New Zealand Aged Care Association conference

  • Tony Ryall
Health

Good afternoon.  It is a pleasure to be here to address the New Zealand Aged Care Association conference and I would like to thank the Association for its invitation to speak to you.

Today I would like to thank you for all you’ve done following the Canterbury earthquakes, clinical integration and the launch of comprehensive clinical assessments for all residents.

Christchurch

I would also like to thank the many health professionals, managers and care workers in aged residential care for the outstanding work they do in caring for vulnerable older people. 

This dedication was particularly evident in the aftermath of the Christchurch earthquakes.

The loss of 7 facilities and over 600 beds in Christchurch created major problems.  With 265 people relocated outside of Christchurch the earthquake impacted facilities throughout New Zealand.

The speed of the response and the quality of continuing care showed the best characteristics of New Zealanders supporting each other.

I was impressed to learn of the response of the aged care facilities and DHB staff in Auckland when residents had to be transferred in the emergency.

Despite flights being arranged, then unfortunately cancelled, then arranged again, staff were at the airport in the small hours of the morning to assess and assist transfers.

Facilities were available to receive Christchurch residents.  Visitors were arranged to help residents settle in. One facility arranged skype communication so residents could talk with family back in Christchurch.

As conditions in Canterbury stabilised, plans for relocating residents back to Christchurch were developed where a return was desired by residents and their families and it was feasible to do so.

Naturally there’s a level of uncertainty about exactly how aged residential care will look in Canterbury over the next few years. The DHB and your members are working this through.

The earthquake has not only disrupted the distribution of residents but also of staffing. And that’s an ongoing challenge for Christchurch and also those providers nearby.

Oldest Federal Judge

Earlier this year you may have read a newspaper report about the United States' oldest federal judge … still delivering justice at the age of 103.

Judge Wesley Brown has presided over his Wichita court room for nearly fifty years.

He arrives at court in a van that collects him from his assisted living home and steers his electric chair into the courtroom.

Next to him, behind the bench, among the court documents is his oxygen tank.

At 103, Judge Brown is the oldest federal judge in America by only six years. There are another eight in their nineties and more in their eighties.

Judge Brown values his job because he says it gives him a reason to live.

As long as you perform a public service he says you have a reason to live.

Living proof that older – even very much older – people, do make a valuable and active contribution.

Population changes

It’s very fashionable to blame the elderly for the increasing cost of health care in New Zealand and around the world.

And while there’s no doubt the cost of health care rises with age, ageing is not the main driver of cost in the health service. So don’t blame the elderly for rising health costs.

Research by the Treasury looked at the causes of real growth in health spending from 1951-2002.

For the decade 1991-2002 real growth in health spending was around 3.6%. This consisted of: 1.34% for population growth, 1.85% for cost of new technology, wider access and staff salaries, and only 0.45% related to ageing of the population.

A similar analysis in Canada also concluded that increased utilisation is driving health costs rather than ageing.

New medicines, new technology, more doctors, more nurses, higher salaries are having much more impact.

But we must still plan for the future to meet the increasing needs of older New Zealanders… particularly those over age 80.

Over 80 year olds use 76% of aged residential care, 70% of home based support hours for over 65s, 63% of respite related care and 32% of all elective surgery carried out on older New Zealanders.

50% of over 80 year olds are living independently – and two out of three of them are women.

Whereas in the past the health service has described the elderly as “65 plus”, over the next few years the focus will increasingly turn to the over 80s. This is understandable since someone in their late sixties is much more active and very rarely dependent on outside care.

So while there is no need to panic about an imminent tidal wave of older New Zealanders, we do need to prepare for shifting resources to support the needs of our growing group of much older New Zealanders…sometimes referred to as “the frail elderly”. You care for many, many of these people.

Clinical Integration:

When I am working in my electorate, or around the country holding public meetings or talking to people in the street, I hear stories that show where the public health service can improve further.

Too often patients find themselves admitted to hospitals because of a lack of alternative forms of care and support, or because their GP can’t help them with ready access to a hospital specialist or nurse, or to a vital diagnostic test.

Patients with chronic diseases like diabetes and heart disease are shuttling backwards and forwards from hospital to GP and back again.

Older people in residential care are turning up at emergency departments and GP clinics and seeing different clinicians every time.

And they have to repeat their health story over and over again. So of course things get forgotten or missed.

These are problems of poor co-ordination… a lack of clinical integration.

When health funding becomes fragmented, there’s a tendency for providers to focus on only that part of a patient’s care that they provide. They focus less on information sharing and working around the patients circumstances.

This lack of integration leads to poor service, poorer outcomes and greater cost.

Solving these problems are part of the drive behind the Government’s Better Sooner More Convenient health care policy.

We are focusing in improved care coordination and clinical integration.

