Ageing in Place: A future direction of services for older people in New Zealand

1
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
2

• What is ageing in place?
• What is ASPIRE and what will it tell us?
• Where to from here?

3
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)

4
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

5
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 dont think its
more expensive for older people to live at home
6

• What is ageing in place?
• What is ASPIRE and what will it tell us?
• Where to from here?

7
Background to study

• Development of Health of Older Person Strategy
• 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.

8
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)

9
Methods

• Commenced November 2003, recruitment finished in
  November 2004 and final data collection completed
  in November 2005.
• Sub-study OPERA
• Report with MoH

10
Outcome Measures

• Primary end-points
• Survival
• Permanent institutionalisation into residential
  care

11
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

12
Research Questions

• 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?
• What is the impact of COSE, PIP and Community
  FIRST on an older persons independence, quality
  of life and social support systems

13
Research Questions

• 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?

14
Research Questions

• 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?

15
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

16
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

17
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

18
Residential care for older people, bed day
utilisation
Source Ministry of Health 2001
19
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

20
Where to from here?

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

21
Where to from here?