District Health Boards have hit back at the New Zealand Aged Care Association’s recent Caring for Older Kiwis report that suggests older Kiwis have to wait a long time for residential care in some parts of the country. DHBs claim that as interRAI assessments do not specify the services to be allocated, a direct line should not be drawn between assessment and entry.

The NZACA report showed that the waiting time to enter a residential aged care facility differs significantly between District Health Board regions. An older person in the Bay of Plenty DHB region who has been assessed as at risk of needing aged residential care, on average will wait nearly six months longer than someone who lives in Waitemata to access an aged care facility.

Wait times don’t tell full story

However, Jon Shapleski, programme director for Health of Older People, says these conclusions are misleading.

“Drawing a direct line between assessment and entry to residential care is a misinterpretation and cannot be concluded so simply.”

He points out that the report considers the time between someone being assessed with a high MAPLe Score (a decision-support system for prioritising clients’ needs) and their entry into aged residential care.

“A high MAPLe Score identifies a need, it does not necessarily mean that residential care is the option needed.  The report does not consider access to alternative care and support services that allow the individual to remain at home or in the community until they decide otherwise,” says Shapleski.

“DHBs invest heavily in ensuring the choice to remain at home is a viable option for individuals. The care and support services available outside of aged residential care differ between DHBs.”

Shapleski notes that interRAI assessments are standardised.

“They provide decision support for assessors, but do not specify the services to be allocated. This is a follow-up process determined by local service guidelines and options.”

Health Minister Dr David Clark agrees.

“I would expect to have a good degree of regional variation in the system because there are different models around the country, which are responding to different local populations. Some populations will want to have their families staying at home longer and some populations will want aged care in a residential setting.

District Health Boards share this view.

The Bay of Plenty District Health Board (BOPDHB) was among those singled out for a long wait time. BOPDHB Portfolio Manager Healthy Ageing Brent Gilbert-De Rios says the results in the NZACA report are largely driven by patient choice as timely assessments are completed for entry into aged residential care (ARC).

“The current occupancy rate of ARC in the Bay of Plenty is 87%, so there is capacity in the system. However, once assessments are carried out people are given the option of when they want to go in. If it is safe and appropriate, some opt to defer that decision and stay in their homes with homecare support services, some go in.

“From the data presented 70.4% of clients who are eligible to enter residential care are choosing to remain supported in the community, usually with a combination of formal and informal support options following their interRAI HC assessment.

Gilbert-De Rios believes this reflects the successful implementation of Ageing in Place in the Bay of Plenty.

“Ageing in Place focusses on older people remaining in the community, either in their family homes, in homes to which they have moved in middle or later life, or in supported accommodation of some type, rather than moving into residential care. The policy is popular with older people themselves, who prize their autonomy and independence.”

Hauora Tairawhiti needs assessment and service co-ordination manager Penny Forrester said residential care services were often the option considered when all other options had been explored, used and were no longer working.

“People whose assessments indicate that they are eligible for care are given options that include home support, and many of our older people wish to remain in their homes for as long as possible,” she told the Gisborne Herald, in response to the report’s findings that Tairawhiti recorded the second-longest wait time at 7.6 months.

More consistency needed for community services

The Home and Community Health Association (HCHA) agrees choice of older Kiwis is important and they should be adequately supported to stay in their homes. However HCHA chief executive Julie Haggie is concerned about inconsistencies between DHBs for home and community support services as well.

“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.

“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.”

Today’s problems can be tomorrow’s opportunities

Richard Hinchliffe, Head of Professionals and Healthcare Banking for ANZ Commercial and Agri, suggests that we need to understand what other factors are driving these regional differences.

“If the regional difference is due to supply, the data could be used to identify areas of New Zealand needing more retirement villages to help deal with the waiting issue.”

“Remember, the number of people living at aged 85+ in New Zealand is expected to grow significantly over the next 25 years from 83,000 and 2016 to 240,000 in 2043. For those companies interested in the over 65+ market, by 2043, the market will double to around 1.4m.”

Hinchliffe notes that the NZACA report discusses issues older people face when they remain in their own homes, such as safety, loneliness and ignoring health issues, and placing a strain on family relationships.

“Any company looking to grow its aged care business will need to understand these issues and seek to address them in their strategic planning. Examples of questions to ask include ‘what is the Problem?’, ‘what is our Purpose?’, ‘can we solve the problem with Technology?’ and ‘how do we create better health outcomes for older people living at home?’. The over 65+ market will grow rapidly over the next 20 years and companies that find solutions to these questions will be rewarded.”

The way forward

The report, based on more than 300,000 anonymised clinical interRAI assessments done throughout New Zealand over the past three years, showed that rest home care adds significant value to the lives of older people.

The results show that 82% of older people reporting that they no longer feel lonely when they move into care, 74.5% had improved health stability and 62.6% had improved levels of pain. Improvements were also noted in cognitive performance, independence and mental well-being.

NZACA chief executive Simon Wallace describes the results as “both exciting and challenging”. He notes that while the interRAI standardised assessment tools allow better monitoring of older people’s health and well-being, these tools need to be used consistently across the country.

“We are keen to work with the Government to progress their policy that the interRAI assessment tools are applied in a consistent way across all the DHBs so that our elderly people can be treated equally,” says Wallace.

Shapleski says it is great to see the NZACA report draw on InterRAI data.

“The whole point of rolling out InterRAI was to ensure consistency in assessments and that the results are used for care planning.

He says it is pleasing to see that residents entering aged residential care are all showing improvements across the board in their health status post admission.

“This affirms that both the residents entering residential care are needing additional care and support, and the fact that their health and wellbeing is improving demonstrates that Residential Care being provided across the country is of a high quality.”

Minister Clark acknowledges the task ahead for the Health Ministry.

“What we as a Government have to do, and it is a challenging task, is to balance the desires of the industry to have more people in aged residential care with ensuring we’re providing adequate residential care and supporting those people who want to stay home in the community for longer.

“People have to have good aged care provision in residential settings and also support to live in their own homes when they want to. I’m most concerned that we support them to have choice in their decision-making process and dignity as they age.”

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