Grey Power AGM, Christchurch

Good evening and thank you for the invitation to speak to you tonight. I bring warm greetings from the Prime Minister Helen Clark, and her apologies that she cannot be here. However, it seems fitting that the reason for her absence has been to fly to London to attend the funeral of the Queen Mother, one of the great role models for older people in our time.

I’m always impressed by the turnout of Grey Power members wherever I speak around the country, and this conference is no exception. Your organisation is obviously in good heart. In particular, I want to acknowledge your president John Jefferson and health spokesperson Dennis Paget, with whom I have an ongoing and lively relationship. You can rest assured that your representatives serve you well, and work tirelessly to achieve Grey Power’s mission statement, “to be the appropriate voice for all older New Zealanders”.

Election year
I see you have quite a line-up of politicians speaking to you throughout the conference, including my colleagues Michael Cullen and Lianne Dalziel. It must be election year!

Which reminds me of the man who rang Parliament shortly after the last election and asked to speak to the prime minister Jenny Shipley.

The receptionist politely answered, "Sir, Mrs Shipley is no longer the prime minister."
"Oh, OK," the man said and hung up.
The next day the man rang Parliament again, and again he asked to speak to the prime minister Jenny Shipley.
For the second time, the receptionist replied, "I’m sorry, sir, Mrs Shipley is no longer the prime minister."
Again the man answered, "Oh, OK" and hung up.
The following day the man rang again, and for the third time he asked to speak to the prime minister Jenny Shipley.
By this time the receptionist was getting a little annoyed, and she said, "Sir, I've already told you, Mrs Shipley is no longer the prime minister. Don't you understand that?"
"Yes, I do," said the man. "But I just enjoy hearing it."

Positive ageing
As I have already mentioned, Helen Clark has been at the funeral of the Queen Mother - Elizabeth Marguerite Angela Bowes-Lyon – who died two weeks ago at the great age of 101.

What impressed people most about this woman was her unassuming dignity, energy, openness and warmth. In class-ridden English society, she treated everyone equally, while her enjoyment of life right up until her death was a great example of how to close the so-called generation gap.

Many older New Zealanders will remember her three royal visits to New Zealand when she went fishing wearing her pearls. They will also remember the leadership she gave during the war when she and the royal family refused to leave London during the Blitz, even when Buckingham Palace was bombed. Asked how she felt after the bombing, she answered, “I’m glad…It makes me feel I can look the East End in the face”.

The Queen Mother represented many of the best qualities often found in older people – wisdom and empathy, an understanding of the important things in life, a diminishing need to conform.

As she told a friend, “I love life, that’s my secret. It is the exhilaration of others that keeps me going. Quite simply, it is the people who keep me up.”

She was a great advertisement for the power of positive ageing or, as I like to think of it, ageing with attitude. Many older people tell me that they never feel old - that ‘old’ is always someone 10 to 15 years older than yourself.

Of course, part of the reason for that is that they’re in denial. I’ve always been intrigued by the fact that older people never want to reveal their age (whereas I’m quite happy to admit I’m 30!)

There’s the story about the census enumerator who knocked on an older woman’s door. She answered all his questions but refused to tell him her age.
"But everyone gives their age for the census," he said.
"Did my neighbours Miss Maisy Hill and Miss Daisy Hill tell you their ages?" she asked.
"Of course,” he said.
"Well, I'm the same age as they are," she snapped.
"As old as the Hills," he wrote on his form.

Then there’s the one about the woman who was worried because she hadn’t seen her older neighbour for a few days. So she said to her son:
“Johnny, would you go next door and see how old Mrs Goldbloom is?”
“Sure, mum,” he said, running out the door.
A few minutes later, he returned.
“Well,” said Johnny’s mum, “is she all right?”
“She’s fine, mum, but she’s mad at you,” Johnny said.
“Why on earth is she mad at me?” the woman exclaimed.
“She said it’s none of your business how old she is.”

UN World Assembly on Ageing
There’s a serious side to our reluctance to admit our age. Opening the United Nations World Assembly on Ageing on Monday, secretary general Kofi Annan said it was his 64th birthday, and that he therefore felt empowered to quote the Beatle’s song and ask, on behalf of all older people,” Will you still need me, will you still feed me, when I’m 64?”

“I trust the answer is yes,” he said.

Nevertheless, these words lie at the heart of what most of us fear about ageing, I think. Not death, but neglect; not the added years (and pounds), but the possible loss of love, security and respect.

Delegates to the week-long assembly are hoping to complete a global document to guide policies for the rapidly greying planet, from providing adequate pensions and affordable health care to preventing discrimination and abuse. Jenni Nana, a manager from the Ministry of Social Development, is attending on behalf of Senior Citizens Minister Lianne Dalziel.

Superannuation
Back home, the Labour Alliance Coalition is committed to building an inclusive, strong and successful society in which people of all ages can participate fully.

One of our first actions in government was to honour our commitment to retired New Zealanders. We did this by reversing the last government’s cuts to superannuation, restoring the pension to not less than 65 per cent of the average ordinary time weekly wage.

