A parliamentary inquiry into the huge increase in the number of Kiwis with dementia is happening at the same time that services could be cut, Alzheimers New Zealand has warned MPs.
Health New Zealand Te Whatu Ora has denied services for older people will be reduced, but Catherine Hall, the chief executive of Alzheimers NZ, said those in the sector are nervous.
Hall appeared before Parliament’s health select committee this morning, which is holding an inquiry into the aged care system, including care for the rapidly growing number of Kiwis with early onset neurological disorders, including dementia.
The inquiry was committed to in the NZ First-National coalition agreement.
“Since submissions to this inquiry have closed, we have heard that decisions are under way to reduce the services available to older people, many of whom are living with dementia or a neurological condition,” Hall told MPs.
“Health New Zealand has said that is not the case, and we certainly hope that is true, because if it is the case then that would make a broken system very much worse.”
Hall said the risks from rising numbers of people with dementia – expected to double by 2040, with higher rates for Māori, Pasifika, and Asian people – were “very significant”, but could be mitigated and even reduced with a proper policy and funding response.
“It isn’t too late to stem the tide...[but] neither the aged care sector, nor the health sector, is ready for the impact of the ageing population, or the impact of the rapidly increasing numbers of people with dementia.”
The commissioner of Health New Zealand, Dr Lester Levy – who was appointed in July to overhaul the organisation after its board was abolished – has been tasked with finding $1.4 billion in savings, but has vowed the clinical front line will not be reduced.
Hall told the inquiry that fully funding and implementing the Dementia Mate Warewarea Action Plan – drawn up by Alzheimers NZ, the Dementia Foundation, the Mate Wareware Advisory Rōpū and Dementia New Zealand, would relieve pressure on the health system and reduce the future costs of dementia to the Government.
Some money was pledged towards the plan under the previous Government, including to run pilot programmes, after its Cabinet endorsed it in 2021. However, more funding is needed for it to be fully implemented.
National MPs on the committee questioned whether proper funding wasn’t provided by the previous Government. In reply to questions, Hall said for community dementia services specifically, $127 million was needed over three years. Currently, less than 20% of people who need community support are receiving it, Hall said, because of a lack of funding.
“What I can’t answer... is how much is needed to solve the funding issues in the home support area and the aged residential care area, in order to get timely diagnosis.”
Tracey Martin, chief executive of the Aged Care Association, which represents most owners of aged care facilities, told the committee that the sector overhaul being done by Health NZ could drive up the costs for New Zealanders needing aged care, and force others to live in ill-health at home.
“The snippets we have collected from this whiteboard session and that slide presentation indicate to us that Te Whatu Ora is creating a model that is being driven from a completely financial perspective. They have been instructed to find a way to release 200,000 hospital bed nights.”
Health NZ was working on flawed assumptions, Martin said, including that dementia needs will increase only mildly, and psychogeriatric need will remain flatline for the next 15 years.
That mistaken belief meant no thought was being given in the overhaul of aged care to the reality that no new psychogeriatric beds are currently being built, Martin said.
“Te Whatu Ora themselves cannot find current placement for New Zealanders who need this level of care. Individuals are being inappropriately placed with our members... putting at risk other residents and staff.
“Without a funding model or contract incentive that supports renovation of existing facilities and provides the capacity to take the risk to build new facilities, then current places are very likely to be closed or at least retracted due to age.”
Martin claimed that Health NZ was looking to lower asset and income thresholds to access residential care, which would mean New Zealanders would pay more. The level of frailty to enter rest home care could also be raised, she said.
“We are being told by Te Whatu Ora officials that they have a working assumption that approximately 20% of the current residential care population could be cared for at home.”
Martin asked the committee to consider asking the Health Minister to pause the aged care sector redesign, and recommend a ministerial taskforce or forum that includes sector representatives be created urgently to be part of any reforms.
She said decades of funding neglect had forced almost all providers into steps such as charging residents and their families accommodation premiums for so-called “premium rooms” (which can top $100 a day), on top of a 24-hour care rate.
“We should not forget that those New Zealanders in need, whose assets and income fall below the current thresholds, already pay all of their income and have to sell down their assets, before government providers will top up anything for their care.
“Everyone over the age of 30 and above will be part of this wave of elders that does not peak until 2078. One of the current trends, one in four of us will develop dementia. This is about them, and this is about us.”
Health New Zealand has denied the claims by the Aged Care Association, including that it is looking to toughen eligibility to get into a rest home - and says “throwing mud” is unhelpful.
“In the next 15 years the number of New Zealanders aged over 85 are going to double to almost 200,000 people. And we want to make sure that we’ve got a system in New Zealand that cares for those people in the right setting,” said Andy Inder, Health NZ-Te Whatu Ora’s director of ageing well.
“And we shouldn’t be competing or throwing mud at each other around the size and scale of the challenge. We should be collaborating to make sure we are solving it together.”
Inder denied Martin’s claims changes to asset, income and frailty thresholds were on the table. It was also wrong to suggest Health NZ isn’t planning for a big increase in demand for dementia or psychogeriatric beds in aged care homes, he told the Herald.
“In dementia beds alone, we are forecasting at least 40% growth in the next 10 years…we have committed to [the aged care association] and other aged care providers to co-design funding and service models when we get to that stage, which we expect in coming months.”
“It is not correct to state that we are designing a system to force people out of aged residential care – we want a system that supports older people, based on their needs and allows them to be cared for in the appropriate setting of their choice. We are not in a design phase as yet, that will come once we know an investment pathway has been secured.”
Inder said on a national and regional level there were currently dementia beds available.
“However, we don’t always have the right mix of beds locally. For example, in the Palmerston North area we have rest homes looking to change rest home beds to dementia beds in response to community need there.”
Inder referred to a public promise by the commissioner of Health New Zealand, Dr Lester Levy, that frontline clinical positions wouldn’t be cut, despite the government’s wish to find $1.4 billion in savings across the health system.
“I think the commissioner has been really clear that frontline services are not going to be cut. He has said that multiple times publicly,” Inder said.
“I want to reassure people that we have a realistic view of the challenges we have on the horizon, and are looking to respond to them.”
Labour seniors spokesperson Ingrid Leary has backed the Aged Care Association’s call for the reforms to be paused, saying the search for savings in health “is driving a chaotic and short-sighted redesign of aged care that could have significant impacts on how seniors access the care they need and deserve”.
Nicholas Jones is an investigative reporter at the Herald. He won the best individual investigation and best social issues reporter categories at the 2023 Voyager Media Awards.
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