Title: Ageing in Place: A future direction of services for older people in New Zealand
1Ageing 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?
3Ageing 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)
4Why 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
5Some 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?
7Background 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.
8Methods
- 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)
9Methods
- Commenced November 2003, recruitment finished in
November 2004 and final data collection completed
in November 2005. - Sub-study OPERA
- Report with MoH
10Outcome Measures
- Primary end-points
- Survival
- Permanent institutionalisation into residential
care
11Outcome 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
12Research 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
13Research 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?
14Research 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?
15Predicted 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
16The 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
17Intermediate 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
18Residential care for older people, bed day
utilisation
Source Ministry of Health 2001
19Restorative 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
20Where to from here?
- Ageing in place a key government direction
- ASPIRE will provide the NZ context
21Where to from here?