Health Boards neeed to do more for the elderly

Posted by on 2 October 2008

In September, The Foundation released a report (which it had commissioned) into how the country’s 21 District Health Boards (DHBs)are caring for their elderly populations.

The Report attracted wide media coverage and is available to view here

With a quarter of our population over 65 by 2040, ageing is arguably the most important challenge facing New Zealand over the next 25 years. It is vital that we develop appropriate responses now rather than just hoping it will go away if it is ignored.

The findings of the Report were that the country’s 21 DHBs need to improve their care of elderly people. While good progress was being made in some areas, there remained issues of concern. For example, the needs of ethnic minorities, the quality of service delivery and the extent of service integration within the DHBs all required improvement.

In 2002, the Government released a Strategy for Older People and gave guidelines for DHBs as to what was expected in terms of providing services for older people by the year 2010. Subsequent enquiries by The Foundation revealed divergences in the preparedness of health boards to meet the Strategy objectives. We therefore commissioned Lisa Stewart to evaluate the 21 Boards to see how they are implementing the Government Strategy for the Health of Older People.

Lisa reviewed documents from all 21 DHBs and also invited each local branch of Age Concern to participate. Her research has also revealed factors that hinder implementation of the Strategy. These include the level of Ministry of Health funding, workforce availability and training and the internal “culture” of some of the DHBs.

In line with our vision statement, Preparing New Zealand for an Ageing Future, and as an independent organisation without ties to any government funding, we are committed to disseminating research-based information in order to improve the quality of policymaking as NZ communities grapple with the implications of a rapidly ageing population.

Our findings include:

• All but one DHB has a section on older people’s health in its District Annual Plan. Otago did not, despite having one of the highest proportions – 14% - of people aged over 65. Bay of Plenty, Wairarapa and Nelson/Marlborough also have 14% of elderly people, with only South Canterbury being higher at 16%.
• DHBs made informal assumptions rather than providing actual evidence that older people were satisfied with their services. One commented: “We are not getting a huge public outcry.”
• Only 12 of the 21 DHBs rated themselves. Of those who did, Capital and Coast Health rated itself the most highly in terms of implementing the Strategy, followed by Hawkes Bay. West Coast rated itself lowest.
• Smaller DHBs had difficulty attracting staff while the larger ones found labour costs were high and suffered quality issues, particularly in home-based support services because of the number of different providers.
• Wages for home-based support staff should be increased.
• Nursing services in the community should be increased.
• Older people are often unaware of what they are entitled to and GPs and other health providers don’t tell them.
• Health services should avoid giving people inappropriate appointment times, such as 8am in rush hour traffic for a frail elderly person.

With a 2010 deadline looming for the implementation of the Health of Older People Strategy, DHBs have less than two years to activate their plans. However, it is encouraging that reasonable progress is being made even though the level of consumer or community satisfaction is not clear. What is disconcerting is the lack of documentary evidence to support DHB management’s contention that the Strategy is being satisfactorily rolled out.

While DHBs were confident that good progress was being made, the Foundation’s research had revealed discrepancies between those perceptions and what the DHBs’ own action plans showed was really happening. Our Report shows, and it is a view which was shared by local branches of Age Concern who participated in the survey, that improvements to health services for older people are less than those being reported by DHB Managers.