This for us was a non-negotiable core commitment – one of seven on Helen Clark’s pledge card. For an individual on super, it meant a little over $12 more a week, while married couples on super were about $21 a week better off.

My colleagues and I are proud of that achievement . It recognised the role and importance of people on superannuation, and their need for a decent and sustainable standard of living.

We are also proud that it marked a significant change from past campaigns and past governments. We not only said that we would do it – we kept our word and actually did do it.

Asset testing
Another pre-election commitment made by this government was to introduce legislation to remove asset testing of older people in long-term residential care.

Asset testing is not fair.
· It applies only to older people – younger people in long-term care do not have to use up their resources in this way, and other health service users are not asset tested.
· People can avoid means testing by ‘gifting’ or setting up family trusts. Arguably many of the people with trusts are the ones who could most afford to contribute to the cost of their care.
· People with few assets are most at risk. They may lose their family home if they stay in care for a long time, and for 75 per cent of older people, the family home is their major or only asset.

Cabinet is currently examining the best and fairest way to remove asset testing. As soon as those decisions are made, the legislation will be prepared, and it will be introduced this year.

Health of Older People

Health and disability services for older people are also being improved. Let me begin by outlining the context within which we have developed our plans.

· Firstly, as we all know, the number and proportion of our population aged over 65 will increase substantially over the decades ahead. People aged 65 years and over currently make up 12 percent of the total population. This is estimated to rise to 18 percent by 2021, and to 26 percent by the middle of the century.

· Along with the greying of the baby boomers, there will be an increase in the ethnic and social diversity of older people.

· People will live longer – and there is some debate about whether this will mean people living with longer periods of chronic illness and disability.

· The vast majority of older people live independently. Only 4.9 percent of older people live in a residential home, and a further 2 percent are receiving long-term hospital care - though these numbers increase significantly for over 85-year-olds.

· Given the choice, the vast majority of older people prefer to remain in their own homes. (A national study in America showed the desire to remain at home for as long as possible increased markedly as people grew older – 71 per cent for those aged 45 and over; 92 per cent for those aged 65-74; 95 per cent for those aged 75 and over. There is no reason to believe New Zealanders would feel much differently.)

What this means is that we need a flexible system with a wide range of health services that meet older people’s individual needs and preferences, recognising that those needs and preferences may change over time. We call it ‘integrated continuum of care’.

Residential care
At one end of the spectrum is residential care, which takes the lion’s share of disability support services funding for older people. About $500 million a year of government money goes into subsidies for 19,000 people in residential care, while a further 13,000 people pay their own costs of care.

After being under-funded for a number of years, these services received a boost last December, when we injected an extra $12.6 million a year into residential care, on top of new money available for volume growth. Further funding increases are expected this year.

The Ministry of Health has also reached agreement with aged care providers to work together to develop nationally consistent contracts by 1 June.

This is good news.

The new contracts will include strengthened service quality requirements, nationwide consistency and more effective administration of aged care services. They will enable older New Zealanders to receive consistent, high quality services wherever they live, and will give providers more certainty in the provision of services.

This week I also plan to release the working party report on dementia care, along with the Ministry of Health’s response. I called for the report following public concern about the quality of services for people in dementia care units, and recommendations include improving staffing levels and training opportunities.

Ageing in place
There will always be a place for residential care, but no one should be going into care simply because they have no other options.

We may get to the stage where:
· we bend down to smooth the wrinkles out of our socks, only to realise we’re not wearing socks;
· we and our teeth don’t sleep together;
· our idea of a night out is sitting on the patio;
· the twinkle in our eye is merely the sun’s reflection on our bifocals;
· our idea of weight lifting is standing up; and
· getting lucky means finding our car in the car park

That doesn’t mean we have less desire or fewer rights than other New Zealanders to live in our own homes and to have control over the way we live.

Some of the changes that need to be made right now include:
§ improving coordination of health and support services around the needs of older people;
§ placing greater emphasis on health promotion and disease prevention to assist older people to age positively;
§ placing greater emphasis on community-level health care and support services to support older people to ‘age in place’.

Ageing in place means the ability to make choices in later life about where to live, and to receive the support needed to do so.

Underlying the changes, as I’ve already said, is the principle of ‘integrated continuum of care’, which in essence means that the right services are provided at the right time in the right place by the right provider.

It means that when an older person requires care, there are close and well-maintained links between the health professionals they see initially, their families and carers, the specialist, the hospital, community support services, and rest home care (including respite care) which may follow.

It means that the older person moves smoothly from one service to another – and sometimes back again – as their needs change, and that all those involved in their care know what everyone else is doing, which unfortunately is not always the case at the moment.

In other words, the continuum of care approach puts the older person, and their families, whanau and carers, at the centre of the picture.

And when we say services have to be integrated, we mean they have to be funded and provided within a consistent philosophical, policy and practice base and provide flexible responses to the service user’s varied and changing needs.

