The spill-over of the aged care crisis in Aotearoa

The evolving landscape of aged care in Aotearoa New Zealand is concerning for a nation with a rapidly aging population.

Stats NZ calculates the number of people aged 65 years or older (65+) living in New Zealand is likely to hit one million by 2028.

Additionally, the number of people aged 85+ years is also increasing.

Currently there are about 93,000 people in this age group, and by 2025 there will be more than 100,000.

By 2040, this could increase to 200,000 people aged 85+ years.

Recently, RNZ reported Health Minister Hon Dr Shane Reti has directed Te Whatu Ora Health NZ to "free up" 200,000 bed nights a year, at a cost saving of $1700 per bed, per night.

RNZ reports it has seen internal Te Whatu Ora documents detailing options to raise the "fragility level" for entry into aged care, and to remove some levels of in-home support, such as housework, meal preparation and shopping for people with mobility problems or recovering from illness.

Meanwhile, Minister for Seniors Hon Casey Costello insists the Government is not considering any spending cuts for aged care but continues to explore "all options" to deal with a projected explosion in demand, and that things are still in the review stage.

Talks around making savings in the aged care sector comes after Dr Reti’s announcement he is replacing Te Whatu Ora Heath New Zealand’s board with a commissioner “in response to serious concerns around oversight, overspend and a significant deterioration in financial outlook” which he claims was leading to a $1.4 billion deficit.

The Aged Care Association warns the plans to cut 200,000 hospital bed nights a year to save money could be disastrous for elderly people without the means to pay for private care.

Plans to cut 200,000 hospital bed nights a year to save money could be disastrous for elderly people without the means to pay for private care. STOCK IMAGE. 

Chief executive officer at the Association Tracey Martin says the priority should be ensuring seniors are well cared for when they need the care.

She adds the average age of those coming into hospital care is 85, and the projection is in the next six years, there will be a shortage of 12,000 beds.

“Corporate providers are already moving away from provision of rest home beds and adjusting their business models ahead of impending changes,” she says.

“Fewer than 40 percent of retirees would have the financial resources to buy into a retirement village and get continuity of care.

"It is the 60 percent-plus who cannot afford to buy into those facilities, it's those who are providing for them, who are causing us the most concern."

While the proposed aged care changes will affect all seniors, the impact on women in Aotearoa is amplified.

Creating health strategies for older women, a paper published by Women’s Health Action, outlines the key issues affecting the health of older women in Aotearoa.

It emphasises the importance of recognising diversity between women aged 65 and over and the implications of diversity on health and wellbeing.

According to the latest Ministry of Health briefing paper, female life expectancy at birth is 83.0 years which is four years longer than male.

However, female life expectancy has increased by 0.8 years for females compared with 1.3 years for males since 2007.

Older women in Aotearoa New Zealand face significant and unique challenges to their health which risk being obscured without a specific gender focus.

Creating health strategies for older women identifies the following six key strategies for improving older women's health:

·        Gender and age equality.

·        Recognising diversity and the social determinants of health.

·        Gender and age sensitive health care practice and research.

·        Addressing high risk illnesses and chronic disability among women.

·        Enhancing quality of life and supporting independence.

·        Taking a human rights-based approach.

The social, political, cultural, and physical conditions under which people live and grow older are also important influences on health and have cumulative effects over a lifetime.

In Aotearoa New Zealand there are significant disparities in the health of different groups of women.

For example, 14 Māori have poorer health outcomes and a higher burden of chronic illness than older non-Māori.

Rates of mobility and agility disability were also higher for older Māori compared with older non-Māori.

Diabetes featured in the top five causes of death for Māori males and females but did not feature in the top five of non-Māori for either gender.

Differences can also be found in the health of Pacific women and other groups such refugees, and lesbian, bisexual, queer and transgendered women reflecting the effects of a range of intersecting factors including racism, homophobia and the transgenerational effects of colonisation as well as structural barriers and socio-economic differences.

Furthermore, there are considerable cultural differences and attitudinal differences between women over the age of 65, due to different experiences based on age, ethnicity, class and other factors.

For example, women now in their 80s may have lived through the 1930s depression and World War II and may have become a parent in the 1950s or 1960s.

The life experiences of this age group are different from that of women who are just turning 65 who were “the first generation to have access to the oral contraceptive pill” growing up in a period of rapid technological and societal upheaval and change.

It is important to remember the diversity of this population, particularly with an emerging discourse about the “burden” of the ageing population when many countries, including Aotearoa New Zealand, are looking at ways to reduce health care costs.

There is a lack of gender-based research in many areas of health, which means information about the health of older women in Aotearoa New Zealand is limited.

Creating health strategies for older women discusses how the increasing focus on the health care burden of the ageing populations means a reduction in state funded benefits is a real risk – and this is what we are seeing with the proposed reduction of hospital beds and aged care changes.

In this context, older women, particularly those from groups who already experience health disparities, may face significant challenges accessing health care and other services and in maintaining good health.

There are multiple other issues which older women face, including elder abuse of neglect.

Each year, New Zealand's Age Concern's Elder Abuse and Neglect Prevention (EANP) services receive over 1000 referrals about people who may be facing elder abuse or neglect, and two thirds of abused older people are women.

Women are more likely to be affected by poverty, associated with poorer health outcomes across all age groups but especially older people.

Because women are living longer and because of their traditional lack of financial retirement planning, they are prime candidates for poverty.

Older women who lack financial security such as superannuation, or owning their own home, may try to live very frugally – cutting costs on heating, quality food, activities that promote social connectedness, or health care. 

Additionally, there is evidence the benefits, both personal and societal, of women’s unpaid work is undervalued and ignored by policy makers.

These are only some of the factors which attribute to older women being challenged when it comes to accessing aged care – and therefore adequate housing, healthcare and quality of life.

The paper states the dominant discourse as being one which views ageing as a social burden, and it needs to be replaced with a human rights approach.

This is something the Coalition to End Women’s Homelessness champions.

It advocates for a human rights framework to discuss ageing which would promote health, wellbeing, security, and dignity as basic human rights throughout individuals’ life courses, including old age.

Human rights are obscured in current discussions by negative influences such as the increasingly held view that older people are a burden, the medicalisation of ageing and the influence of the pharmaceutical industry on the public's view of health.

However, the promotion and protection of older women's human rights are particularly important as they are more likely to face multi-sectored challenges.

As they age, women and men share the basic needs and concerns related to the enjoyment of human rights such as shelter, food, access to health services, dignity, independence and freedom from abuse.

The evidence shows older women merit special attention at the likelihood of being poor, vulnerable, and lacking in access to affordable health care.

Inadequate aged care in Aotearoa New Zealand is looming and particularly relevant for our older women.

The proposed cuts by the Government present yet another obstacle in an already burgeoning housing crisis for wahine, and solutions must be sought.

The Coalition to End Women’s Homelessness is putting the needs of older women front and centre in our advocacy.

Specifically, we are calling for:

• Better data and evidence on more “hidden” forms of women’s homelessness.

• Investment in affordable, accessible rentals that are designed to cater to the social, cultural, and health needs of older women.

• Reporting and action on gender pay gaps and per the Retirement Commission’s findings, “ensuring the universal nature of NZ Superannuation protects women’s incomes in retirement” given they are currently less able to contribute to earnings-based schemes or build up other savings.