Difficulties for Health Boards in Dealing With the Elderly

21July 2011

Difficult relationships with primary health organisations (PHOs), poor home-based services and problems with IT remain key issues for District Health Boards dealing with the country’s growing elderly population.

These are the findings of an independent report released today by the HOPE Foundation for Research on Ageing. It’s a follow-up to the foundation’s 2008 report on how well DHBs are meeting Government policy on the health of older people.

Foundation chair Professor Emeritus David Richmond said the growing number of older people would have an impact across all levels of New Zealand society.

“The coming decades will be characterised by smaller family size and a significant increase in people 65 and over, with a marked increase in Maori, Pacific and Asian people. By 2061, there will be 1.44 million people aged over 65 in New Zealand – that’s 2.6 times the number in 2009.”

Professor Richmond said the Ministry of Health estimated older people would consume around 63% of total available health dollars by 2051 compared to 40% in 2002.

“It is vitally important we get systems in place to deal with this. There has been some progress made since our last report three years ago but DHBs are still facing considerable challenges in implementing successful strategies to deal with our ageing citizens.”

Findings in the report include:
• Developing an integrated continuum of care is the biggest problem cited by DHBs, especially regarding co-operation between professionals, the provision of home-based support services and the realignment of services.
• Frustrations were evident around institutional boundaries, such as the lack of collaboration between primary and secondary services, the ‘patch protection’ experienced within and between services and the time it was taking to change attitudes.
• Many DHBs had achieved one or two aspects of integration, such as a single point of entry for assessments or enhanced community education roles by DHB-based geriatricians and nurse specialists, but none reported this fundamental cornerstone of delivering services to older people was complete, a position mirrored in other OECD countries such as Canada, France and England.
• Many DHBs identified the lack of integrated information technology as a barrier to information sharing and therefore service integration.
• A number of DHBs said an essential component of an integrated model of care was the widening of GP services to provide preventive services and co-ordinate community services for older people. They felt GPs were reluctant to do this and that DHBs had no mechanism for encouraging it.
• Despite the reduction in the cost of doctors’ visits and the success of PHOs in encouraging older people to enrol with GP practices, health promotion and prevention-based activities of PHOs received few positive comments. Only one DHB positively mentioned the relationship with a proactive PHO. Most appeared uninformed or unsure about the activities of their PHOs.
• Poor capacity and capability of home-based service providers is apparent, despite DHBs and the Ministry committing significant resources to support development of this industry. However, some positive progress was reported, especially in smaller centres where budgetary constraints are apparently not as significant as in larger centres.
• DHBs in the larger cities and in regions with higher than average numbers of older people raised concerns about the financial viability and prudence of providing home-based support services long term, with budgets unlikely to keep up with demand unless government policy changes.
• Some DHBs said, as older people lived longer and became frailer, they would require a broader range of support services to remain safely at home. This could make providing home-based care more expensive than residential care.

“Our research shows collaboration and good collegial relationships are key to achieving change and that view is supported by international experience,” said Professor Richmond.

“However, good teamwork does not occur without effort. Those DHBs which had positive relationships with providers confirmed an investment of time was needed to achieve this goodwill. The challenge now is to ensure every DHB improve its relationships to enable the elderly to receive integrated care.”

The Foundation's research was carried out by Sarah Jane Hood as part of the requirements for her Master's degree in Public Health.

ENDS

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