In March 2024, Carolyn Cooper, the Aged Care Commissioner, released a report titled “Amplifying the voices of older people across Aotearoa New Zealand”. It contains 20 recommendations to improve services and care for older people in Aotearoa.
So, why is this report important and how does it affect every day New Zealanders?
Who is the Aged Care Commissioner?
Carolyn Cooper has held the role of Aged Care Commissioner since March 2022. She is the first appointment in this role and has a background in health sector leadership across Australia and New Zealand.
She is responsible for advocating for older New Zealanders to improve health and disability services including medical centres, public and private hospitals, home and community support services, and aged residential care.
What work is currently underway to address the issues and gaps in the health system for older people?
There is no dedicated, coordinated plan for the health of our ageing population despite statistics showing there will be 1 million people aged 65 years or older living in New Zealand by 2028. There have been past investigations into how aged care is funded, such as the Ernst & Young Aged Residential Care Funding Model Review 2019, however its recommendations were not implemented. This has resulted in a system and funding model that is increasingly unsuitable for both older people and those who provide care (aged residential care (ARC) and home and community support services (HCSS)).
The Aged Care Funding and Service Models Review is a current project underway by Health New Zealand | Te Whatu Ora. There are numerous current and future challenges that need to be addressed including: our ageing population, inequities around access to services, aged care workforce shortages, and more people choosing to stay in their own homes rather than move into care facilities.
The review aims to create a new model that allows older people to receive individualised, high-quality care whilst also being cost-effective.
The first output of the review, a strategic assessment of aged residential care and home and community support services, has now been released.
What are the key issues and recommendations identified in the report?
The Aged Care Commissioner has provided 20 recommendations to address issues facing services and care for older people in New Zealand. A selection are summarised below (read the full report here).
- Older people need timely and safe discharge from hospital to quality care (home and community support services or aged residential care).
|
The issues |
The recommendations |
|---|---|
|
Older people are facing longer hospital stays due to bed shortages in aged residential care, especially higher levels of care like psychogeriatric, and in rural areas. Those needing care at home following a hospital stay are also facing longer waits for discharge due to a lack of home and community support services. |
Create better discharge processes by introducing roles in Health NZ | Te Whatu Ora that support older people being discharged from hospital to either aged residential care or care in their home/community. The Aged Care Funding and Services Model Review should address the shortages in aged residential care beds, especially psychogeriatric services. |
|
There are significant shortages in the aged-care workforce, particularly registered nurses in aged residential care homes. |
The Aged Care Funding and Services Model Review should include an action plan to train and retain aged care nurses, plus other vital roles in older persons’ health. |
|
There is a need for culturally safe care options, led by Māori for Māori. |
The Aged Care Funding and Services Model Review should provide a plan for Kaupapa Māori aged care services. |
- We need improved models of primary and community care, including roles to help older people navigate the system, and preventative action plans on ageing-related conditions such as dementia mate wareware.
|
The issues |
The recommendations |
|---|---|
|
There are long wait times for older people to see their GPs. The GP workforce is declining due to many of them being older and reaching retirement – over 50% plan to retire in the next 10 years. |
The Commissioner is supportive of the Health NZ Workforce Plan that aims to address GP shortages via rural GP allowances, an increase in international recruitment, and an increase in the number of specialist GPs trained in NZ each year. |
|
The lack of a consistent contact person makes it difficult for older people to navigate the health system. |
Primary care should have a single contact such as a health worker and/or social care worker focused on older people’s health to support older people and their family/whānau access services. |
|
Despite hearing loss being a risk factor for dementia mate wareware, the current hearing aid subsidies are inadequate. |
Increase the New Zealand hearing aid subsidy to cover the cost of hearing aids, assessment, and fitting. Increase the New Zealand hearing aid funding scheme to cover the cost of assessment and fitting. |
|
Dementia mate wareware is the most common diagnosis from an interRAI needs assessment. |
The Commissioner is supportive of the Dementia Mate Wareware Action Plan, and noted that the successful projects from this initiative will require ongoing funding to fully address the needs of those living with dementia mate wareware in the community. |
- Older people need access to quality home and community support services in order to live and age well in their own homes.
|
The issues |
The recommendations |
|---|---|
|
There is a lack of transparency and consistency in care provided by home and community support services, resulting in some providers being ill-equipped to meet older people’s needs. Home and community support services are difficult for older people and their family/whānau to navigate and access due to complex and varied funding arrangements. |
The Aged Care Funding and Services Model Review should consider home and community support services, in particular:
|
|
There is a shortage in staff and high turnover in the home and community support services workforce, resulting in not enough healthcare workers to support older people living at home. |
Introduce a system to track shortages of home and community support service workers, so that gaps can be identified, and plans put in place to ensure older people still receive the care required. Implement a home and community support services demand planner so current and future needs for home support are captured. This will ensure there are enough providers and health workers to provide care and older people can access care when required. Fund training and technology to help home and community support service workers deliver care and support family/whānau. |
What happens next?
The Aged Care Commissioner has shared the report with a number of important decision makers in the sector including the Minister of Health, Minister for Seniors, and Associate Ministers of Health, as well as funders, planners, and providers of health and disability services for older people in Aotearoa.
The Aged Care Funding and Services Model Review is currently in its second stage which will identify recommendations for a model redesign to be presented for the government to consider (expected mid-2024).
It’s important that the voices of older people are heard so your thoughts and experiences can influence the decision makers; after all, it is your future. The Commissioner has requested that any older people reading the report share any comments and feedback: email agedcare@hdc.org.nz.
Updated: 17 Apr 2024