The report claims that while progress has been made since their 2010 inquiry, many of the same problems remain. The residential aged care sector and home and community support services sector have welcomed the inquiry and its findings. New Zealand Aged Care Association’s Simon Wallace says he is pleased to see a focus on interRAI, historic funding shortfalls and small providers, in particular.
However, there are several recommendations around transparency and accountability that Wallace felt were unnecessary as they were already well incorporated into systems and contracts in residential aged care. Home and Community Health Association (HCHA) chief executive Julie Haggie also felt this was an area that, while important, was being sufficiently addressed in the home and community support services (HCSS) sector.
Haggie says she would like to see the HCSS sector treated with the same importance given to the residential aged care sector, particularly when it comes to funding contracts and reviews. She also felt the glaring hole in the report was the lack of recommendations around dealing with elder abuse, which she describes as “a massive problem in our society”.
The 13 Recommendations
- Review interRAI governance and implementation of mandatory assessments. Investigate options for extending interRAI to home care services.
Simon Wallace is pleased to see the inquiry’s emphasis on interRAI. Julie Haggie says while interRAI is already used in home care services, the assessment tool is not used as consistently as it is in residential aged care. In some areas, people are assessed every three years in home care, which Haggie thinks is inadequate. She would support regular assessment where there is need.
- Review and investigate updating the aged care standards to set a nationally consistent baseline.
Both Haggie and Wallace feel this is recommendation is unnecessary.
“The sector is already heavily regulated,” says Wallace. “Standards are enforced with regular audits every three to four years.”
- Improve the consistency of treatment criteria between District Health Boards.
The recommendation refers mainly to the ‘postcode lottery’ experienced by older people in terms of meeting criteria for treatment.
However, there are also inconsistencies in the way DHBs currently assess people, which means a person’s assessment and resulting care may differ depending on where they live in New Zealand. A question to this effect was raised at the NZACA conference, to which National MP Simon O’Connor said, “We have too many DHBs. I think there are changes needed.”
As for the home care sector, the recommendations from the Director-General of Health’s Reference Group about moving to nationally consistent funding through the 20 DHBs for home support contracts is still not in place. Union E tu’s John Ryall said he believes this is being “actively resisted by the DHBs”.
- Establish the Office of the Aged Care Commissioner and a position of Aged Care Commissioner.
While in previous years, aged care providers have advocated for such a role to be established, the feeling at the recent NZACA meeting was that it would be adding yet another layer of bureaucracy. During a political panel discussion, Labour’s Jenny Salesa proposals for an Aged Care Commissioner and Pay Equity Commissioner did not go down well with the audience.
Wallace believes introducing a Minister of Health and Aged Care is more important.
“Such a position would give more clout to the bureaucracy.”
- Develop improved monitoring and reporting on health outcomes to enhance accountability.
While this was perhaps an area of concern a few years ago, this has been rectified to a large extent by the Ministry of Health’s decision to make rest home audit reports publicly available. Wallace says this is a good thing for the sector.
Haggie is all for more accountability and transparency in home care. “We’re all for having audits published,” she says.
- Task the Office of the Aged Care Commissioner to work with stakeholders in the sector to improve outcome-oriented performance measures and investigate the need for a government-backed system to star rate providers.
The inquiry calls for a government-mandated five star rating service like they have in the United States.
“A model similar to this could provide a more authoritative guide on the performance of different facilities and home care providers,” it states.
In the past, aged care providers have rejected the idea of a star-rated system. However, Aged Adviser is slowly gaining acceptance with the sector.
- Require the Office of the Aged Care Commissioner as part of its initial work programme to investigate the effectiveness of complaints processes in residential care facilities.
Simon Wallace believes the current complaints process within residential aged care is very transparent, with clear pathways to make a complaint, including the manager or owner, the local DHB and the Health & Disability Commissioner.
“The Health & Disability Commissioner process can be slow and cumbersome,” he concedes.
