Comparing Health Policies 5 – Elderly Health

National do not have a stated policy for elderly health, but do have a discussion document (PDF). Labour’s policy can be found here. As there is nothing to attempt a head-to-head comparison on, I will instead compare Labour’s thinking with National’s on this subject.

“Labour will continue the progressive removal of asset testing for older people in long-stay residential care by increasing the asset thresholds by $10,000 on 1 July of each year.”

One of the first dollar figures that I’ve seen in Labour policies. In general, I agree with the removal of asset testing, if only because of the hugely unpleasant family squabbles this generates when elderly folk are forced to sell assets in order to pay for residential care. It is not unusual for an older person to be obviously in need of nursing home placement, but they are kept inappropriately at home, or worse, in hospital, because families do not want to see their inheritance eaten up. 

National propose streamlining the funding arrangements and arranging multi-year contracts for more certainty of funding, but shy away from removal of asset testing. Personally, I would only favour asset testing with a very high threshold, say $1 million at least.

“Labour will ensure that the results of audits of aged care facilities are made publicly available, in much the same way that the Education Review Office’s school audits are.”

National’s approach here is to get the DHBs to monitor standards of care. In some ways this would be better than simply publishing audits. Because the public do not have access to exactly what is being audited, it is possible such a site may cause confusion. However, if combined with objective reviews from professionals (in a similar manner to restaurant and hotel reviews), this may be more effective than simple DHB monitoring. National also wish to emphasis mid-cycle self-audits in an attempt to prevent pre-audit “tidy ups”. 

“Labour will strengthen aged care workforce development and regulation by reviewing staffing and funding guidelines including consideration of specified minimum staffing levels.

“Labour will implement a comprehensive workforce development programme for all those working in the aged care sector including carers, home support workers and nurses at all levels.”

The first point is more of the same unimaginative, prescriptive regulation that Labour has been using for nine years. These sort of staffing regulations offer little in the way of an improved standard of care but often constrain nursing homes into employing qualified nurses where a trained care-giver would be perfectly adequate. The second is much more promising, and is where National has placed their emphasis:

“National will work with the sector to establish an aged-care sector-specific Industry training Organisation (ItO) to oversee independent providers of training. 

“National will remove Labour’s de facto compulsory unionism requirements for aged-care workers. ”

Overseeing the standards of training will make a great deal of difference in the quality of care provided by care-givers, many of whom are given minimal training. And before unionists start screaming about the last paragraph, it is this insistence on unionisation that has left many relatives caring for their loved-ones without the funding normally given to caregivers. This is something that needs urgent correction. 

Labour will ensure the availability of robust and effective complaints processes.

“Labour will ensure that prevention of elder abuse and neglect guidelines are included in all District Health Board contract specifications for elder care providers”

Neither of these are mentioned in National’s discussion document. Currently complaints processes work through the DHB or HDC. I am uncertain whether Labour is proposing a third system. I hope not. Multiple avenues for the same complaint just generates enormous amounts of unnecessary paperwork and wastes time. In my experience, the vast majority of complaints could be resolved with a short meeting of all the parties concerned and a simply heart-felt apology, if called for.

“Labour will enhance the awareness of green prescriptions for older people.

“Labour will investigate the introduction of nurse-led wellness checks in primary care for older people.”

Both good things. But, I would have thought that both could be handled at a primary care level, with a minimum of fuss. Both are already being done by many GPs or their practice nurse. Some promotion is probably all that is required rather than the endless committees implied by the word “investigate”.

“Labour will encourage and support older people contributing to the voluntary sector as a means of combating social isolation and building stronger and healthier communities.

“Labour will recognise the importance of allowing older people to remain in their own homes by continuing to expand the provision of home-based support.”

In my experience, the elderly either contribute to society or they can’t. Creating artificial opportunities will not help this. However, ensuring that they have the equipment they need to overcome their mobility difficulties will enable older folk to participate properly in society. Being able to remain in their own homes as long as possible is also important in ensuring the elderly feel part of society. National’s suggested tack on this is to streamline the funding avenues into a single “support-at-home” payment. Both National and Labour’s approach will work, although I suspect National’s will be the cheaper of the two (i.e. you will get more money from Labour, but they will tell you where to spend it).

“Labour will investigate ways to increase the availability of fully subsidised personal alarms for those who are able to remain in their own homes.”

More “investigation”. Personal alarms should be fully funded for all on the basis of a single GP prescription. Or you could limit them to an asset-tested threshold of less than $1 million. If you must.

Interestingly, Labour’s elderly health policy is probably the least waffly of all their health policies. The cynic in me wonders if this is because only the elderly and madmen like me are likely to read the entire thing. I was a little surprised that National had not made their discussion document a firm policy with definite dollar figures, but perhaps the figures were a little too scary for print…

Additional

Some nice person from National has posted the new one-pager from National on Aged care in the comment below. Thank you, and nice to be read by the pollies…

The new policy is much the same as the discussion document (what? no secret agendas? Shame on you!). I welcome the new hard figures on increasing respite care beds. Caring for your disabled loved ones is probably the hardest (and least appreciated) job you can do in New Zealand.  Respite is the equivalent of annual leave and is essential to avoid burn-out. Most respite, particularly for elderly health carers, seems to be in the 10-14 days bracket which has always seemed absurdly short to me. Extra respite costs for older persons will probably be offset by fewer nursing home placements, with additional benefits of elderly folk remaining at home and happier caregivers.

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