A Kaipara town is determined to provide aged care from within their community and have taken on their biggest challenge yet – constructing a dementia unit.
With their project, Maungatūroto is tackling what aged care advocates believe is a pressing issue in Northland.
Located 45km south of Whangārei, Maungatūroto with its 1200 residents is about to become the smallest Northland settlement to provide dementia care due to the efforts of its community.
While all 10 existing dementia units in Northland are scattered around larger towns within the region – four alone in Whangārei – Maungatūroto will be able to keep their elderly closer to home once they are in need of residential dementia care.
The new $3.6 million unit will be the latest addition to the community's cluster of aged care facilities and provide 14 beds.
Jamie Ewen, chairman of Maungatūroto Residential Care Limited, said the foundations had been poured and they were ready for the next stage of construction:
"We are currently bouncing back from the Covid [lockdown], but we are catching up with the builders, and we'll be back on site soon."
Ewen said the more feasible it is for people with dementia to stay close to their home, the better.
"Having community-based dementia care solves a range of issues, patients tend to feel more comfortable in a familiar environment. Also, families don't have to plan entire days around visits which means more frequent visits, and it saves them time and money."
One of the early driving forces behind Maungatūroto's care facilities is resident Don McKay, trustee and former chair of the Maungatūroto Community Charitable Trust (MCCT).
In the mid to late '80s, McKay together with members of the community purchased the town's old post office to set up a rest home unit.
Since then, MCCT has successfully established a 14-bed rest home, 14 low-priced rental units, 14 further discounted housing units and numerous rooms for doctors and other health.
McKay said about five years ago the trust sought advice from the Northland District Health Board (NDHB) what kind of care facility they should put next on their list. They recommended a dementia unit.
While the trust has been running into stone walls trying to access public funding, McKay said they received huge support from the community.
"We have been flat-out with fundraising," he said. "We tried to get money through all sorts of pathways. But as soon as you mention dementia care, the doors slam shut. It's been really frustrating."
McKay said MCCT had two goes at securing money through the Provincial Growth Fund and even had Deputy Prime Minister Winston Peters visiting Maungatūroto. However, the Government is yet to stump up some funds for the project.
Ewen stressed that it was thanks to the support and generous donations of the community that they were able to build the unit.
He confirmed that finances for the build were approved by the bank and they were looking at options for funding once they get to the fit-out stage.
Aged care organisations have previously pinpointed the lack of financial support by the government as a major issue in dementia care and the expansion of the facility network.
Simon Wallace, Aged Care New Zealand chief executive, said banks were usually happy to finance rest home developments; however, dementia units are seen as entirely different.
"Often, banks will understand how retirement villages work, which makes a better case than a dementia unit. A stand-alone dementia unit is unlikely to be financially successful."
This is not a well-kept secret. Aged Care NZ have previously urged Governments to take appropriate steps.
A report by Aged Care NZ from 2010 reads:
"Dementia has the highest rate of demand but an unsustainable rate of return, therefore it is unlikely to attract any future investment. As such, early priority needs to be given to address this."
However, the funding system hasn't changed since. Investors have to stem all construction costs privately.
Once the build is completed, the dementia unit can get accredited with a district health board to enter a contract.
DHBs then pay a subsidy for all eligible residents after they went through a needs assessment.
A bed in a dementia unit can cost up to a third more than a regular rest home bed, hence dementia beds are less profitable than other care facilities.
For Northland, this can become a dire issue in the future.
An estimated 2500-3000 Northlanders have a moderate to severe cognitive condition, meaning they are fully dependent on others. The dark figures are presumed to be much higher as most are not formally diagnosed.
According to an Alzheimer's New Zealand report from 2016, a third of those with dementia are in professional care.
While it doesn't specify how many require a bed in a secure dementia unit, for Northland that would mean 800-1000 people can't be solely cared for by a family member.
Currently, there are about 170 dementia beds in the region.
NDHB weren't able to confirm the current occupancy rate but following numbers on Eldernet, the Northern Advocate assumes it's well above 90 per cent.
"There is a shortage of dementia beds in Northland," Kevin Salmon, Alzheimer's Society Northland general manager, said.
Salmon commended the Maungatūroto community for their efforts to take on the dementia care problem despite significant funding challenges.
"There is no money in dementia care because it's quite expensive. There is not a lot of enthusiasm to build new dementia units. That's why Maungatūroto is gold.
"People have to go to Orewa or elsewhere in Auckland for dementia care when they should be close to their relatives. This stress is just wrong."
He said not being able to see one's spouse who had to go into care in a facility that is too far away to visit regularly could be a traumatic experience.
Salmon believes the shortage will worsen because Northland is one of the fastest-growing regions in the country and New Zealand's population is ageing.
Alzheimer's NZ estimates the dementia rate will increase from the current figure of 1.3 per cent of the population to 2.9 per cent by 2050.
The Ministry of Health and the NDHB neither denied nor confirmed a shortage of dementia units in the region, with the ministry relegating the responsibility to the health board.
NDHB noted that there were currently vacancies in three dementia units. And though the number of Northlanders with dementia is higher than the number of beds, NDHB said many did not require the secure environment of a dementia unit.
For Salmon, the future of secure dementia care lies in projects such as Maungatūroto.
He said the better way of facilitating care was through smaller institutions spread across the region so people had the chance to stay within their community, even though investors might favour larger developments.
Once the Maungatūroto community have established their new unit, Ewen and his team aspire to take on a new challenge, a hospital care facility.