This means coordinating services across hospital and community in ways that put the patients' needs at the centre of how care is provided.

But that doesn't often happen now because the necessary primary care teams and infrastructure do not broadly exist.

And the historical divide between hospital and community clinicians doesn’t make it easy.

Increasingly local hospital and community clinicians around the country are talking and working together in ways they haven’t before. This alliance leadership approach is our way to encourage this clinical integration.

Because improving coordination, integration, is about relationships between people.

Over the next few years there’s a real opportunity here for aged residential care to become a more integrated part of the local health systems. Already in some DHBs we are seeing specialist doctors and nurses moving between hospitals, general practice and rest homes.

So much of the expertise in care of the elderly rests in your facilities. I’d urge you to talk with your community and hospital clinicians about how you can share that expertise and better link in with the work they are doing.

Comprehensive Clinical Assessment

At your conference two years ago you featured the Comprehensive Clinical Assessment system from the interRAI suite.  The tool’s purpose is to provide a sound assessment of the needs of the resident as well as to support the development of a care plan.

Like you, this Government is committed to the provision of high quality residential care for older New Zealanders. That’s why the public health service is pleased to be working in partnership with you to establish regular, uniform, comprehensive clinical assessments of all aged residential care residents.

This new comprehensive clinical assessment system will help nurses better identify and monitor the needs of individual patients.

A steering group with NZACA, DHB and Ministry of Health representatives will be responsible for the implementation of the programme, with the public health service providing $10.8 million dollars for its roll-out.

The steering group will work to establish the new system across the country’s rest homes over the next four years, with a target of 75% within three years or 90% of residents. I welcome your participation and I am sure many of you will want to be early adopters.

A Comprehensive Clinical Assessment will provide many benefits to you as providers of aged care and to your residents.  It will support your nurses by providing an early risk alert about resident’s areas of concern.

It will highlight risks of adverse outcomes so they can be addressed and the risks avoided.  The assessment tool acts as decision support and helps communication with medical or other health professionals involved with the care of an older person. 

Training on how to use the tool will be provided with the expectation that it will also increase the sector’s capability to undertake assessments and develop quality care plans.  

Similarities with the Comprehensive Clinical Assessment undertaken in home-based care will enhance continuity of care across the two settings.

There will be challenges for facilities without good information technology but I encourage you all to embrace this new approach, to make the most of the opportunity for resident care and continuing quality improvement. 

Workforce

Maintaining a strong and skilled workforce is a challenge for the whole health sector. DHBs are now employing well over 1,000 extra nurses and over 500 extra doctors compared to three years ago.

In 2011, aged care and mental health were added to the hard-to-staff specialty list for nurses on the Voluntary Bonding Scheme.  This is intended to encourage new graduates to explore working in these areas.  Of the 349 nursing graduates who registered their interest in the Voluntary Bonding Scheme in 2011, 25% are either currently working in or intending to work in the field of aged care.

I can also announce the government is providing 300 training places for nurses working in aged care to strengthen the aged care nursing workforce.  Currently 158 of these places are filled.  We are funding education and training for new graduates, upskilling for existing nurses, and post graduate opportunities in aged care,

This is a priority area for us. And those of you with nursing staff keen to be involved should contact your local DHB Director of Nursing.

The Year Ahead

If the government has the privilege of being re-elected the year ahead will be a busy time as we work with you through the recommendations of the Grant Thornton report on Aged residential care.

The Review pointed to significantly increasing numbers of residents in a few years time and with that, increasing costs.  It will be necessary to explore all the means of efficiently providing effective services that best meet the needs of frail elderly. 

The ARC review used 2008 as the base year for projections and projected that overall numbers would continue to decline until around 2014 to 2016. So we have some time - but not that much time - to improve investment signals.

We have already started with the $40m over 4 year boost to dementia care subsidies, and further increases in this key area can be expected. Focusing on dementia care was recommended by Grant Thornton.

Aged residential care subsidies have increased by $100 million over the past three budgets.

In the next year we will also look to standardised contracting across the home care and aged care sectors. There’s considerable efficiencies to be made if we can reduce these levels of variation.

In closing

While there have been many positive achievements in aged care, events like the earthquakes in Christchurch remind us about the most important things to all of us: our families; our well-being and safety and what it means to belong to a community.

The aged care sector was on the ground in Christchurch making sure that vulnerable older people continued to receive high quality support and care in the most trying circumstances. All the while, the staff involved frequently faced their own personal challenges of damaged property, dislocated families and ongoing concerns over safety. 

There will be other challenges that the health sector will have to face, such as finding the most efficient ways to deliver services that meet the needs of older people and their families.  The lessons of Christchurch show that with the goodwill and commitment of everyone in the sector, future challenges of whatever form can be faced with confidence.

I wish you all the best for a successful conference and once again, thank you for the opportunity to address you.