Speech: NZ Aged Care Association conference

E aku rangatira, tēnā koutou katoa. Ka nui te honore ki te mihi ki a koutou.

It is a pleasure for me to join you today at your national conference.

Thank you to Martin Taylor, for your warm welcome. I would like to thank the Association for the invitation to address you. I would also like to acknowledge the work of the Board and Martin in representing the aged residential care sector.

The Government recognises that our population is ageing and we are committed to ensuring older New Zealanders are provided with the choice of high quality care they need.

One of the Government’s key expectations for public health services is the delivery of better, sooner, more convenient care, so that health outcomes are improved for all New Zealanders, including older people.

I would like to briefly recap on the Government’s commitments in this area:

• Providing greater support for informal care givers through respite care. An additional $5 million per annum was allocated from 2010 for respite care in general, and a further $1 million per annum was allocated to District Health Boards from 2011 targeted at dementia respite care. The Ministry of Health is currently working with DHBs to ensure this funding is used to best effect.

• Introducing mandatory quality standards for home and community support services, combined with regular audits of service providers and a more robust consumer complaints process and satisfaction measurement. The Ministry is working with DHBs, ACC and home and community support service providers to make this happen.

• More money is also being spent in aged residential care. The Government has invested an additional $127 million into aged residential care from 2009 to 2010, with additional funding targeted towards dementia care in Budgets 2011 and 2012.

Dementia care

Dementia is a key issue for our country into the future. The Government wants to support people with dementia to receive quality services, and live as good a life as possible – whether they live at home or in residential care.

The Government is committed to ensuring the public health service supports all people with dementia and their families during a very difficult period in their lives. The aged residential care services review, completed in 2010, identified the need to expand dementia provision, both beds and services.

Budget 2011 delivered an extra $44 million over four years to look after people living with dementia: $40 million for residential dementia services and the remaining $4 million over four years for additional dementia respite care for full-time carers.

Budget 2012 delivered an extra $30 million over four years specifically for residential dementia level care and $10 million over four years to DHBs for the development of dementia care pathways for their regions.

I note that the conference programme included discussions on the design of dementia units and on care for people with dementia in residential care. I am advised that research on these topics is increasing – with Stirling University in Scotland and the HammondCare Foundation in Australia leading this work.

I applaud the programme planners for arranging for experts in this field to speak with you and present up to date information. Design of specialist units is an important factor in the quality of care provided for residents.

Dementia care pathways

District Health Boards have been asked to develop dementia care pathways that include the diagnosis and treatment of dementia within primary and community care. It is expected that this work will be completed by June 2013.

The Ministry of Health has established a project to support DHBs in this work. As part of this work a Sector Advisory Group has been established to inform the project.

Membership of the group includes members of the National Dementia Co-operative, DHB Clinical Champions, representatives from primary care, and Ministry staff.

It is expected that each dementia care pathway will set out a continuum of care to meet the needs of a person with dementia and their family/whanau. A pathway will include steps that may be taken, from the point of diagnosis, to the end of life. It will inform service development and delivery of care across the entire range of services needed, including residential care.

People with dementia and their families should be able to access services at the earliest possible point so that they are able and well supported enough to stay at home for as long as it is safe to do so.

Integration

Integration has been a buzz-word for a while. I would like to touch on how I picture it working in the care of older New Zealanders.

International evidence shows that integrating primary care with other parts of the health service is vital to better management of long-term conditions, an ageing population and patients in general.

This is achieved through better coordinated health and social services and the development of care pathways designed and supported by the community and hospital clinicians.

The Ministry is working closely with DHBs to ensure the provision of “wrap around services for older people” as part of its Integration Programme. This work includes:

• specialist clinical support for primary care providers;
• the introduction of the world class comprehensive clinical assessment framework interRAI; and
• best practice stroke management and dementia care.

Our aim is to keep older people out of hospital acute services and cared for in the community.

These initiatives all involve collaborative work and innovative approaches to aged care that will result in positive outcomes for older people. Your support and expertise will be essential to the success of this work.

Specialist clinical support for primary care providers

It is expected, and in fact critical, that more DHB Specialists like Geriatricians and Gerontology Nurse Specialists, will be available to provide advice and support to health professionals in primary care and aged residential care. This will contribute to older people receiving better health and disability services through opportunities to discuss and review plans of care, including medication reviews, in a multidisciplinary team.

I am aware of some very good examples of where this is happening already. I’m sure you know of others, and encourage you to let me know about them as well.

