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Address to Aged Care Policy Summit

Wednesday 4 May 2005

Address to Aged Care Policy Summit

Address to Health Care Providers NZ's Aged Care Policy Summit, Civic Centre, Wellington, 11:30,

It’s a pleasure to speak to you again. You’ll know better than anyone how New Zealand’s ageing population is going to reshape our society. The impact of that ageing has been plain to see for a while now, but will become more pronounced when the Baby Boomers like myself start retiring.

It’s worth repeating some of those figures again. They point to some massive demographic changes. Within 50 years a quarter of the population will be over 65, and the number of those aged over 85 will have quadrupled. Ageing must be a central part of our planning for New Zealand’s future, socially and economically.

Residential care is what springs to most peoples’ minds when we talk about ageing and I’ll talk about it soon. First, it’s important to place it in the context of the Government’s wider work in addressing the health needs of older people.

Our Government has put a great deal of effort into making health care more accessible and more affordable for older people.

In May last year we announced the orthopaedic initiative, which is designed to double the number of hip and knee replacement operations provided in New Zealand’s public hospitals by June 2008. By that time another 4650 New Zealanders a year will be receiving major joint replacements. In the first eight months we saw an increase in operations of 31 percent.

As you’ve probably heard, yesterday we announced a new cataract initiative. It aims to increase the number of publicly funded cataract operations by 50 percent over four years.

Ninety-seven percent of people over 65 are enrolled with their PHO. Not bad given that they have been eligible for only ten months. All of them are eligible to receive a reduction in the cost of visits to their GP or nurse. All of them pay a maximum of $3 for prescriptions on the pharmaceutical schedule, so we know that they’re benefiting from this investment.

People aren’t just living longer; they’re also living healthier as they age. That has implications for our wider society. More and more older people are choosing to continue working either full time or part time, including in the voluntary sector. Just as well. The voluntary sector would otherwise struggle, given that we have the lowest unemployment rate in the western world.

While those countries that experienced a large increase in births after World War Two have a ‘baby boom’ generation – and New Zealand’s boom was the largest – that’s not the only explanation for the challenge we face. It explains why there will be more older people, but not why they’ll live longer and healthier.
Medical advances, and the skill and dedication of our medical professionals, have meant that the baby boomers have access to an unprecedented quality of health care.

Social changes played their part too. We grew up in an historically prosperous time, with better hygiene, better diets, and more money. Together this all means that the baby boomers are healthier than any previous generation.
Ill-health and disabilities still occur for many of these older people, but today they are more likely to be temporary challenges, which can be met and overcome.

New Zealanders will still need long-term residential care. That’s obvious. But we’re going to see increasing numbers using residential care for episodes of ill health, and returning home after treatment and rehabilitation. The challenge is to build an aged care sector that can better support this reality.

That means a new approach and new skills will be needed on the part of providers and their staff.

You have concerns about funding in the aged care sector. You have voiced them variously, often, and for quite a while. These problems aren’t new; more demand and higher expectations have combined to lead to a funding gap arising over a significant period of time.

That’s why this Government has stepped in to assist the sector at various times. An extra $52 million was provided in 2002/2003, which represented a 9% price increase. Another $18 million was provided in this financial year – a further 3 percent. You have said that isn’t enough.

There is a budget a fortnight tomorrow and I shall not reveal its contents today, except for this.

Pressures arising from the Holidays Act will be addressed in the upcoming budget. The Government has made available an extra $11.5 million (GST excl) to DHBs, so they can compensate their non-DHB providers for reasonable costs arising from the Holidays Act, where this has not already occurred. What proportion of that goes to residential care providers will of course vary from DHB to DHB. That money is backdated to 1 July 2004.

In this year’s budget, and in future budgets, we need to take a series of complex funding decisions.

To ensure that those funding decisions are informed decisions, we needed to do some homework. Many of you will be aware of two major investigations already completed. One is the Ministry of Health’s Quality and Safety Project, which reported late last year. A significant finding of the Quality and Safety Project was that the support workforce, both in the community and in residential care, and despite the evident experience and commitment of workers, needs higher-level skills and qualifications in order to fully contribute to the needs of older people in the 21st Century. I’ll return to how those needs are changing later.

The second is the Working Party on Support Services for Older People and People with Disabilities. The Working Party was made up of representatives from consumers, unions, funders and providers, and was asked to advise the

Government on how we can ensure appropriate and cost-effective care now, while considering the long-term sustainability of the sector. The Working Party has produced its report and made recommendations to Government. The Government will respond soon, with a detailed work programme with timelines. We will make that work programme public.

Both those investigations have informed this year's budget, will inform our work programme and will inform future budgets.

Older people want independence and choice, and they deserve it. Older people have higher expectations today, and rightly so. With older New Zealanders healthier than ever, living in their own home is a viable and positive option that we are committed to supporting.

People who want to live in their own home and community for as long as possible must have systems in place to support them. People who need to enter residential care for a short period must be supported to recover and return to the community. People who need to enter residential care for the longer term need to know that high quality provision is there when they do need it.

Older people will have more options, and will need a wider range of care in different circumstances. That means a broader and more varied role for the residential care sector. In particular we need to refocus residential care towards rehabilitation and restoration for the future.

Let me give you an example from a rest home and residential village I visited last week. The Horowhenua Masonic Village in Levin is an example of how the needs of older people are changing, and how a residential care provider has adapted to those changes.

This Masonic complex is both a residential village with 69 units, and a rest home with 67 beds. Of the 67 rest home beds, 10 are for short-term use as part of a rehabilitation unit.

This 10-bed unit offers rehabilitation to older people following a medical event that has impaired their activities, and its aim is to return the person to their own home. Usually an older person will be referred to the rehabilitation unit by their GP, or they’ll enter after a hospital stay.

While in the unit they receive extensive treatment from a wide range of professionals – physios, speech therapists, occupational therapists, nurses and rehabilitation assistants – all trained to provide and support a therapy programme identified for that individual.

Most people stay in the unit for six to ten weeks. These are people who, a few years ago, would be expected to enter long-term residential care. No more. Fully 70 percent of them are able to return home. That unit is a success that the Wellington Masonic Villages Trust is rightly proud of. It shows not only what an important role residential care providers will always have, and but also the potential for that role to change and meet the future needs of New Zealanders.

I believe every individual is worthy of our society’s care, support and respect through every stage of their life. That’s what shapes our policy towards older people. These principles underpin the Positive Ageing Strategy, and the Health of Older People Strategy, which set out our policy for older people.
Older people deserve real choices about how they live their lives.

It’s about one person choosing to live in their own home at 90, looking after themselves and driving themselves to the bowls club, where they still clean up the competition;

It’s about another person, with more trouble caring for themselves, choosing to stay in their own home with the support of their family, their friends, and professional caregivers;

It’s about a third person, who breaks their hip, choosing to go into residential care to recover after surgery, and being helped to move back into their own home;

It’s about another person, who needs more high-level care, choosing to move into a residential facility long term.

Older people deserve the support to be able to continue doing the things that are important to them in their old age. That means different things to different people.

For increasing numbers of New Zealanders, ‘old age’ is a time of life for continuing to grow as an individual: for learning new skills, for making new contributions to society, for new experiences, and not at all about winding down. As a Government, and as service providers, the challenge for all of us is to respond to that reality.


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