The NZACA’s report ‘Caring for Older Kiwis’ draws some interesting conclusions from the data. We know from our members who provide homecare services that assessment doesn’t always result in the same or consistent level of service allocation per DHB. It also applies to a range of other health services. The extent to which variability in support may be driven by DHB debt pressure is a really good question that needs more attention, and our members regularly comment about clients needing more home support than they are getting. (The average publicly funded home support for older people is just over three hours per week).
It is good to see efforts to establish reliable outcome measures for aged residential care. Considering that they are receiving 24/7 support, it would be expected that health stability would improve in many cases.
We think it is more problematic when the bow of value is drawn between an assessment in the community and a later one in aged residential care. There are some important variables at play here that aren’t taken into account in the NZACA report. One is the circumstances and place of the community assessment. We know from interRAI data that 22 per cent of all interRAI assessments take place in the hospital setting, for example when a person has had a fall or a stroke or a serious health event, at a point where a person may be very unstable in their health. Seventy-eight per cent of assessments take place in the home environment, where a person may be at the start of a journey to recover from a more serious event or may be getting a reassessed as a result of a change in their health status. Based on this any future assessment for this group of older people is likely to result in improvements in their health status regardless of whether they are in the community or residential care. It is problematic to draw a direct line of improvement.
A related variable is what has happened after a high needs score was recorded in the community. Again, that varies per person and from one DHB to another. The response can include support from health professionals including medication management, rehabilitation, more family support, home support, meals support, respite care, social integration services and carer support. Models of support in the community also vary widely across District Health Boards. Some older people whose health is quite unstable may receive increased services to see if that helps their health stabilize. It is useful to look at, but harder to draw a conclusion. We think there should be more consistency in the community services that are offered, but that is a slightly different issue.
The most important variable is the choice of the older kiwis. This is the heart of ageing policies, and is not directly addressed by NZACA, though briefly in the Grey Power message. Our point is that if people choose to stay at home as they decline in health, then we should make sure that they and their carers have the right amount of support to safely exercise that choice.