Enrolled Nurse

Depending on who you talk to, the crisis in aged care is either coming or already here.

There is even an ugly term for one aspect of it: bed-blocking.

The definition is simple enough: because of the ageing population, when elderly people land up in hospital, they often tie up beds for longer than strictly necessary because there is nowhere for them to go.

They can’t go back home, because they can’t cope alone. And if that home is a retirement village, most don’t offer nursing care. And so they stay in hospital.

And bed-blocking is getting worse, Ryman Healthcare development manager Andrew Mitchell said during a resource management hearing into a Hamilton rest-home proposal.

“The lack of retirement and aged care in New Zealand is at crisis point,” Mitchell said. “Ryman already has a list of 150 people who want to move into the [proposed Flagstaff] village.”

The complex would house about 500 people. Of those, there would be 120 care beds offering comprehensive care for residents with more complex health needs and 93 assisted-living suites.

Those aged 75-plus in Hamilton are expected to number 22,200 by 2043, Mitchell said – almost triple the 2013 figure.

And in general, District Health Boards’ spending on services for older people has increased twice as fast as their overall expenses over the last 10 years, according to the Ministry of Health.

But supply of quality care isn’t keeping up with the demand, due to the closure of smaller rest homes after aged-care pay increases, Mitchell said.

“Residents that cannot cope independently in their own homes are sometimes forced to live in hospitals and there is no acceptable combination providing needs-driven residential care available.

“This is known as bed-blocking.”

And 20,000 more New Zealanders will need residential care by 2026, according to Te Pou, a government-funded organisation.

But the term is degrading, older persons advocate Dame Peggy Koopman-Boyden  said.

“Blocking from who? Who has higher priority?

“I think it’s derogatory.”

And it distracts from a bigger issue – that New Zealand isn’t ready for a dramatically older population.

“A certain proportion of older people have health problems and that is no different from 20 years ago,” Koopman-Boyden said. “It’s just we have more older people. The system needs to plan for that. We knew years and years ago we were going to have a lot more older people.

“This was all predictable. We have had projections. And if we don’t have enough resources, well, we have to try to work out our priorities and what we’re going to do about it.”

Grey Power national president Tom O’Connor agrees the term is unhelpful. He also said Mitchell is overstating the case, but acknowledges the baby boomer generation is bulging into retirement.

“I don’t believe the situation is at crisis point, but it is certainly an issue that needs to be dealt with,” O’Connor said.

Ministry of Health spokeswoman Emma Prestige agrees, saying ministry staff are looking into challenges set by the ageing population, but bed-blocking is “not an immediate issue”.

“Although there is pressure in some DHBs, national occupancy levels for aged residential care beds are not at full capacity,” Prestige said.

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Governments have seen aged-care pressures coming for at least 40 years, O’Connor said, and were over-reliant on private sector rest homes to provide what is essentially a health service.

Before the election, Grey Power worked with Labour and the Greens to put together a new aged-care policy and he’s confident the issue will be addressed.

Grey Power has also asked the Labour-led government, as it did the previous government, to establish an aged-care commissioner.

“We can adequately address the issue. It’s going to take some management, some logistics and some money, but it’s not the overwhelming crisis Ryman would tend to paint it.”

There is a bigger fear at play, though, he said. Aged care workers in New Zealand are paid “pittance wages” and there aren’t enough of them to address the need.

“Until we address that issue, we are going to have an ongoing problem,” O’Connor said.

The Waikato Hospital’s Older Persons and Rehabilitation (OPR) ward is often full, with an average stay of around 15 days.

Another ward for frail older people will reopen on Monday to make room for the spike in patients over the last few weeks.

“We know nationally and locally that our population over 65 is growing,” OPR director Barb Garbutt said.

“People are surviving much later in life with much more complexity around their health needs – what we would call more co-morbidities.

“Old people don’t recover well from injury, either, so tend to have a longer stay in hospital.

“But as a result of that population shift, you are absolutely going to see more people going to hospital who are old.”

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