Ageing in Place:

A future direction of services for older people in New Zealand Deb Kerry

Acting Manager, Health Of Older Person Team, The Ministry of Health

Dr Matthew Parsons

Senior Lecturer in Gerontology The University of Auckland

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What is ageing in place?

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What is ASPIRE and what will it tell us?

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Where to from here?

Ageing in place: what is it?

• • • 1994 OECD - people should be able to continue living in their own place of residence in their later years. New Zealand- ageing-in-place is about government supporting people to make choices about where they live The ability of older people to remain dwelling in the community, including within retirement villages (MSD, 2006)

Why in the community or at home…

• • • • • • • Person centred Familiarity with the home, neighbours, surroundings etc A place with memories - especially of a dead spouse/partner A focus for privacy A place (in most cases) for security A way to stay independent Maximising the potential for social integration

Some assumptions

Older people prefer to live at home Government strategy is to encourage older people to live at home It may not save money, but we don’t think its more expensive for older people to live at home

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What is ageing in place?

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What is ASPIRE and what will it tell us?

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Where to from here?

Background to study

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Development of Health of Older Person Strategy

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Ageing in Place Demographic shifts / costs Risk of ad-hoc development of AIP services Drive for evidence base MoH desire for standardised assessment and evaluation.

Methods

• Prospective meta-analysis of randomised controlled trials (met-RCTs) to evaluate the effectiveness of ageing in place initiatives.

• • Population: 569 older people assessed with ‘high’ or ‘very high needs’ Assessments at: baseline, 3-months, 6 months and every 6-months for up to two years (average 12 months)

Methods

• • • Commenced November 2003, recruitment finished in November 2004 and final data collection completed in November 2005.

Sub-study: OPERA Report with MoH

Outcome Measures

Primary end-points

• Survival • Permanent institutionalisation into residential care

Outcome Measures

• • • • • •

Secondary end-points

Disability Number of Acute Hospitalisations Number of Falls Social Support Network Health-related Quality of life Experience of the primary informal caregiver •

Tertiary end-points

Costs- direct/ indirect

Research Questions

1.

To what extent do the three initiatives (COSE, Masonic PIP and Community FIRST) collectively (a) delay or prevent entry of older people to residential care and (b) reduce mortality? 2.

What is the impact of COSE, PIP and Community FIRST on an older person’s independence, quality of life and social support systems

Research Questions

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4.

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Are there differences in quality between the three initiatives and conventional care?

What are the differences in quality of life of caregivers of older people within conventional services compared to the ageing-in-place initiatives?

How cost-effective are the ageing-in-place initiatives to the client, family, providers and funding agency in relation to conventional services?

Research Questions

6.

7.

Will ASPIRE be able to assess the sustainability of AIPI to improve outcomes and cost changes over a two year period?

Will ASPIRE be able to identify key elements of the AIPI healthcare models of community-based service delivery that lead to beneficial outcomes?

Predicted outputs

• • • • Relative success of: – COSE, – Promoting Independence Programme – Community FIRST • Risk factors for admission to residential care Role of NASC Costs associated with ageing in place Key elements of ageing in place

The role of NASC

• • NASC – a very significant role in assessing needs and brokering services COSE an evolution of NASC – Linked to GPs – Enhanced coordination – Geographically based and therefore aware of local community resources and services (both formal and informal) – One point of contact for health professionals (GPs), older person and family / whanau

Intermediate care

• • Masonic PIP and Community FIRST both use residential care in the form of slow stream rehabilitation / transitional care Change in the use of residential care – Respite, dementia care, end of life care • Key aspects of successful intermediate care

Residential care for older people, bed day utilisation

4500 4000

Rest home

3500 3000 2500

Hospital

2000

Extrapolated

1500 1000

Dementia

500 0 1996/1997 1997/1998 1998/1999 1999/2000 2000/2001 2001/2002 2002/2003 2003/2004 2004/2005

Source: Ministry of Health 2001

Restorative home support

• • Community FIRST is an example of restorative home support for older people with high and complex needs Restorative home support key components: – – Goal setting Repetitive functional exercises incorporated into every day activities – Comprehensive assessment and care management – Community reintegration

Where to from here?

• Ageing in place – a key government direction • ASPIRE will provide the NZ context

Where to from here?

26 September Mid October Release of Findings at HOOP Forum Sector Consultation Mid December Cabinet Report