All care & some responsibility

By Joanne Black In Commentary

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25th March, 2006 Leave a Comment

Alistair Shepherd says he would rather be lined up and shot than put into a rest-home. The 84-year-old’s bleak view of the standard of residential care for the elderly is based on his wife’s situation. She has advanced Alzheimer’s disease and has uttered only a few words since she fell five months ago in the dementia-care unit of a rest-home, breaking her hip and fracturing her skull.

His main concern is cleanliness and hygiene in the hospital wing, where he says many of the residents are incontinent and left too long in soiled clothes and chairs. He also believes that a lack of staff means that some patients rarely get fresh air and sunshine, or walk at all.

“I’ve got to the stage where I wake up at three o’clock in the morning and can’t go to sleep for thinking about these people. I’ve been absolutely horrified and I said to a manager at my wife’s home yesterday that I’d sooner be put up against a wall and shot than go into one of these places.”

The operator of the home told the Listener that they take all complaints seriously and Shepherd’s concerns will be thoroughly investigated. They assure him that patients get regular exercise, often outside, and that the situation regarding the suitability of some furniture is being addressed.

“We do everything we can to ensure the highest possible standard of care.”

Yet Shepherd is not alone in his concern about the adequacy of care of some older people.

Released before last year’s Budget, a government-commissioned working-party report made grim reading on the elderly care sector, focusing particularly on a lack of money, insufficient staff and lack of training. Ministry of Health figures show that at June 30, 2005, there were 9831 people aged over 65 in rest-homes, 2068 in dementia units, 8251 in geriatric hospitals and 507 in psychogeriatric care. Although last year’s Budget had more money for elderly care, relatives of the most vulnerable elderly, especially in dementia-care units and hospital wings, say that the minimum staff ratios, particularly of trained and qualified people, are too low.

Those who run the rest-homes insist that high standards of care are maintained and are not compromised by the financial struggle many rest-homes are facing. Since the mid-1990s, the contracts between district health boards (DHBs) and rest-homes have not been indexed for inflation. For the past two financial years, as rest-homes have continued to be closed or sold, the rest-home operators have gone directly to the Minister of Health to have their budgets topped up on the one percent and two percent offers from the DHBs.

“The impact has been low caregiver wages, low returns for providers, deferral of maintenance and more providers willing to sell their rest-homes,” says HealthCare Providers CEO Martin Taylor, whose group represents rest-home providers. He says care of residents is not compromised because certification standards have to be met at all times.

Because of a government strategy to keep older people in their own homes for as long as practically possible, the rest-homes complain that erosion of their funding is coinciding with the arrival of residents who are older and frailer and therefore require more medicines, equipment and care.

Caregivers, usually women, are among the lowest-paid workers in the country, receiving an average of about $11 an hour before tax for what can, at times, be an emotionally and physically demanding job. Annual turnover among caregivers, including those looking after the disabled, is 39 percent for home support and 29 percent for residential care, with a median employment of 24 months.

Taylor says no one disputes that caregivers are poorly paid and he believes that will continue until there is a change in the way the sector is funded. In the meantime, rest-homes want DHBs to give them the same insulation from inflation that DHBs themselves get from the government.

“If you don’t do that, it’s like reducing the amount you pay each year to look after someone,” says Taylor.

But the daughter of another Alzheimer’s patient says, “It’s bullshit that there isn’t enough money to pay for more caregivers, and to pay for them to be trained.” She says hospital wings of aged-care facilities are getting nearly $1000 per patient a week and the care provided is substandard. She does not want to be identified, because her family has a formal complaint against the home where her mother lives (not the same home as the one that looks after Shepherd’s wife), and where rostered family members go every dinner time to ensure that their mother gets enough to eat. “The patients are treated like, at the end of their life, they’ve done something wrong and been put in prison.”

She thinks that many people do not complain because the emotional load of dealing with a loved one with dementia is so draining that there is little energy left for taking on the rest-home.

Health and Disability Commissioner Ron Patterson says it is known that the elderly are under-represented in complaints statistics and less likely than other age groups to complain. “Do I think there’s a concern around care for people with dementia, and around standards? Yes, I do, and I think you’ll find that’s fairly generally acknowledged. They are about the most vulnerable group.”

