Why more Kiwis are choosing where to die
Businesses and the Government are forced to adjust as an ageing population creates care demands, writes Bonnie Flaws.
Demand for in-home end-of-life care is increasing as baby boomers reach their 70s and 80s and elect to be looked after in familiar surrounds rather than move into care facilities.
New Zealand’s ageing population is putting pressure on the health services for the elderly.
Stats NZ predicts that the number of people over 65 will make up almost a quarter of the population by the late 2030s.
Tracking alongside is the death rate, which is expected to rise 50 per cent to 45,000 by 2038, levels not seen since the 1940s and 1950s.
All this has the potential to be a perfect storm where demographics meet a cluster of pressures facing the aged-care sector.
Staffing issues, already inadequate, have become acute since district health boards (DHBs) reached a pay settlement with nurses last year, giving them their first pay rise in 10 years. Consequently, care facilities have seen staff flock to DHBs for the increased pay.
Unable to compete, the aged-care sector is calling for a change to the immigration rules, which currently require migrant staff to renew their visas every three years, affecting care. Immigrants make up 21 per cent of workers in the aged-care sector, recent figures from the New Zealand Aged Care Association show.
The crisis is even more acute for the ‘‘oldest of the old’’, says Professor Merryn Gott, a researcher at Auckland University and director of the Te Arai Group, a research group focussed on improving palliative and end-of-life care.
Gott says the majority of dying people don’t get access to hospice care and the very oldest in society, who die of conditions such as dementia or chronic heart or respiratory conditions, are the worstaffected.
‘‘Traditional models of palliative care grew out of provision of end-of-life care for people with cancer. However, increasingly people are dying at older ages, often with multiple chronic conditions, frailty and possibly dementia.’’
The Ministry of Health says that in 20 years half of all deaths will be people aged over 85. Over 80 per cent of deaths will require palliative care by 2038.
Home-based care provider Miranda
‘‘Increasingly people are dying at older ages, often with multiple chronic conditions, frailty and possibly dementia.’’ Professor Merryn Gott
Smith Homecare has been operating for 20 years, but the business has doubled in just the last six years, and this is due in large part to the care it provides for people who want to die at home.
Owner Miranda Smith expects palliative and end-of-life care to increase to 80 per cent of the company’s revenue by 2025.
People in their 70s who are given a palliative-care diagnosis want to stay in their own home and are more likely to consider private care, Smith says.
Research that Smith commissioned from Colmar Brunton last year showed that 40 per cent of ageing New Zealanders would prefer to stay at home than live in a care facility.
Private care companies will have to provide a suite of services such as nursing to ensure that ‘‘if we start looking after your parents or your husband or wife, we can do this right through until the end, and be really skilled and capable’’,
Smith says.
Custom Care Nursing, another homecare service, has noticed an increase in inquiries from private clients wanting help to enable them to stay in their homes.
‘‘Most families we deal with are very keen to keep their elderly family members in their own homes and coordinate care with a mixture of family members and Custom Care Nursing staff,’’ chief executive Alison Brittain says.
Palliative care is also on the rise for the business.
‘‘We work in conjunction with the hospice if they are involved and other professionals as needed,’’ Brittain says. However, Gott said that research showed dying at home was not a priority for people over 80.
‘‘Their top priority is not being a burden to their family, pain and symptom control and, for Ma¯ ori, addressing spiritual needs. And we have found that we are currently not doing well in supporting the significant amount of work family and whanau do in providing end-of-life care,’’ she says.
While Gott agrees there will be huge demand for more home-based care, most older people will still die in aged-care facilities or hospitals.
‘‘We therefore need to make sure that all care settings – including hospital and aged care – can provide really high-quality palliative and end-of-life care.’’
The Aged Care Association will release its annual report next week on the trajectory of death in aged residential care. It looks at when people die, what they’re dying of, how it happens and the palliative care involved.