HEALTH of OLDER PEOPLE Progress Report

HEALTH OF OLDER PEOPLE – Progress Report

Purpose This paper provides a progress report on the Health of older People plan (Wairarapa Elder Local Links - WELL document). It is a summary of the various initiatives and work towards implementing an integrated continuum of care for older people.

Introduction Older people form a larger part of the Wairarapa population than in New Zealand in general and by 2021, it is predicted that more than a quarter of the local population will be over 65 years. Issues identified by older people/kaumatua in the Wairarapa and those interested in their wellbeing have been linked with key strategies and policy frameworks to give direction to the DHB plan for introducing an integrated continuum of care which was adopted in April 2004.

The DHB has prioritized implementation of the Health of Older People Strategy through its DSP. The “Wairarapa Elder Local Links” (WELL) plan provides a model for progress to be identified through the dimensions of: Effectiveness (health and wellbeing), Access and Equity, Safety and Efficiency (continuum of links).

Progress has been achieved in all of these dimensions and this paper is a report on progress to date.

Effectiveness (health and wellbeing)  Continuing development of the Early Intervention service for Koroua and kuia which enables increased participation of older Maori in health education and activity programmes.  Recent appointment of a Carer Support coordinator to a newly established role which focuses on linking carers with appropriate supports and development opportunities.  The intersectoral Falls Prevention project, ‘Stay on Your Feet”, has been initiated. This project is supported by SPARC, Sport Wairarapa, Wairarapa DHB, Wairarapa Public Health, Wairarapa Community PHO, Wairarapa Organisation of Older Persons and ACC. A communication strategy is currently being developed to ensure consistent messages throughout a range of activities aimed at increasing balance and strength of older people.  The DHB has also met separately with ACC to identify Falls Prevention strategies and address any overlap between the DHB and ACC.  The Health of Older People Advisory Group is currently planning another public forum for older people and those interested in their wellbeing. The focus of the forum this year will be on staying healthy, (including balance and strength).  Six of the seven GP practices have greatly exceeded the national target for Flu Vax, with the other practice only 1% below the national target (see table below).

Wairarapa Community PHO National Fluvax 65 + target 2005 actual To 31/5/06 Practice 1 65% 55% 75% Practice 2 65% 66% 80% Practice 3 65% 54% 81% Practice 4 65% 72% 89% Practice 5 65% 65% 87% Practice 6 65% 62% 64% Practice 7 65% 72% 79% Total WCPHO 65% 62% 73%

D:\Docs\2018-04-10\003acdf14d3407ac2452aa3d2a42f9b1.doc WCPHO Fluxax 65 +

100% 90% 80% d

e 70% l l o r 60%

n National target e

+ 50% 2005 actual 5 6

To 31/5/06 f 40% o

% 30% 20% 10% 0%

Access and Equity The Wairarapa Community Transport van has become well established, and for a donation, provides transport within and outside of the Wairarapa District. The Transport bus - figures for 6 months to June were

Age Group Total to Date Under 6 3 6 - years 4 18 – 24 years 6 25 - 44 years 7 45 – 64 years 259 65 years & over 735

 Work has commenced with the Director of Maori Health to identify how Maori carers might be better supported.  The multisectoral Wairarapa Healthy Homes project has continued to focus on people with low incomes who have chronic conditions (e.g. COPD), Offering them retrofitted insulation for their homes if appropriate. This project also includes a follow-up nurse visit to ensure that people are linked in with appropriate health and support services. To date 428 houses have been retrofitted with insulation and a further 160 are planned for 2006 – 07.  The Wairarapa Community PHO continues to increase its enrollment of people over 65 years old every quarter, as illustrated by the graph below..

WCPHO Enrolled population trend age - 65 & over

Enrolled pop 6100

Census 2001 5700

D:\Docs\2018-04-10\003acdf14d3407ac2452aa3d2a42f9b1.doc5600 5500  Overall GP consultation rates for Maori and pacific people are slightly better than for the rest of population aged 65 and over. One practice has driven their numbers up through effective use of Care Plus. Practice 4 has very low numbers of Maori aged 65 and over. No significance can be attributed to their lower access rates. Overall this is a good result, demonstrating that access rates throughout the Wairarapa are within a fairly narrow band (see graph below).

