05 September 2007
SPEECH: On Aged Care discussion document
Speech to the Health Care Providers Conference
Thank you for inviting me to speak here at your conference – “Celebrating aged care in New Zealand”.
We are all ageing. It is one of life’s certainties, like death and taxes. In government, National intends to do something about taxes, but I’m afraid ageing and death are beyond even the most determined of prime ministers.
While by definition we are ageing every day, we seem to be putting off the serious part of ageing until much later in life. We are living longer than ever, and in better health. For most people, 65 is not old and 70 is not old.
Retirement for many people is an enjoyable time in their lives. They are at last their own boss, free to do what they never had time to do during their working lives. Eventually, as they get older, most people need help with the tasks of daily living. Most, but not all, of this care is provided by family and friends. Most, but not all, happens within the elderly person’s own home.
People’s experiences of ageing are very diverse. In old age, as in all other phases of life, there is not one size that fits all. Many older people see out their days in their own homes, or in retirement villas or rest-homes, content and comfortable. They enjoy visits from friends and families, and require no special medical attention beyond the occasional trip to their GP.
For others, however, the story is neither as smooth nor as satisfactory. They may come to need the intensive or specialised kind of care that even the most loving and attentive spouse, partner, or family cannot hope to provide in their own home, or in the older person’s home.
On that subject, I would like to pay tribute to all those people who do, selflessly, care for their partner or spouse with kindness and self-sacrifice for as long as they possibly can. What an enormous job. What an act of love. It can be a very hard decision indeed to assess when the time has come to say, “I can’t do this any more. This person I have been with for 30, 40, 50 or even 60 years has to leave home.” That is a difficult time for all concerned.
That is where the professionalism of your industry and the wide range of services and style of accommodation it offers is now a godsend to so many people.
For those who want or need to move out of their own home, there is usually a style and price of accommodation that can be found to suit most people’s needs. Ideally, that does not signal the end of community and family engagement for those people.
I hardly need remind you that your industry deals with some of society’s most vulnerable members.
We should remember that the patience required to meet the needs of an older person may, in some cases, be much like the patience required to attend to the very young.
Those older people who do not have family, or who have outlived those who knew them best, or who are finding it frustrating ageing, can have a lonely time of it. Society, therefore, places a very high degree of trust in your industry to get it right. In the majority of cases, you do.
But you would acknowledge, I am sure, that your success rate is not 100%. Some of the cases that have been highlighted in the media have made harrowing reading. Every one of those stories represents some kind of trauma and upset for the family involved, and reflects badly on the industry as a whole.
That is not to say, however, that elder abuse is confined to incidents in rest-homes or other residential facilities. That is by no means the case. The most vulnerable older people of all may be those in their own homes, or living with family members where no one sees what goes on.
If I may be permitted a short diversion, I would like to say this:
In the same way we are all being urged to look out for the welfare of children in our neighbourhood, and to report anything we think is suspicious or on which we need reassurance, so too should we be looking out for vulnerable older people.
I am not talking about spying on your neighbours, I am talking about getting to know them, especially if they include an older person living alone. Take an interest in their life. Have days gone by when you haven’t seen them? It’s not prying to be concerned about the welfare of others. It is human.
These are small things but they are meaningful and help erode the isolation that so often accompanies old age.
The future of aged care
I want to consider for a moment what the future holds for the aged-care industry.
It’s hard to predict the effect of changing social trends and the effect of rapidly evolving technology on people’s future decisions to go into care. That doesn’t matter. By far the biggest driver of future demand for residential care is demographics. It is the ageing of the large baby-boom cohort and the trend of increasing life expectancy at older ages.
Consider those people who are very old, and therefore the most likely to go into care. Of people aged 85 or over, for example, 27% are in some form of residential care.
Right now, there are 60,000 people in New Zealand aged 85 or over. In 25 years there will be 160,000 people aged 85 or over. That is a massive demographic change. That extra 100,000 very elderly people is the same size as the current population of Tauranga.
So it doesn’t matter whether it’s 27% of that group who require residential care, or 20%. The sheer demographics overwhelm everything else.
Over the next 25 years and beyond, the demand for residential care will just keep on growing. To meet this demand there are going to have to be an awful lot more residential facilities built. You are in the enviable position of being a growth industry.
These trends are not so comforting for the government, however. Government funding of Disability Support Services for people aged 65 and over totals $1.1 billion, of which more than half is spent on residential-care subsidies. This funding is going to have to rise dramatically in the future if we are to maintain current levels of provision.
Population ageing, in fact, has a double whammy effect on the government. Not only does it put severe pressure on age-related social spending, but it also acts as a hand-brake on GDP growth, because the proportion of the population who are in the labour force is going to be falling each year. Lower GDP growth means lower tax revenue and less ability to pay for social spending in the first place.
The affordability of future spending on aged care therefore comes down to two things:
Firstly, it depends to a very great degree on how prosperous we are as a country. Wealthier countries can have better aged-care services because they can afford more of those services, and that is the case both collectively, through the government, or individually, out of people’s own pockets.
At the heart of National’s policies are those to make New Zealand a more prosperous country.
Second, the challenge for governments is to spend money on aged-care services wisely and effectively. National takes this challenge very seriously indeed.
National’s discussion document
Today, I am delighted to announce the release of a discussion document on aged care, called “Choice Not Chance for Older New Zealanders”. Copies can be downloaded from our website – www.national.org.nz.
This document is the result of some wide consultation and hard thinking by Jo Goodhew, National’s MP for Aoraki, and the rest of our health team.
