Aged care nurses who worked around the clock to keep residents safe during lockdown say they face a critical staffing shortage if their pay is not boosted to bring them in line with their District Health Board colleagues.
More than half of the New Zealand Covid-19 deaths were in rest homes - with five of the 16 clusters at aged care facilities.
Today, an independent review of Covid-19 clusters in aged care facilities found that the infections were introduced to the facilities by staff or visitors. It detailed how staff at some rest homes were operating in an "atmosphere of fear", how they did not have a strong knowledge of epidemiology and how a single positive Covid-19 result could lead to heavy staff shortages.
The report laid bare struggles and shortfalls the country's aged care sector.
There are about 300 vacancies for registered nurses at rest homes around the country.
Those positions require the same qualifications and skills as nurses working for District Health Boards (DHBs), but are paid significantly less.
Among them is Criszel Mosquera - a registered nurse at Christchurch's Chatswood Rest Home.
Originally from the Phillipines, Mosquera began as a healthcare assistant here four years ago, before getting her NZ nurse registration last year.
She changes dressings, provides palliative care and medical assessments - everything you would expect in a hospital.
"The majority of the time we're the only clinicians here on the floor - so it's expected of us to make clinical decisions without really the support of other medical professionals on the floor."
Those challenges were especially felt during the lockdown.
"It's pretty tough every day but we love taking care of our people here."
Rhonda Sheriff is the co-owner of Chatswood - she said the staff had been incredible throughout the pandemic - but they were facing a crisis across the country getting people to fill roles, with DHB nurses getting paid between $20-$30,000 more than rest home nurses.
"We're reliant on our immigrant staff, we rely on them to come in, because our New Zealand registered nurses aren't working in aged care unfortunately, because of the fact we can't meet their wages."
With around half of all aged care nurses trained overseas, she said the border closures were only going to add to those staffing shortages.
Sheriff said nurses came in during their 20s and 30s with experience from the overseas countries they had trained in - often the Philippines or India.
"They come, they increase their base level, and then they move off."
She wanted to see the government increase funding for aged care nurses to bring them in line with their DHB colleagues.
Sheriff said operational costs were extremely high, with wages making up about 60 percent of total expenditure.
"I do not make anything operationally out of this business."
Aged Care Association chief executive Simon Wallace told Checkpoint the aged care sector had been undervalued for far too long.
"I think what we've seen with Covid-19 is the tremendous value that they've delivered in keeping our old people safe through this really difficult time."
Wallace said he thought the Ministry of Health had a responsibility to value the role of nurses in aged care.
"Aged care is a mainstream part of the health system, we have 40,000 beds, we are looking after very sick people and keeping them from admissions into public hospitals. We play a huge role, and they can't renege on the responsibility in terms of valuing our nurses, and that's gone on for far too long.
"The situation was compounded in 2018 when the government reached the settlement with public hospital nurses, and that's just seen that difference in those pay rates become even more."
Wallace said the Aged Care Association was doing everything it could to train more New Zealand nurses.
"The border closure means that it's much harder for us to bring nurses in, even though that they are regarded as essential workers. There is a cap on the border in terms of how many people are coming through each day.
"And they are returning New Zealand ... residents and citizens. So it's very hard still for us to bring in nurses from overseas to fill those gaps.
"Even though they're essential workers there's a 250 cap on the number of people that are coming in each day… We're not getting those internationally qualified nurses and that we need to fill the gaps. Meantime we've got the DHBs poaching our staff, simply because they can pay more."
In a statement, the Ministry of Health said rest homes agreed on a price with DHBs each year for the delivery of services, and they were responsible for wage costs.
It said it was not appropriate for the Minister of Health or the ministry to comment on the wage rates agreed between these private sector employers and their employees.