Decisions about residential care can be traumatic for patients and their families, but most people will never need it. The majority of older people live in their own homes, with other family members or in retirement homes and do not require extra support from outside agencies. About 25,000 people live in more than 300 retirement villages. The Department of Statistics estimates that in this decade the number of people aged over 65 in New Zealand will increase by about 100,000 to reach 566,000 by 2011. From then, the rate of increase is expected to accelerate as the baby-boom generation enters that age group. Projecting further, by 2051 the Department of Statistics estimates that there will be 1.2 million people aged over 65 and they will account for about one in four New Zealanders.

For those who do need extra support, perhaps with showering or meals, the lack of caregivers, their lack of training and poor pay rates can be just as evident in home support as in residential care.

Age Concern CEO Ann Martin says physical, psychological and financial abuse and neglect are occurring in older people’s own homes, as well as in institutions. “This is a very disturbing feature of our society and is certainly an issue.”

Age Concern has an accredited visitor programme under which socially isolated older people are visited regularly, but Martin says more effort is needed to ensure that older people remain active and connected to their communities.

The choices available to people after retirement are dependent not only on their health and level of need, but also their financial position. Retirement Commissioner Diana Crossan began the year saying that since 2006 could be a year of belt-tightening for some, it was an excellent time for people to calculate their net worth and work out how to stick to their long-term financial goals.

“The Retirement Commission’s message to New Zealanders is clear – taking action to sort finances now means a better life in retirement,” she said.

More older people are working than ever before, though the actual numbers are still small. In 2001, 50,000 people over the age of 65 were in paid employment, more than doubling the figure 10 years previously. It seems likely that the most recent Census will show another increase, as people become accustomed to the idea of there being no compulsory retirement age, and because people are being urged to remain active and engaged as they age.

New Zealanders’ levels of household savings are generally poor. However, the 2001 Census showed that 80 percent of people aged between 65 and 74 owned their own home. Selling a home, either because it is too big or in order to release capital, is common as people age. Reverse mortgages, sometimes used by older people to cope with the costs of home maintenance, are also increasing.

Many, though not all, of the residents of retirement villages extol the lifestyle they offer. Village managers say that the comment they most often hear is “we should have come here sooner”. Those complexes that offer rest-home and hospital-level care on site also provide a level of security for residents who know that if they require it, that extra level of care is available nearby.

For couples, one partner may go on living in a villa but be able to visit their spouse if he or she has had to move into the rest-home because of a need for increased care. Many people are able to stay in their villa by paying for extra services such as delivered meals. Often, transport to shopping centres is part of the package – particularly important to those who no longer drive.

Disputes about maintenance and services occur, but the most common negativity about retirement villages involves costs that residents or their families were not expecting. It was partially to counter those concerns that the Retirement Villages Act was introduced to Parliament in 2001. Although it was passed in 2003, its main provisions have not yet come into force because regulations, crucial to the Act’s operation, are still being written.

The Act will ensure that anyone buying into a village will have a straightforward document that outlines exactly what their purchase price buys, and how their return will be calculated when they leave. Another purpose of uniform documentation is that potential residents will be able to line up one village against another and compare the costs and benefits.

Although many retirement village residents are likely to have ticked the Census box saying that they live in their own home, in fact what they often own is a “licence to occupy”, which also entitles them to use the shared facilities of the village.

“We encourage people to do their sums,” says Retirement Commission retirement villages adviser Wendy Proffitt. She says the sector is very diverse, but the main villages operate in a similar way to one another, with residents buying the right to live in a villa, apartment or unit at market price, but sharing none of any capital gains that may accrue in the period they live there. When they sell, the village usually keeps 20 to 30 percent of the original purchase price, and a portion for the costs of the sale.

The commission’s website (60plus on www.sorted.retirement.org.nz) includes a cautionary tale based on actual residents who bought into a village on the expectation that they would move from their villa to a smaller apartment when they needed to. However, the price of an apartment went up, while the value of their villa was still being calculated in yesterday’s dollars, so they couldn’t afford the move.

“Other villages may let you transfer from one to the other without that cost, but it’s another fish-hook of a licence to occupy where residents don’t share in capital gain,” says Proffitt. “It’s a matter of knowing. People tend to go into villages on look and feel, without tending to look carefully at the financial side or legal side.”

Proffitt says that in those villages that do not share capital gain, “you have to conclude that you have made the decision for the rest of your life. Unless you have lots of extra capital, you’re not likely to be able to move if it doesn’t work out how you thought.”

Retirement Villages Association executive director Petrina Turner says that the industry hopes the legislation, expected to be in force later this year, will bring everyone up to minimum standards. “You only need to get one bad story in the media and everyone is impacted.”