In Waitemata DHB a team of Gerontology Nurse Specialists provide outreach services to the residential care facilities in the DHB. Counties Manukau DHB uses Health of Older People specialists, including Gerontology Nurse Specialists, to provide multidisciplinary reviews, education sessions and phone support. Hutt Valley DHB is offering a pilot where nurses in aged residential care are given an opportunity to work in the general or orthopaedic wards of the public hospital, as a way of updating skills and building relationships between facilities and hospital wards. Many other DHBs, for example MidCentral, Taranaki and Southern District Health Boards are providing educational programmes for nurses employed in aged care or encouraging nurses working in the field to attend training programmes offered by the DHB to their own staff.

These initiatives provide clinical support to a group of professionals who at times do feel professionally isolated. At the same time it assists the DHBs to reduce avoidable admissions to hospitals and enables more residents to remain in the environment they know.

World class needs assessment framework

Assessing people’s needs is an essential prerequisite for delivering high quality, seamless service provision and a personalised care plan. To ensure this happens, the Ministry is rolling out the internationally accepted comprehensive clinical assessment framework interRAI.

The roll-out of interRAI for assessing needs for home-based support services was completed in June 2012. As you know, work has begun on the introduction of interRAI into aged residential care. Participation in this programme is voluntary but strongly encouraged. We hope to get at least 90 per cent of facilities participating by the end of the project in June 2015.

Each resident will receive a Comprehensive Clinical Assessment at least twice a year, or when their health status changes.

The training of nurse assessors is well underway and I am gratified by the interest from aged care providers to be involved.

I understand that the roll out of interRAI was a topic for discussion earlier in this conference.

As with any new system, interRAI brings with it some challenges. I believe the assessment will support the clinical care you provide to your residents, so I urge you to work with the Government to get the best out of it.

Quality care is very important to the Government, but no more so than I believe it is for you, the people who work in the sector. As you know, the media are quick to report where care may be less than optimal. I believe your sector has a great record of striving for safety and quality and the use of interRAI assessment tool will help us both tell that story.

I am therefore very keen for interRAI to be rolled out as quickly as possible. That is why I’ve asked the Ministry for advice on how the process can be expedited and what the barriers to doing so might be. The Government is also considering linking funding of cost pressure increases to quality improvement processes such as uptake of interRAI.

Workforce

The workforce needed to support older people is a critical issue for the future of aged care services.

I want to acknowledge the government-sector partnership that has seen a stronger emphasis on workforce training. In 2011, over 2,700 National Certificate qualifications were completed by aged care workers. This is double the number in 2009. We will continue to encourage aged care workers to complete qualifications and we thank employers for their role in this.

Last year we also added aged care and mental health to the hard-to-staff specialty list for nurses on the Voluntary Bonding Scheme. This is intended to encourage new graduates to work in these areas. Aged care was one of the most popular hard-to-staff specialties for nurses enrolling in the scheme in 2012. Twenty-three percent of nursing graduates who enrolled this year – 95 out of the 411 total – are either currently working, or intending to work, in aged care.

We need to identify ways to better utilise the existing workforce and the small number of highly trained professionals in aged care to positively impact on the health and wellbeing of older people, including those with dementia. The future will require people to work differently. Just how this will look is currently being developed by Health Workforce New Zealand.

Two examples of projects currently underway are:

1. An evaluation of a Nurse Practitioner role in the Central PHO. Due to the shortage of GPs in the area the Nurse Practitioner has been employed specifically to work with two Aged Residential Care providers, and a number of practices, to undertake assessment and management to prevent avoidable hospital admissions and readmissions. The evaluation report is due in December 2012.

2. Development of the Lower North Island Palliative Care Clinical Network which is an initiative which includes three DHBs (Capital and Coast, Hutt, Wairarapa), Mary Potter and Te Omanga Hospices, primary care and Aged Residential Care. The Network aims to develop consistency of service across the region as well as identify opportunities for service improvement and workforce innovation. The Ministry is currently working with the Network to finalise the proposal.

The Office of the Chief Nurse in the Ministry is undertaking a “Strengthening of Older Persons Health Nursing Workforce Project”. Officials are working with senior nurses from the sector and DHBs to develop and support nursing capability to meet the care requirements of older New Zealanders.

There are two areas that are specific to aged residential care:
a) Strengthening nursing practice support and expertise for staff working in aged residential care.
b) An alternative aged residential care “Nurse Entry to Practice” model to support new graduate nurse transition into the aged care sector.

Additionally the Ministry is going to be developing a fact sheet for employers about how they can utilise enrolled nurses under their new scope of practice.

