The implications of the changing demographic profile of selected occupations involved with the healthcare of older people in New Zealand

Abstract

The healthcare workforce is spread across many occupations that vary in their workplaces, tasks and qualifications. For this study, specialists, general practitioners, pharmacists, registered nurses, caregivers and hospital orderlies were examined to give a broad coverage of healthcare occupations. New Zealand's population has undergone significant demographic changes resulting in increases in the size of the older population and its proportion relative to the whole population. In addition, the structure of this older group is changing, with continuing increases in the 'oldest-old' (aged 85+). As demand for health care increases with age, there will be an increasing need for people whose occupations involve work in the healthcare of older people. The demographic structure of occupations has also undergone changes as a result of political, economic and technological changes and changes in lifestyle and family patterns. The ageing of the population is reflected in the changing age structure of the health workforce. During 1991-2001, the mean age of the general workforce increased by 2.5 years. The number of women in the workforce has increased in relative size, in proportion to all women aged 15+, and in proportion to men in the workforce. Although there was an increase in the numbers of people in the workforce, there was also a large increase in numbers of part-time and casual workers. For most of the healthcare workforce, growth in numbers has not been as great in relative terms as the growth of the general workforce or of people aged 75+ and 85+. The increase in mean age echoed the increase for the general workforce, although it was much higher for registered nurses and caregivers. For specialists, general practitioners and pharmacists the proportion of women increased. The proportion of women decreased for registered nurses and caregivers, although women still make up 94% of these occupations. There was a large decrease in the proportion of women hospital orderlies and this decrease appears to have been the main reason for the large decline in growth of this occupation. Government policies have also caused an increase in demand for all healthcare workers in addition to that created by the increase in the number of people aged 65+. The growth in the number of specialists matched the growth in number of people aged 75+ and 85+, but may not have kept pace with the increase in demand. A large increase in demand for general practitioners, pharmacists and registered nurses, coupled with the small increase in their growth, means their workload has increased. Caregivers showed a large increase in numbers over the decade but when the large numbers of part-time workers and the decreasing numbers of enrolled nurses and nurse aides is taken into account, the increase in growth is slightly below that of people aged 85+. These trends are disturbing, as present political strategies will result in an increased demand for community healthcare workers. Bearing in mind the inherent difficulties in forecasting numbers of people, occupational trends and disability and disease rates, this study made the assumption that the ratio of healthcare workers to people aged 85+ will need to be the same in 2011 as it was in 2001 in order to maintain the same standard of healthcare. Two projections were calculated. The first predicted the numbers of workers based on a continuation of the 1991-2001 trends, while the second showed the number required to maintain the same in ratio of health workers to people aged 85+ that existed in 2001. These projections indicated a shortfall of numbers in all healthcare occupations (except specialists) if the occupational trends of 1991-2001 continue. While there have been some moves to increase the number of young pharmacists, nurses and general practitioners and to increase the skills of those involved in the healthcare of older people, the main policy appears to be increase the number of professional healthcare workers through immigration. Very few initiatives appear to be in place to increase the recruitment, retention and number of FTEs for female healthcare workers. Registered nurses appear to be the only healthcare occupation for which any initiatives have been undertaken to retain workers.