To develop this discussion document, Jo and her team invited people involved in all aspects of the care and support of older people to 15 aged-care forums throughout the country, and talked to many older New Zealanders, and their families and carers.
Older people told stories of the difficulties they had in navigating a myriad of services, of wanting to remain independent for as long as possible, of wanting to ‘know’ their caregivers, and not have them change all the time. It was important to older people that they could choose their caregivers and that they could be assured of safe and high-quality care.
Older people wanted to know where they should turn when they didn’t feel safe or had concerns about their care. They expressed anxiety about the transition from hospital back to their home or to a community facility.
Families expressed concern about these issues as well. They were also worried that the pressure of caring for loved ones at home impacted on their health, particularly because of difficulties accessing respite care. Families spoke of concerns that they themselves were not adequately trained for their roles as caregivers.
Health care providers expressed concern about their workforce turnover, the high compliance costs involved in auditing, their reliance on government subsidies, and their annual contract negotiations. There was concern about a ‘silo’ approach that makes it difficult for them to provide a progression of care across the continuum of needs of the older person.
This discussion paper proposes some actions to address these areas of concern. I would encourage you to read it and give us your feedback on its proposals.
I am not going to go through all the proposals this afternoon, but I do want to mention three of them. These concern government funding, workforce development, and respite care.
As I just said, the ageing of New Zealand’s population means there will need to be a substantial investment in residential-care facilities in the future.
Who will be developing those facilities? Well, it won’t be District Health Boards or the Ministry of Social Development who are out there building rest-homes.
In the future, as it is currently, residential-care facilities will be owned and provided by private firms and, to a lesser extent, by not-for-profit welfare organisations. In National, we think that’s a good thing. And we recognise that people won’t invest in residential care unless they are making a return on their investment. Otherwise they will put their money somewhere else.
So, we want to pay a fair price for a quality service, and we recognise that you need to make a profit or you won’t be in the business at all.
In addition, National will consider the use of public-private partnerships in the aged-care area, for example by contributing government-owned surplus land towards residential developments.
National also recognises that businesses, whether providing home-based or residential-care services, need certainty of funding. Many providers told our health team they could provide improved services with greater certainty of future funding.
Therefore, National is keen to look at improved multi-year funding agreements which incorporate an agreed increase in funding each year. This would give providers greater certainty of funding, improve their ability to deliver services, and reduce compliance costs.
The second thing I want to mention is workforce development.
National recognises that there are significant numbers of loyal and hard-working caregivers and nurses who have stuck with the sector through tough times. However, we also believe that the high turnover of the aged-care sector workforce is threatening the safety and quality of the service provided.
The provision of recognised training for carers, which allows them to complete qualifications appropriate to their care-giving roles, and then remuneration adjustments that recognise those skills, is one way of increasing morale in the sector.
We think there is a need for training that is portable and relevant to both the home-based and residential-care sectors. This would keep the costs of training, for both employers and employees, to a minimum. The lower turnover that results from such training is also a cost saving to providers.
National’s proposal is, therefore, to work with the aged-care sector to establish a sector-specific Industry Training Organisation to oversee independent providers of training. Caregivers and nurses should have a recognisable career pathway and training opportunities that support progress on that pathway.
Furthermore, National will remove the Government’s de facto compulsory unionism requirements for aged-care workers.
In the most recent pay round, the Government is demanding that aged-care employers promote collective bargaining agreements with their staff. That is compulsory unionism by stealth.
National believes those workers deserve the freedom to decide if they want to join the union or not. They should be entitled to negotiate for themselves as individuals if they want. Aged-care workers are caring for the some of the most vulnerable people in our communities and the Government’s plan to force them into unions will only affect one group – the elderly.
Finally, I want to talk about respite care.
I take my hat off to those informal caregivers who care for an elderly parent, or relative, or friend. What a hard job that can be, but what a vital job.
National wants to do more to help those caregivers. We want to make sure that when caregivers need to use respite care they can do so, and they can do so in a planned way
During our aged-care forums we heard from many informal caregivers who had reached breaking point because they could not readily or regularly gain access to respite care. As a result, when an older person finally did go into residential care for respite, they did so with trepidation and reluctance, fearing their caregiver could no longer cope with having them at home.
Rest-homes reported that respite patients, because of this anxiety and because of their unfamiliarity with the staff, often found it hard to settle and their health suffered accordingly.
Planned access to respite care, both in residential care and, where workforce constraints allow, at home, would be beneficial for the health of the informal caregivers, and may ultimately mean the elderly can be cared for at home for longer.
That is why we propose that DHBs contract for the provision of dedicated respite residential-care beds. Some DHBs already do this, but the majority does not.
Having dedicated beds means that respite care is always available and can be planned in advance, rather than being slotted in on an ad-hoc basis.
None of us know at this point in time what old age, and especially very old age, will bring us personally.
However, I am sure there are certain things each of us hopes for in our later years. We hope we will be able to depend on the care and support of our family. We hope our friends will still be looking out for us, even though they, too, will be growing older. And we know there will be government support if we need it – that is the way all of society contributes.
Talking to older people has revealed that what is fundamentally important to them is to have genuine choices about how and where they live. They want to be able to choose between options that promote and protect their independence.
Your industry is a vital part of this network of care. You provide this choice and you enhance the quality of life of older New Zealanders.
National is committed to supporting New Zealanders in the decisions they make about their care in older ages. I commend this discussion document to you. I think it is a very solid piece of work, and I look forward to your feedback on it.Tweet