WCPHO : Consultation Rates 65+ by Ethnicity m u

n 20.0 n a

r 18.0 e p 16.0 n o

s 14.0 r e p

12.0 r

e MaoriAndPac

p 10.0 Other e t

a 8.0 r

t l 6.0 u s

n 4.0 o

0.0 Practice Practice Practice Practice Practice Practice Practice Total 1 2 3 4 5 6 7

 DHB funding of 6 short term residential care beds in Wairarapa (with occupancy managed by the NASC agency) has ensured that carers are able to access respite care when needed. These beds are also used for the transitional, Health Recovery, programme for people recovering from illness, but not yet safe enough to return home. 77% use has been at the higher(‘continuing care’)level.

Safety  Following a review of current bed status and projection of need for residential care beds in the future, the DHB has invited expressions of interest for additional beds and is currently discussing future options with three providers.  One off project funding has been allocated to Home Based Support Providers from the residual 05 – 06 funds for implementing the Fair Travel Policy. This project funding is being used by the providers for workforce development.

Efficiency (Continuum of links)  Flexible packages of care have continued for individuals with complex needs, using a care coordination model to ensure services for these people are integrated.  As the new Wairarapa Hospital is becoming established a range of processes are being reviewed. Work has progressed with a review of admission and discharge processes, especially for older people. As part of this work, the PHO Patient Coordinator and Hospital Discharge Coordinator have developed closer links for patients with complex needs.  The Red Cross “Meet and Greet” voluntary service has now been established for the new Wairarapa Hospital. This service provides information, companionship, and general assistance for patients, mostly older people, who arrive at the hospital.  Homelinks, the DHB Home Based Support provider, has been focusing on its role in supporting other DHB services such as District Nursing and AT&R services. The care workers have been involved with the patients care prior to discharge and are adopting a restorative focus under the supervision of nursing and allied health staff.

D:\Docs\2018-04-10\003acdf14d3407ac2452aa3d2a42f9b1.doc  Many people 65+ access the Care Plus programme, which is now available at all Wairarapa Practices. The chart below illustrates the dramatic increase in access to Care Plus.

WCPHO Care Plus to Target to May 06

800 Actuals Target 600

0 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 / / / / / / / / / / / / / / / / / / / / / / / 7 2 2 4 9 0 1 2 3 5 8 9 0 1 1 3 5 6 7 8 1 2 4 0 1 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 / / / / / / / / / / / / / / / / / / / / / / / 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

D:\Docs\2018-04-10\003acdf14d3407ac2452aa3d2a42f9b1.doc NON DEVOLVED SERVICES (for people aged less than 65 years)

Purchase Unit Measure Actual Volumes Contract Volumes Budget 2005 - 06 Vol. Variance % Revenue Variance 2005 -06 2005 - 06 DSS214 ATR Inpatient Bed Days 504 486 $188,981 3.6% $6,999 DSS215 ATR Outpatient Clinics Attendance 127 324 $46,980 -155% -$46,545 DSS217 ATR Domiciliary Attendance 65 378 $54,810 -313% -$45,385 DSS216*** ATR Day Programme 0 0 0

*** Volumes for ATR Day Hospital and Day Programme have been transferred to DSS215 and DSS217 for 2005 – 06.

A variation in small numbers can give a distorted picture when presented in percentages. Although the under delivery, in percentage terms, appears large for AT&R Domiciliary and Outpatient Clinics, the actual value of the under delivery for these purchase units is comparatively small in terms of staff resources (e.g. 1 ½ FTE). Shortage of staff in the inpatient AT& unit impact on AT&R domiciliary and outpatient staffing levels as staff rostering gives priority to maintaining capacity of inpatient services.

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