The Grey Power submission on the inquiry into Aged Care Provision, Parliament, on 18 Sept 2024
Notes for Health Committee presentation
Kia ora, Colleen Singleton Grey Power Federation Board member. An apology from our new President, Gayle Chambers, who is in the South Island. Thank you for the opportunity to talk to the Grey Power submission and answer any questions the Committee may have.
Grey Power is a membership organisation with advocacy as its purpose. It is not a service organisation. The submission was developed by the Health Committee comprising members from across the country.
The Grey Power submission has looked at health from the wider perspective of all older people, not only those experiencing neurological cognitive disorders. Our lived experience is that while people with cognitive disorders have issues specific to them, many of their issues are the same as, or similar to, those experienced by older people.
Both the Health Committee and Grey Power members know what the general health issues are for older people. We hope Grey Power is seen to be solution focussed by suggesting that existing programmes could be available to older people.
Government agencies have all the statistics and projections. However, the dots don’t appear to be joined, so often individual outcomes are not achieved.
Most older people want to have sufficient income to live in a warm dry home and when something out of their norm happens they receive services in a timely way that achieves a positive outcome. This fits with the Healthy Ageing Strategy.
The deficiencies with Aged Care are grabbing the headlines. We submit that most older people want to age in place for as long as they are able, which means reliable and improved home-care services. In saying this, we refer to paragraph 12 of our submission, that older people need an integrated approach that includes the family/whanau with their health, spiritual, cultural, economic, social and occupational needs met to maximise their independence and wellbeing.
Grey Power supports a strategy for older people as set out briefly in paragraphs 27 and 28 of the submission. We ask whether consideration has been given to a social investment approach for older people. The Housing Foundation provides a way for younger people to own a home. Could this be extended for older people? There will be other Government programmes that could be extended for older people.
A strategy for older people would pull together the physical, psychological, spiritual and cultural aspects of an older person’s life. At present we have a number of agencies, but none take into account the totality of an older person’s wellbeing.
Submission to Health Select Committee
Inquiry into Aged Care Provision
Introduction
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Grey Power Federation New Zealand Inc. is a non-party political advocacy organisation comprising 70 independent Associations with approximately 40,000 members.
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Grey Power has taken a broad view of the Terms of Reference as the membership covers several age groups, many cultures, and both rural and urban dwellers.
Models of care
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Grey Power policy supports the New Zealand Healthy Aging Strategy priority action: To ‘identify and implement models of care that are person-centred, needs-based and equitable, and [to] deliver high-value, high-quality and better outcomes through home community support services across New Zealand.
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“Ageing in place” is the preferred option for many older people because it provides them independence and autonomy.
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When thinking about any form of residential aged care, many older people fear losing their independence due to lack of mobility, change in neurological function, stroke, social isolation, management of medications. An example – a diabetic for 40 years will fear that their insulin dosage may not be given on the sliding scale they have used at home, having tested their blood sugar and estimated the food value of the upcoming meal.
Home care services
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Home care services enable an older person to live at home with dignity. Professional home care requires well-trained home support workers who are adequately compensated for their work and supported by providers who use up-to-date, monitored and standardised management systems. Communication systems must take account of the client’s condition and useability. Many of the complaints appear to be due to failure of these systems.
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Well-funded professional home care services relieve hospital beds, for which the daily cost is much increased.
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Anecdotal evidence is that Home and Community Services (HCSS) are diminishing and the requirements make it harder to qualify. These issues are of particular concern to older people (and family/whānau) who suffer neurological disorders such as mild cognitive impairment, dementia, brain injury, as well as all the other disabilities that accompany the aging process.
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Diminished services include
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complete loss of home care assistance,
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reduction in hours of care,
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different carers each week/fortnight,
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no set arrival time,
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lack of carer training,
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withdrawal of shopping assistance,
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re-assessments for care being done by providers’ under-qualified staff,
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insufficient carer travel time between jobs,
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denial of domestic assistance unless a client requires personal cares.
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Older clients are hesitant to complain about lack of service delivery for fear of repercussions Their worst fears include cessation of or a reduction of care hours.
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Grey Power does not have access to employment arrangements between providers and care workers. From communication with clients, we note some issues in paragraph 9.
Medical and other models of care
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In the past, people living with neurological disorders have been treated only with a medical model of care, which does not maximise their wellbeing and independence. Overseas, models of care for all older people have moved towards a more integrated approach that includes both health and social aspects of care. New Zealand has started moving in this direction, but there is still a long way to go.
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Support services need to include the client’s family/whānau with their health, spiritual, cultural, economic, social and occupational needs to maximise independence and wellbeing. Dietary advice and an exercise programme should be included.
