A report following a "significant overspend" in the Whanganui District Health Board's budget for elderly care has shown a growth in demand for long-term home support.
The matter was discussed in a committee meeting on Friday.
The board was "almost a million unfavourable to budget", committee chairwoman Kate Joblin said.
"That's a fair discrepancy in terms of what we were pitching and what we were budgeting for."
Funding and contracts manager Matthew Power said there had been "quite a number of people" receiving non-standard, short-term home care that "might have really been more appropriate in long-term home-based support services".
The health board looked at cases of people on short-term care and assessed them to see whether they still needed those services.
"What we saw was a shift, generally, of people moving out of the non-standard, short-term home-based support services into the long-term ..." he said.
While they expected the numbers to calm down - with fewer people in short-term and more people in long-term, this did not happen. Instead, the number of people going into long-term home care continued to grow, "which was unexpected".
Mr Power said they had "gone through a process of trying to identify why is this occurring ... that's where we have sort of got to today".
The report noted the number of people on long-term home and community support has risen from about 470 in 2013/14 to 658 in February this year.
Committee member Matthew Rayner pointed out a graph in the report showing the average dementia bed days utilised per month per person aged over 65.
In the graph, Whanganui is the lowest in mid-2013, beneath Capital and Coast, Hawke's Bay, Hutt Valley, MidCentral, Tairawhiti, and Wairarapa district health boards. But Whanganui had steadily risen until it was fourth highest in March 2016.
"Are we expecting it to keep going up and eventually be number one?" Mr Rayner asked.
The report noted ways to mitigate the climb in demand for support services. This included maximising rehabilitation opportunities through the Individual Rehabilitation Programme, which was introduced in February.
Since it began, 84 people have been referred and assessed, 48 people remain on the programme, and 36 people are no longer on it. Of these 36, 22 people required no further services, 10 people were referred for long-term support at the same level or less, and four people required an increased level of support.
The report also mentions a review of ACC Discharge Planning, saying there are times when a patient is eligible for ACC or joint-funded support, but were using only health board-funded support.