Audit process

Following improvements to the audit process in aged residential care facilities throughout 2010 and 2011, including integration of the certification and contractual audits, we have continued to look at ways of reducing the regulatory burden while maintaining the integrity of the process.

The next improvement involves auditors taking a risk based approach to the certification audit focusing on each standard and 50 per cent fewer criteria. More time is then available to audit the outcomes of services received by older people. A trial of this approach has just been completed and the evaluation of this will be completed in October this year. Preliminary information suggests the trial has been highly successful and is likely to result in the new audit approach being introduced nationally.

Premium-only

I know many of you are interested in the issue of development of premium-only aged residential care facilities.

The Ministry of Health is developing advice for Ministers on this issue. A key to resolving this issue involves balancing the need for choice of a range of facilities with the need to ensure that there are aged residential care options that are available and affordable for all who need it. We also need a solution that will work for residential care providers giving them certainty over the longer term.

Striking this balance has proven a challenge and I am not yet in a position to share our thinking on this matter, although I can say that the NZACA has been involved in on-going discussions.

Health Quality & Safety Commission

Another of my delegated responsibilities is the Health Quality & Safety Commission. The Commission is currently focusing on reducing harm across four key priority areas – surgery, medication, hospital-acquired infections and in-patient falls. While the Commission’s work has initially been DHB hospital focussed, I am very keen to see the benefits of the programme rolled out wider, including to aged residential care.

To demonstrate the impact of these and other quality improvement initiatives in the health sector, the Commission is finalising a set of quality and safety process markers and outcome measures and I will announce these in the next couple of weeks. The aim is that these will be embedded into “business as usual” clinical practice and used to track progress in implementing improvements. Initially they will focus on DHB hospitals, but they look to be equally applicable across other areas including the aged residential care sector.

Medication safety

The medication safety team is working with the aged residential care sector to develop a standardised national medication chart suitable for use in all aged care facilities. The standardised chart aims to reduce harm associated with the prescribing, dispensing and administration of medicines and standardise the medication management process within the sector.

Falls reduction

Falls reduction is also a priority and the Commission is leading a collaborative programme focussed on reducing harm from falls, and the number of falls by older people in care settings. Initially focussed on “in-patient” hospital settings, the programme will also extend to aged residential care and those receiving care in their homes. The Commission will work in partnership with other agencies such as ACC, and with representatives from the aged care sector.

Atlas of Healthcare Variation

Among its suite of quality improvement initiatives, the Commission has developed the Atlas of Healthcare Variation. The Atlas aims to stimulate debate by highlighting variation in healthcare, rather than making judgements about why this variation exists or whether or not it is appropriate.

One of the Atlas domains particularly important to the aged residential care sector is the “polypharmacy” indicator for older people, which is currently under development. The Commission is engaging with sector representatives to inform its work in this area, and the aged residential care sector will be involved in this process.

It is very pleasing to see the Commission engaging with the sector in a number of its key programme areas.

Older People’s Oral Health

Oral Health Survey

The Ministry of Health is undertaking an older people’s Oral Health Survey this year. The survey covers older people of 65 years of age and over who are living in residential care facilities, as well as those who access home-based personal care services.

The last oral health survey was conducted in 2009 and showed that older people were more likely to suffer poor oral health than the rest of the population. However, not all the community were represented in that survey. This survey will supplement the findings of the 2009 findings and provide a better insight into the oral health of older people.

The survey is being completed between April and December 2012 and will collect information about the extent and type of oral health needs of this group. This will be the first step in considering how to respond to these needs in the future. I thank those of you that have come into contact with the survey personnel for your assistance.

Oral healthcare training workshops for caregivers

Oral health care training workshops for caregivers of older people have been funded by the Ministry and organised by the New Zealand Dental Association. The half day workshops, which are held locally, are facilitated by dentists. The workshops are free and certificates of accreditation are provided.

I understand that the workshops are well underway. Feedback on the workshops has been very positive. I hope you have found them useful.
Twenty half-days training for caregivers of older people are being provided per annum for three years from 2012 to 2014.

Conclusion

I have outlined for you the Government’s initiatives and some of the work the Ministry of Health is involved in that relates to the sector. There are many other areas of work involving older people across the health sector. Care for older people is a challenge as our population ages. I would like to acknowledge the work of the Association and your commitment to providing quality care to older New Zealanders.

Thank you also for this opportunity to speak to you today. I extend my warm wishes to you all as your conference comes to a close.

Nō reira, tēnā koutou, tēnā koutou, tēnā koutou katoa.