INsite editor Jude Barback asks Hon NICKY WAGNER, the new Associate Health Minister with responsibility for health of older people, to address the big issues affecting aged care and home and community support services including funding, sustainability, equal pay and palliative care.

INsite: Opposition-led aged care inquiry: Upon recently launching their inquiry into aged care in New Zealand, Opposition parties have stated that “many of the same problems with quality and consistency of home support services and aged residential care remain” since their inquiry in 2010. Do you agree there are still problems with quality and consistency around aged care?

Wagner: All health services should be constantly working to achieve better outcomes and ensure the system remains sustainable.

Over the past decade, there have been significant improvements in the quality and safety of aged care services, and aged care expenditure has grown at a higher rate than total health expenditure.

There is always room for improvement, that’s why, in December last year, the Government released The Healthy Ageing Strategy to guide comprehensive improvements to health and social services for older New Zealanders.

INsite: Equal pay: The pay equity case has dragged on for years now and while workers are anxious to see pay rates lifted, aged care and home and community support services providers are nervous about what an increase in wages would mean for their businesses. Can you offer providers any reassurance that a potential lift in wage rates would be accompanied by a corresponding lift in provider funding?

Wagner: This matter is better addressed by Minister Coleman.

Minister of Health, Dr Jonathan Coleman referred INsite to his comments on the subject made to the NZACA conference in October 2016: “No doubt top of mind for most of you will be the TerraNova case relating to pay rates in the aged care sector. This has been a key area of focus for me, and it is complex work needing careful consideration. With the negotiations still ongoing I’m limited in what I can say. I hope to have a fuller update for you on this issue in the coming months.”

INsite: Rest home-level care: The Government’s emphasis on ageing in place has seen a trend towards older people being assessed as requiring residential aged care at their most frail. They are consequently assessed as needing hospital-level care and enter care with very high needs and co-morbidities. This means they are increasingly bypassing rest home-level care. Many smaller providers say they often find themselves providing hospital-level care, despite being funded at rest home-level. Due to this changing trend, many small rest homes are struggling and an increasing number of facilities are closing, which results in less choice for consumers and people having to go into care further away from their home and family. Do you think it is possible that rest home-level care could be phased out altogether in the future?

Wagner: There has certainly been a move toward enabling people to age in place for as long as possible, provided it is safe and in accordance with their wishes.

This is widely supported nationally and internationally by older people, researchers, health and social sector players, as well as the World Health Organisation.

Anyone moving into residential care should first be assessed through the interRAI framework. This determines the level of need and care they require. If a person is assessed as requiring hospital-level residential care, then they should be placed in a facility that is equipped and certified to that level.

The current trend of reducing demand for rest home care is expected to continue, however, phasing it out would require new, alternative care arrangements.

INsite: Small rest homes: Is the Government taking measures to support smaller rest homes? Smaller facilities provide a service that is greatly valued by their communities, yet struggle to provide this service because of the low level of funding and the high level of care delivery required.

Wagner:  All residential care facilities provide essential services, and come under the national Age Related Residential Care Agreement, regardless of size or location.

If there were sustainability issues for small operators, we would expect these to be raised in contract negotiations. This matter could also be considered in the Aged Residential Care funding model review being undertaken by provider and DHB representatives.

INsite: Palliative care: The reality for many aged care providers is that they are effectively providing end-of-life care for the majority of their residents. This care is complex and costly to deliver and therefore the aged care sector is pushing hard for a palliative care supplement. What changes would you like to see to the way palliative care is currently funded and organised in New Zealand?

Wagner:  Palliative care for older people has always been core business for aged residential care providers.  Concern over funding levels is something for discussion with DHBs in annual negotiations.

Whether palliative care should in some way be separated from the current aged care payment framework is something providers could raise in the funding model review.

A review of Palliative Care was completed in 2016 and reported to Minister Coleman. High level actions will be progressed by the Ministry, working closely with the palliative care sector, including aged residential care.

INsite: Inconsistency between DHBs: One topic that consistently crops up, for both residential aged care and home and community support services, is how funding levels and contracts vary so much from one DHB to another. At the NZACA conference, several speakers from Opposition parties pointed to the inconsistencies across DHBs as an area they would like to see addressed. Does the Government have an opinion on this matter and any objectives to help even out the playing field for providers across the country?

Wagner:  Residential care prices for the four different care levels are set nationally and applied through the national Aged Related Residential Care agreement, negotiated yearly between providers and DHBs. The only variation on this is to recognise different land values across the country.

There is no national contract for HCSS. DHBs are free to contract for these services in ways and at prices that are locally relevant and appropriate.

There is work underway to develop nationally consistent performance indicators for aged care, including home and community support. This should provide more consistent performance information and greater ability to measure and compare performance across DHBs. 

INsite: Home& community support services: As far as I am aware, the HCSS sector is still waiting on the Ministry to honour Part B of the in-between travel time agreement, which means a move to a regularised workforce, including the implementation of guaranteed hours and training-related pay. Why is the Government stalling on this and when can the sector expect to see some progress on this issue?

Wagner: There is no stalling — implementation of the In-Between Travel Settlement Agreement Part B is underway. Regularisation trials were run in 2016, and the results of these are being used to finalise the overall approach to regularising hours for the majority of care workers.

INsite: Minister of Health and Aged Care: The NZACA is advocating for a Minister of Health and Aged Care and capacity within the Ministry to support this. What are your thoughts on this idea?

Wagner:  The Health portfolio has three dedicated Ministers. Responsibility for aged care falls within my delegation as Associate Minister.

INsite: Your vision for aged care in New Zealand: I’m eager to hear your vision for aged care in New Zealand. What are the key barriers to achieving this vision? And what is the plan for overcoming these barriers?

Wagner: The Government recently released its Healthy Ageing Strategy. The vision is: “older people live well, age well and have a respectful end of life in age-friendly communities”.

It is not a vision for aged care services only, but rather one for all older New Zealanders and those who support them.

Aged residential care and home and community support services are essential to the healthy ageing process, but so are social services, community initiatives to maintain social connectedness, primary care and many other components of the health and social sectors.

The NZACA, its members, a large number of older people, their families, and a wide range of health and social sector interests helped create the vision, and the strategy’s outcomes, goals and actions. We expect the NZACA and its members to be actively involved in the strategy’s implementation.

The new Healthy Ageing Strategy will help guide improved services and make constructive changes for older New Zealanders. This is important work and I’m delighted that as the Associate Minister of Health I have the opportunity to help make a positive difference in people’s lives.

INsite: And last but not least, can you tell our readers a little about yourself please?

Wagner: I’m a very proud Cantabrian and have lived and worked in Christchurch all my adult life. I have been married to David for longer than I care to remember and we have two sons. They both have lovely partners and one is getting married later this year, but so far I’ve only got a grand-dog!



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