Goal 2 of the Positive Ageing Strategy

Older people in good health generally enjoy a good quality of life and can contribute positively to their families and communities. However, as people age their health issues can become more acute and complex, and specialist care is often required.

Details below about this goal are taken from the 2014 report on the Positive Ageing Strategy, published in April 2015. Your feedback will help inform the next comprehensive update due to be carried out in 2017.

More information and references are available by downloading a full copy of the report

Health: key achievements

• Providing access to residential care for those in need, particularly those with dementia
• Providing fall-prevention programmes for older people
• Supporting older people to live in their own homes for as long as they choose to and it is safe to do so
• Encouraging health professionals to train in hard-to-staff areas (which often involves working with older people)
• Focusing on health and wellbeing programmes for older people
• Providing better assessment tools for clinical assessments of older people in home care and aged-care residential facilities.

What’s happening

Older people dominate the health budget

Older people use more health and support services than younger people, and use more as they age. The 75-plus group receives about 90 percent of the support services for older people15 – and in 20 years’ time 11 percent of New Zealand’s population will be in this group, compared with 6 percent now.

However, while older people use a high proportion of the current health budget, we don’t know if this will increase as the population ages, because people are becoming healthier in older age.

The dementia rate is increasing

Many DHBs have noted increases in cases of dementia, which means a greater demand for dementia-related services such as carers, both in-home and in aged-care facilities. In 2011 more than 48,000 New Zealanders had dementia (1.1 percent of the population); this is projected to more than triple to 147,000 in 2050 (2.6 percent).

Many older people have disabilities

Around 59 percent of people aged 65-plus are classed as disabled, compared with 21 percent of adults under 65 years. Māori and Pacific people aged 65-plus are more likely to be disabled, with 63 percent of Māori and 74 percent of Pacific people classed as disabled compared with 58 percent of New Zealand Europeans. Around 50 percent of older Asian people have disabilities.

Ageing (at 31 percent) is the third leading cause of impairment for adults, behind disease and illness (42 percent) and accident and injury (34 percent).

Health professionals are likely to be in short supply

Health Workforce New Zealand projects that doctors, nurses and associated health professionals will soon be in short supply, largely due to the health sector’s ageing workforce. For example, it’s forecast that by 2035 over 50 percent of the present nursing workforce will retire, and similar prospects are forecast for doctors and other medical specialists. The number of general practitioners (GPs) is already declining, particularly in rural areas.

The Ministry of Business, Innovation and Employment, MSD and MoH are working with the aged care sector to look at the skill needs and potential shortages of carers in relation to home and residential care.

Around 31,000 older people are in residential care

New Zealand has more than 650 facilities for older people who need long-term residential care. In 2014 about one in four of those aged 85-plus lived in aged-care residential facilities, with the rest living in their own homes.

We’ll need more carers, both paid and unpaid

Around one in 10 New Zealanders supports a friend or family member who needs assistance because of a health condition, injury or disability.20 Carers are a critical workforce for the care of older people, including those with disabilities. The need for carers, both paid and unpaid, for older people (particularly those aged 85-plus) will likely increase in the future.

More older people are going straight to emergency departments

Many DHBs are noticing more older people attending emergency departments (EDs) with general health issues, often related to ageing. The Ministry of Health (MoH) is encouraging DHBs to have more ED specialist care teams (eg geriatricians and physiotherapists), so that older people can be better assessed and followed up with in-home care, if appropriate, to prevent further admissions.

Health and wellbeing programmes are helping older people

Older people who live healthy lives generally have better health prospects – and many DHBs and councils offer initiatives such as exercise and healthy eating and nutrition programmes. The Accident Compensation Corporation (ACC) and MoH are currently working on a new wellness and injury prevention initiative for older people.

Older people’s health issues could put pressure on the ACC system

Although older people are expected in future to be healthier and more active for longer, health and age-related conditions increase with age and are associated with longer recovery times and higher health care costs. Falls are the main reason for claims to ACC for people aged 85-plus. ACC is preparing for the effects that the ageing population and the ageing workforce may put supply and demand pressures on its claim management, health and rehabilitation services – particularly in relation to elective surgery, residential care and home and community support services.

