care of the resident so, as from the same background it will help to
improve quality of care.(Scott, Webb, & Sorrentino, 2015)
Managing the service delivery planned and coordinated meets with the laws and needs of the consumers,
safe emolument.
Quality assurance plans for this all staff members are required in this process
Care planning should be client focus it will help to deliver quality of service it will done by the promotes
the care evaluation on care plans and the most important maintenance of the pla
There should be screening to hire eligible person as the staff and like a 4 -5 days to check the individual
performance before signing the contract.

References
Bowers, Barbara J, Esmond, Sarah, & Jacobson, Nora. (2000). The relationship between staffing and
quality in long-term care facilities: Exploring the views of nurse aides. Journal of nursing care
quality, 14(4), 55-64.
Duffield, CM, Roche, MA, O'Brien-Pallas, Linda, & Catling, C. (2009). The implications of staff'churn'for
nurse managers, staff, and patients. Nursing Economic.
Esmond, Sarah, & Jacobson, Nora. The Relationship between Staffing and Quality in Long-Term Care
Facilities: Exploring the Views of Nurse Aides.
Goldsmith, Seth B. (1993). Long-term Care Administration Handbook: Jones & Bartlett Learning.
Madas, Eshwar, & North, Nicola. (2000). Management challenges faced by managers of New Zealand
long-term care facilities. Australian Health Review, 23(1), 100-113.
Needleman, Jack, Buerhaus, Peter, Mattke, Soeren, Stewart, Maureen, & Zelevinsky, Katya. (2002).
Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine,
346(22), 1715-1722.
Scott, Karen, Webb, Margaret, & Sorrentino, Sheila A. (2015). Long-Term Caring: Residential, home and
community aged care: Elsevier Health Sciences.
Vincent Mor, Tiziana leone , anna maresso. (2014). Regulating Long Term Care Quality: Cambridge
University Press.

Consumerorgnz. (2017). Consumer NZ. Retrieved 19 June, 2017, from

https://www.consumer.org.nz/articles/rest-home-investigations

Govtnz. (2017). Ministry of Health NZ. Retrieved 19 June, 2017, from http://www.health.govt.nz/our-
work/regulation-health-and-disability-system/certification-health-care-services/services-standards

Oupcom. (2017). Oupcom. Retrieved 20 June, 2017, from

https://academic.oup.com/gerontologist/article/43/suppl_2/4/637528/Challenges-in-Nursing-Home-
Care-A-Research-Agenda

Govtnz. (2017). Ministry of Health NZ. Retrieved 20 June, 2017, from http://www.health.govt.nz/

Govtnz. (2017). Govtnz. Retrieved 21 June, 2017, from

http://www.health.govt.nz/system/files/documents/publications/improving-outcomes-age-residential-
care-aug16.pdf

Appendix

Financial resources (FAQs)

1)What are financial problems in the rest home?

2)how the management of the financial resources

3)what are the funding sources to the rest home?

4)how the budget is prepaid?

Human resources (FAQs)

1)what are the staffing problems?

2)how you fill the staff requirement?

3)what are the main barriers to managing staff?