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Grey Power recognises that there is a huge gap between theory and practice. This was identified by Rosa Kornfeld-Matte, the United Nations human rights expert, who visited New Zealand in March 2020, when she said that there is a “persistent lack of urgency” regarding older peoples’ issues, evident at all government levels.
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Grey Power draws the Committee’s attention to the person who needs hospital care. A decision is made while in hospital that the patient can no longer live at home independently with home care services. The patient and their family/whānau are required to make a quick decision about future care. The patient may choose a rest home and need to sell their home to cover the commercial arrangements of rest-home care. After a period of rest-home care the best outcome for the older person is to return home to live with home-care assistance. However, if their home has been sold they may no longer have sufficient funds to purchase suitable accommodation and suitable rental accommodation may not be available. The public health system has insufficient beds for the patient’s physical, mental and spiritual needs to be fully assessed before major decisions are made.
Evidence collected by Grey Power
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Grey Power has provided evidence to the Ministry of Health at the request of the Minister for Seniors.
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Grey Power has received many contacts from throughout the country regarding deficiencies in care, and not all have been recorded. These were by email, posted mail, phone calls and face-to-face contact with members.
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Evidence has been gathered from carers’ unions (New Zealand Nurses Organisation, PSA and Etū), as well as from numerous media articles.
Housing
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In 1961 Jane Jacobs wrote in The Death and Life of the Great American Cities, “Cities have the capability of providing something for everyone only because, or only when, they are created by everybody.”
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Grey Power acknowledges the shortage of home ownership and rental housing stock. It also notes that not all housing stock is in the right place or meets the needs of the current demographic and family/whānau lifestyle. The single resident to the multigenerational family needs to be accommodated. The cost of refurbishment is often out of reach.
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Grey Power supports building universal homes. The outcome is homes that accommodate residents from ‘cradle to grave’. The cost to ACC to accommodate a disabled accident victim is reduced considerably in a universal home.
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Kāinga Ora’s Masterplanning for Universal Design contains useful information for universal housing and urban design.
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Grey Power has supported the review of the Retirement Villages Act 2003 carried out by Housing Urban Development (HUD). The Commerce Commission’s investigation into village owners thought to be in breach of the Fair Trading Act, following complaints from the Consumer NZ and others, has had mixed results.
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Under ‘Seniors’, the National Party and New Zealand First Coalition Agreement states: ‘Progress the review of the Retirement Villages Act.’ While no announcement has been made about a time-frame for this work, Grey Power requests the Health Select Committee to assist with that continuing work, as appropriate.
Strategy for Older People
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The 2023 general election party manifestos were thin on policy for older people. Grey Power acknowledges that many general policies apply equally to older people.
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Many older people are feeling unsure about their future, particularly about their financial ability to care for themselves into the future.
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The Aged Care Commissioner has supported a strategy for older people regarding health. “There is a need for a targeted strategy to ensure high quality health and disability services for older people. There is no dedicated strategy and planning for the health and disability needs of an ageing population. Despite strategies and action plans relevant to aging well, there is no coordinated strategy focused on our ageing and increasingly diverse population, including rising numbers of people with chronic conditions and high health needs.”
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Grey Power urges the Health Select Committee to use its spheres of influence to recommend to the Government that it develop a strategy for older people. This should include, but not be limited to:
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Cost of living
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Health
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Retirement income
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Housing
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Sustainable Transport options
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The Better Life Strategy 2019-2034 needs to be updated. It does not pull the various entities together nor bind them to common solutions for older people.
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The Office for Seniors, the Aged Care Commissioner and the Retirement Commissioner (retirement villages) provide policy advice/recommendations about services for older people. A strategy for older people should include a review of how these older people’s services and support could be aligned.
Funding
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Grey Power acknowledges that Vote Health is stretched and steps are being taken to prioritise spending. Grey Power expects that publicly funded services have monitored outcomes.
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A just and civil society cares for its older people and respects the contribution they have made to society during their lifetime.
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Funding for New Zealand’s infrastructure and support systems for older people is unevenly distributed across the country. This results in inequitable service delivery. Services need to meet the test of being person-centred, not system-centred, and evidence-based using best practice.
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Both the public and private sectors need appropriate up-to-date technology to deliver services.
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Grey Power is not putting forward a funding model, but as people with lived experience members could contribute to the discussion on adequacy or otherwise of different funding proposals. In other words, Grey Power members could walk alongside the Committee and its advisers sharing experiential knowledge.
Appearing before the Committee
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Grey Power would like to discuss the issues in this submission if the Committee meets with submitters.
Gayle Chambers
President, Grey Power Federation Inc; Chair, Health Committee
Email: Nationalpresident@greypower.
Tel: 0210538707
12 August 2024