Primary care and in-home support services are increasing

DHBs have reported that more programmes and care are being provided to older people closer to their homes, if they choose that option and it’s safe, and more specialist support is being provided to prevent hospital re-admissions.

Examples of services and programmes

MoH and Health Workforce New Zealand – Voluntary Bonding Scheme

The Voluntary Bonding Scheme encourages graduates in the health sector to move into the communities and specialties that need them most, particularly aged-care nursing and general practice. Participants receive annual payments to help repay their student loans or as top-up income.

MoH and MSD – Residential Care Subsidy and Loan

The Residential Care Subsidy contributes to the cost of care for older people who are assessed as needing long-term residential care in an aged-care facility. The Subsidy is subject to income and asset tests.

Older people with assets that exceed the subsidy limit may qualify for a Residential Care Loan to help with the cost of their care, if they still own their own home and have limited other assets.

MoH – Framework for Dementia Care

Released in 2013, the Framework for Dementia Care aims to ensure that people with dementia get the services they need, from diagnosis to the end-of-life stage. The Framework encourages health and social services to work together, and emphasises services need to people’s wishes, cultural preferences and lifestyles. It also encourages health professionals to diagnose dementia early, so that people get the help they need as soon as possible.

Planned dementia village in Rotorua

Planning is underway for a dementia village in Rotorua that’s expected to be the first of its kind in the Asia-Pacific region. Inspired by a Dutch dementia village, De Hogeweyk, it will cater initially for about 80 residents, with each living in a small group with others who share similar interests and backgrounds. The village is scheduled to open mid-2017.

Workforce action plans

Health Workforce New Zealand and Careerforce (the industry training organisation for carers) are working on a ‘kaiāwhina workforce action plan’, which will provide a career pathway for those in the health and disability kaiāwhina/non-regulated workforce.

MoH and DHBs – interRAI

interRAI is an internationally recognised tool that nurses in aged-care facilities use in making clinical assessments of residents’ needs and developing tailor-made care plans. More than $14 million has been spent in implementing interRAI in aged-care residential facilities and more than 1,000 registered nurses have been trained to use it, completing more than 11,000 assessments to date.

Capital & Coast DHB – CaREFul trial

To address the increasing number of older people presenting to its ED, Wellington Hospital has run a trial programme called ‘Caring for the At Risk Elderly patient who is Frail’ (CaREFul). ED staff assess every patient aged 75-plus for frailty then, if appropriate, refer them to the ED-based CaREFul response team, which comprises a geriatrician, nurse, allied health professionals (such as a physiotherapist) and a pharmacist. Follow-up treatment (if necessary) is provided by in-home community services, such as district nurses, to try to limit unnecessary re-admissions.

DHBs – Fall-prevention programmes

Many DHBs are responding to the increase in fall-related injuries with fall-prevention services and education campaigns. In addition, a research programme is looking at the suitability of housing and modifications that better prevent falls.

ACC – Return-to-independence programme

ACC has piloted a dedicated team focused on rehabilitating injured people who are not in the workforce, of whom a high proportion are older people. Feedback on the pilot has been very positive. ACC is considering implementing the programme nationwide.

So how are we doing?

Health is the dominant focus of policies and services designed for older people in New Zealand, and that’s likely to remain the case.

It’s encouraging to see:

• the increasing number of health and wellbeing programmes being provided
• the work underway to attract more people to train in hard-to-staff areas and to areas with skill shortages

However, the health system is forecast to come under pressure owing to:

• a rising shortage of health care professionals and carers, particularly for older people in smaller and rural areas, which could leave them isolated and vulnerable
• increases in the number of people with dementia. The forecast rise in the number of people with dementia will also place pressure on the system. The improved diagnosis of dementia and the drive to provide the right services need to continue, as does the development of innovative approaches, such as the planned dementia village in Rotorua.

What do you think?

1. What are the implications of having appropriate services to enable older people to live at home for as long as they choose to?
2. How can we address the likely shortage of health professionals and carers?
3. How can we improve access to health services for older people in rural areas?

If you would like to share with us your views on Goal 2, then please send us an email.