Northland and Canterbury DHBs have been chosen as two lead providers to develop the continuum of care approach. Other DHBs will follow, learning from their experience.

Canterbury has led the way in this area for some time. In 1997, primary and secondary care professionals set up the Elder Care Canterbury Project out of concern to provide patient-focussed health services for older people. Since then, the clinician-led group has expanded to include more community involvement, and action plans are being developed on four sub-projects – block bookings to deal with outpatient delays; elder friendly practice; medication; and discharge planning.

Stay on Your Feet
On Monday I launched the Stay On Your Feet initiative in Christchurch, an excellent practical example of how older people can be supported to ‘age in place’ and maintain a good quality of life.

Its objective is simple: to reduce the incidence of injury from falls among older people in Christchurch.

The health and social effects of injury from falls in older people are substantial. No doubt the costs are too. So Staying On your Feet has the potential to make a huge difference to the health of our older people.

It is exciting for other reasons.
· It strengthens community action.
· It empowers older people to take action to reduce the risk of falls.
· Not least, it has come about through a great collaborative effort between government and non-government organisations.

We are keen to see the formation of partnerships like this one throughout the health system and across all the relevant sectors and at all levels. It is through developing trusting collaborative relationships that we will achieve our aims of improving the health status of our communities.

But I appreciate that is easier said than done. Good relationships don’t necessarily form on their own, no matter how good your structure is, or how clear your goals are, or how well integrated your funding might be.

Relationships require a lot of work. They require initiative and motivation. They also require a shared understanding of each other’s roles, an appreciation that partnerships are often an evolving process and, perhaps above all, good communication at all times.

Health of Older People Strategy
The changes I have just described are embodied in the Health of Older People Strategy that I will launch at Parliament on 16 May.

I know that Grey Power members actively participated in the public consultation on the draft strategy last year, and helped to ensure that older people’s views were heard. Over 400 people attended public meetings, and 116 written submissions were received. The level of interest was such that the closing date for submissions was extended from November to mid-January.

This strategy sets out a demanding work programme for planners, funders and providers of aged health care to develop services over the next 10 years.

As a result of the submissions, some changes have been made, including:
· a separate objective with a focus on consumers, independence and positive ageing;
· greater emphasis on issues for older people in rural areas; support for people with disabilities; integrating mental health with personal heatlh and disability support services; and equitable access to services and national consistency;
· greater recognition of the role of family and whanau carers, and the role of volunteers and voluntary organizations; and
· greater recognition of the needs of older people from other ethnic minority communities, including refugees and recent migrants.

The Health of Older People Strategy is a key part of the broader Positive Ageing Strategy, which provides a framework within which all government policy with implications for older people can be understood and developed.

It is partly about ensuring that older people can participate fully in the community in the ways that they choose. It is also about encouraging people of all ages to think positively about ageing.

This may be easier said than done.

A grandfather and his grand daughter were sitting talking when she asked,
”Did God make you, granddad?”
“Yes, God made me,” he replied.
The little girl thought for a few minutes, and then she asked, “Did God make me too?”
”Yes, he sure did,” the older man answered.
For a few minutes, the little girl studied her grandfather’s and her own reflection in the mirror, while he wondered what was running through her mind.
At last, she piped up,” You know, granddad,” she said. “God’s doing a much better job lately.”

We may not be able to do a lot about the wrinkles (and our grandchildren’s perception of us), but an ageing population does not inevitably mean a less able or less healthy population. Lack of action can cause this to become a self-fulfilling prophecy. This is why these strategies are not only designed to improve the quality of life of today's older people, but also to promote and support more healthy and active lives among tomorrow's older people and thereby reduce dependency in later life.

As well as the development of these strategies, the practical groundwork for the much-needed changes is already under way. The establishment of district health boards, for example, has been crucial, because the kind of integrated, collaborative approach to providing services that we are signaling, with a greater emphasis on meeting needs in the community, could not have been achieved under the previous corporate hospital structure.

Conclusion
To summarise, our vision for health and support services for older people will be achieved through developing an integrated continuum of care focused on promoting positive ageing. In 2010 the scene will look like this:

· Health promotion and disease prevention will be at the forefront of services.
· Older people will have access to a range of living options and support services to assist them to age positively.
· There will be well-developed specialist health services for older people.
· Older people with high needs will have access to timely and comprehensive assessment, and appropriate treatment, rehabilitation and support.
· Services will respond flexibly to the diverse needs of older people.
· There will be culturally appropriate services for the increasing numbers of older Maori and Pacific peoples, as well as for older people in other ethnic groups.
· Support services will work with caregivers to strengthen informal support and support networks.
· Older people will receive a range of services through a coordinated package of care.
· There will be smooth transition between services when an older person’s needs change.

Making the strategy a reality calls for the Ministry of Health, District Health Boards, NGOs, health professionals and all those with an interest in health services for older people to work together to make the changes we need by 2010.

I am looking forward to that challenge, as I'm sure you all are. It represents a significant turning point in the way we approach the health care of older people, and will contribute to a society where older people are valued and supported.

Thank you.