She says the operators welcome the legislation, but are concerned about the compliance costs it will impose, especially on those who may have as few as half a dozen retirement units. Retirement villages are popular, she says, because of the security of the lifestyle for residents and their families.

“In many places, the villas turn over within a day of going on sale.”

The manager of Waikanae’s Parkwood Retirement Village, which is run by a charitable trust, says there is still a misconception that a retirement village is a rest-home “and there are strict rules and the lights are off at 8.00pm and the doors are locked. They still have a dormitory thought of a retirement home. It couldn’t be further from the truth. I look around Parkwood and if you need help at home, there’s help. If you have a turn at night, you can call the hostesses and someone will come and you don’t have to pay for it. The residents have great networks and great friends. They enjoy community facilities, yet everything outside is available, too. You can go away on holiday knowing that your lawn is being mowed and your neighbours aren’t wrecking your fence. It is a fabulous lifestyle. I’ll certainly be buying one.” 

Money isn’t everything

Retired Wellington couple Pauline and Phon Simes talk once a week about what they would do if they won Lotto.

“I’d like a place on the ground floor,” says Phon, 80. “Just so we’re thinking ahead for how we might be in five years’ time.”

But the couple, married for 54 years, are not complaining. They are used to the modest first-floor, two-bedroom city flat they have owned for 12 years since selling their Newtown family home. They get on well with most of the residents in their company-shares apartment block and do about 20 hours’ voluntary work a week for various organisations. The Simes do not have a car, but can walk to their nearest supermarket for most of their regular provisions, then, every few weeks, get a taxi home with the heavier items, such as tinned food.

They were prompted to leave Newtown when one of their daughters suggested it was time for them to move to something smaller. The couple had only recently returned from working with the Catholic Overseas Volunteer Service in Papua New Guinea and Kiribati. Because they thought they might travel again, they readily agreed.

They have friends in various retirement villages and have looked at some, but think it’s not for them. If they sold their flat, they would have too much money to be eligible for a government-subsidised place in a rest-home, but they don’t have enough money to be unconcerned by the fees in some retirement villages.

“One of the considerations is that often there are financial fish-hooks,” says Pauline. “You have to sell back to them at the price you bought in, not the market price.”

“They’re greedy,” says Phon. “And at places like Rita Angus [Retirement Village], the outgoings are quite high,” he says. “You can have as many services as you want or as few as you want, and there is certainly plenty of entertainment, but do you want that?

“If our health is reasonably good in another three or four years, we’d like to stay in whatever house we’re in, which may be this flat. We’d be happy to live in our own accommodation until we reach hospital point. There’s a lot of talk through Grey Power and at the city centre for the elderly about the home help available, and it’s poor. There is no other word for it.”

The Simes experienced it first-hand when Pauline broke her arm about four years ago. ACC paid an agency $15 an hour to provide home help. The woman who came was paid $8 an hour and at that rate the Simes were not at all surprised when, on the two occasions she came, she left after 30 minutes – in response to a car tooting outside – instead of staying the two hours she was supposed to do.

Pauline told the carer that she didn’t need home help any more, so not to bother coming back. “I suppose we should have reported the agency, but we didn’t,” she says.

“People are paid poorly and you get what you pay for,” says Phon.

Pauline says she has come across more families, and men in particular, going to the Home of Compassion for a meal for $1. The couple say Wellington’s city centre for the elderly, based at Wellington Central Library, provides excellent midday meals including three-course hot meals on Wednesdays and Thursdays for $6 each.

Born in the Depression, and growing up during World War II, Pauline says she learnt to be careful with money. But in the 1980s, Phon, an accountant, was swayed by workplace colleagues saying he was mad to be in a traditional super scheme when so much money could be made on the sharemarket.

“One of them said, ‘You’re getting peanuts for it and I’m investing in shares and doubling my money every now and again’, so sucker Phon withdrew from superannuation and invested in shares. And it worked very well, for a while.” Then, while they were in the Cook Islands, the sharemarket crashed almost overnight and most of their savings were lost.

The pair are philosophical and think that money isn’t everything.

“If I passed on, Pauline would get by probably easier without me, but if she passed on, I’d need help,” says Phon. “I’m not very domesticated.”

Proffers Pauline: “He wouldn’t know where the vacuum cleaner is.”

