From jars of homemade jam to gifts of cash, petrol vouchers, holidays, household appliances, and part of the family estate, more of us are pondering ways to say thanks to loyal, reliable care workers.
It is no secret that care workers are not well rewarded financially. Yet they add richness to the lives of those who need help to stay living at home, and are a vital support for family carers, who need regular breaks from what can be intensive 24 hour responsibilities.
As in other countries, New Zealand has a shortage of skilled care workers. It can be hard to find someone with the experience and personal qualities to make the difference between coping with high health needs, or burning out and not coping.
Care workers are not like other professionals. They come into our homes, share the ups and downs of family life, and build intimate friendships that can endure for a lifetime.
In lucky cases, workers become part of the family, staying in touch even after the person needing support has died, entered residential care, or no longer requires their services.
It is thus not surprising that clients and their families think carefully about how they might recognise and reward support workers on special occasions such as birthdays or Christmas, and when the need for caring ends for whatever reason.
Families may not realise that there are ethical rules for workers about receiving gifts.
Workers are typically employed by agencies, which have strict policies about what kinds of gifts can be accepted.
The New Zealand Home Health Association says it is always best if clients and/or their families contact the worker's manager before giving gifts of money, holidays, household effects or appliances, jewellery, or other valuable items.
NZHHA executive committee member Leanne McLiver says everyday gifts (home made preserves, a bottle of wine, a Lotto ticket, a book voucher) aren't a problem.
"Even a thank you card is very much appreciated. The simple act of saying thank you is one of the best rewards anyone can have, knowing that their work has made a difference and been appreciated."
"Often people take care workers for granted. They feel entitled to this help and see no need for thanks. It is always nice to receive a handwritten note or card."
The ethical lines blur at the other end of the acknowledgement spectrum, she says.
"We had a client who asked her worker to act as the executor for her will. The worker had to choose between continuing in her paid role for the client, or leaving to have a personal friendship."
The worker opted for friendship.
Sensible workers are wary of accepting valuable gifts without first securing the formal sanction of their agency coordinator.
"There have been instances where families have asked why a worker accepted an item of jewellery, when the client had dementia and was not of sound mind to give the gift," says Leanne.
"When such gifts are offered, we always ask the client's family for approval. This process prevents any comeback after the client has died or no longer needs the worker. In every case where we have done this, the family has supported the gift, and there have not been recriminations later."
It is still uncommon in New Zealand for clients to leave bequests of money or property to long-time care workers.
But the legal lines in such cases are hazy, says Leanne, because once someone has died, the worker is no longer bound by employer policies.
In other countries, there is a growing practice to give care workers a week's salary or a piece of jewellery when their caring service ends.
Agencies are also recognising long service with bonuses of money or gifts.
Often gifting decisions hinge on the worker's tenure of service, and also each family's financial situation.
The key, says Leanne, is that workers must not expect gifts of any kind.
"It is a firm policy that we enforce continuously with workers and with clients. If a client wants to give a gift of monetary or sentimental value, it must be approved by the worker's coordinator."
Workers often receive modest gifts of home grown produce, crafts, bottles of wine, chocolates, book tokens, and petrol vouchers.
"We don't need to approve these, but beyond such items, it's in everyone's interest to be over-cautious," she says.
"This is due to the unsupervised nature of home care. Our workers go into peoples' homes and there is no constant supervision, as there would be in a hospital or rest home. There is more risk all round."
"That's why it's fine if you want to give a worker chocolates or a bottle of wine for their birthday ... but if you're sending them to Hawaii for their birthday, you need to talk to us first."
For more advice about home health or to access a service in your area, visit www.nzhha.org.nz