Julie Haggie would like to see the system better equipped to handle complaints about elder abuse, particularly in the community. She says elder abuse is prevalent in its many forms – financial abuse, emotional/psychological abuse, racism, isolation, and is compounded by dementia. Haggie is concerned that since elder abuse is now handled by the Ministry of Social Development’s Super Seniors (it was previously handled by Age Concern), that the issue is not being treated with the seriousness it deserves.
“Elder abuse occurs within publicly funded services, and it is important for us to address this through the quality systems we have in place. My impression is that it is a major problem and we need to get some honest information on this, and clearer strategies to understand why it is happening, how to educate families and the community, and how to enable people to get help to stop it from happening.”
- Encourage the development of more housing that meets lifetime design standards for older people thereby better enabling seniors to age in place, including a review of building standards.
The issue of seniors housing has been increasingly on the radar of retirement village operators. Retirement Villages Association (RVA) executive director John Collyns was pleased to see a focus on social housing included for the first time in this year’s ANZ Retirement Villages Association survey.
“We know there is an issue. At least 20 per cent of people aged 65 and over don’t own property, and this is set to increase. We have a strong interest in making sure we don’t lose sight of these people,” he says.
Incorporating “lifetime design standards” into seniors housing is important to ensure it is fit for purpose.
- Investigate support for Local Councils to build or upgrade their council housing stock for older people such as the provision of low-interest loans.
This issue was recently brought to light by the Salvation Army’s report Taking Stock; The Demand for Social Housing in New Zealand, which gave a sobering overview of the actual levels of new homes needed to provide for low income New Zealanders now and in the future. The Salvation Army’s call for between 2000 and 2500 more state and social houses per year is strongly supported by the New Zealand Council of Christian Social Services (NZCCSS).
- Support innovation in aged care to provide more inclusive care which caters to the diverse needs of everyone in aged care.
Innovation has been the over-arching theme at nearly every aged care and retirement conference for the past five years. There are certainly pockets of innovation occurring but it seems clear that innovation can’t truly happen in this sector until overall funding is increased to allow providers to extend their focus beyond survival and sustainability.
- Increase overall health funding so that it is able to meet inflation and demographic pressures while making up for the shortfall in funding over the last eight years.
This is the big ticket item, but one that needs more detail. Both Wallace and Haggie welcome the acknowledgement of the historic underfunding of both their sectors.
At the recent NZACA conference, both Jenny Salesa from Labour and Barry Coates from the Greens indicated they would support the completion of the residential aged care funding review, which is just getting underway. Providers suggested that one of the potential solutions from the review could be to push some of the costs onto the resident. While National’s Simon O’Connor suggested his party would be prepared to have “those difficult conversations with the public”, the other parties were reluctant to go down this road.
- Review the current funding model for residential care and measures to support the viability of small providers serving specific communities, including not for profit providers in small towns and rural areas.
Care Association New Zealand represents a large number of small aged care providers and advocates strongly for their sustainability.
Indeed many smaller, rural providers are struggling as a result of the pay equity settlement agreement. A mix of long-serving staff, softer levels of staffing, fluctuating occupancy levels, and the inability to cross-subsidise like larger integrated providers, means that many smaller providers are experiencing a shortfall in pay equity settlement funding. Yet, if smaller rural providers close, this narrows the choice for older people and their families, who may not want to go to the large facilities in big urban areas.
Julie Haggie questions why there isn’t a funding review for the home and community support services (HCSS) sector, when one is clearly needed to resolve the long-standing and worsening issues around funding.
“We need a national funding contract and an even approach across DHBs.”
- Ensure that funding contracts include robust performance requirements and transparency in reporting on outcomes.
The inquiry report correctly identifies that many providers are looking for ways to lower their staff costs in order to afford the increased wage expenses resulting from the pay equity settlement agreement. It suggests that the Government “needs to take action to guard against adverse impacts that might follow from increasing pay for care workers”. This recommendation could be interpreted as an effort to keep providers in check, and ensure corners are not cut when it comes to delivering quality care.
Wallace believes the Age-Related Residential Care (ARRC) contract is fairly watertight when it comes to transparency of reporting on outcomes against performance requirements.