Happy Now

After accidentally starting a fire in the kitchen of her retirement village unit, Ora Eddy, 88, was only too happy to agree when her daughters suggested it was time to move into a rest-home.

Before that, she had lived for nearly 60 years in Wainuiomata, but after her husband died she found maintaining the house too expensive and bought a small unit in a retirement village in the Hutt. One evening, she accidentally turned on a stove element under a pan with oil in it, and it caught fire.

“It was put out quite easily, but I was scared of using the range after that. It meant I wasn’t getting my meals properly. I was sort of skipping things and not doing things I should have been doing. It was also getting too expensive for me.”

She moved to Longview, a rest-home in Tawa, near Wellington, run by Presbyterian Support Central. She sometimes walks around the perimeter of the buildings but no further, because Longview is on a hill that she finds too steep to walk down.

“It took me a while to come to terms with being in a place like this. I wasn’t sure I needed to be here and looked at some of the others and thought, ‘God, what am I doing in here’, but when I found there were other people similar to myself, I was all right. I’m very comfortable and happy here. The staff are wonderful. We are brought breakfast in bed, have our main meal in the middle of the day and tea at 5.00pm, which is a little bit early, but I’m getting used to it.”

The 97-year-old mother-in-law of one of Eddy’s daughters is also in Longview, and the pair sometimes watch TV news together.

“I haven’t made friends as such, but I didn’t come here to make friends. I don’t join in any of the activities. Some of the people here are a bit away with the fairies, but there are three or four of us along this corridor who read the papers and do the crossword and get together.”

Suddenly, A New Lifestyle

efore Bob and Joan Lewis moved into Waikanae’s Parkwood Retirement Village, they would occasionally stroll through the grounds with Joan wondering whether the residents were “sitting in their chairs waiting for the call from yonder”.

Since moving in five years ago, they have been disabused of any idea that the village is full of people waiting to die.

“It’s a bit like a duck on water: it’s quiet and serene on top, but things are going flat-stick underneath,” says Bob.

When they were 60, Bob, now 83, and Joan, 82, retired from Wellington to a house with a large garden in Waikanae. About eight years ago, tired of maintaining their section, they started to consider their next move. They thought about buying a smaller place, but realised that might involve another shift later in life, so they spent three years considering all the possibilities, including visiting every retirement village on the Kapiti Coast, before deciding on Parkwood.

“We looked very carefully at the financial side and the main advantage of this place is that it is a trust, not a privately owned business,” Joan says.

The most significant difference of the trust arrangement, compared with a more typical commercial retirement village, is that when the Lewises sell up, they or their estate will receive the market value of their house, less 10 percent. Many retirement villages require residents to sell back at the value of the property at the time they moved in, no matter how many years they have occupied it, sharing none of the capital gain.

“Believe it or not, even though we can’t take the money with us, we don’t want to just give it away after we’ve gone,” says Bob. “We want our heirs to get what little there is.”

“All parents want to do that,” adds Joan.

“It’s not that we’re depriving ourselves. We still travel overseas and we’re even still buying furniture. We’re still spending on ourselves, and if there’s anything left we don’t want a business to get it.”

The couple pay for the maintenance of their roomy two-bedroom villa, and pay a $310 monthly fee to cover rates and maintenance of Parkwood’s shared facilities and extensive gardens. They love the village lifestyle, including the companionship and security it offers.

“We found that with our friends dying off over the years, and because you don’t make friends as quickly as you do when you’re young, the circle was growing smaller and smaller. Once you come into this place, all of a sudden you have an extended family,” says Bob.

The couple have two adult sons with families of their own in Auckland, but the Lewises never considered moving north to be closer to them.

“It’s a mistake to follow your children, because then you inhibit them,” said Bob. “If they got the offer of a job elsewhere, they’d have to bring us into their calculations, which wouldn’t be fair. You don’t follow them.”

“The other aspect is that today’s working generation has to work so darned hard,” said Joan. “The little free time they get is so precious that they don’t want to use it going up to see the old folk. It’s not fair. We’ve had good lives and they should, too.”

They like the idea that there is a rest-home and hospital care on site should either of them need it in future. Joan says the services and facilities available give a sense of security not only to residents but also to their families.

“We had visitors from Australia just after Christmas and I think they felt rather superior, as some people do, with the attitude of ‘you poor sods living in an old-age place’, but as soon as they got home, they sent an urgent email saying, ‘Give us all the details: how do you get in, what does it cost, and can we come?'”

25th March, 2006 Leave a Comment

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