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Long Term Care of Older People in New Zealand

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Long Term Care of Older People in New Zealand Long term care of older people in New Zealand: inconsistent counts may mislead Joanna B Broad1, Toni Ashton2, Thomas Lumley3, Martin J Connolly1 1. Department of Geriatric Medicine 2. School of Population Health 3. Department of Statistics University of Auckland, Auckland, New Zealand 2nd International Conference on Evidence-based Policy in Long-term Care, London, September 2012 New Zealand • population 4.4m • 13% aged 65+ years • 23% born overseas • 31% Auckland region • sporting interests • In ~2004, 4.5 % Sweden Switzerland of older people in Belgium New Zealand were France reported in long- Norway term care in Netherlands institutions Denmark Australia • 10th of 15 Finland OECD countries New Zealand United Kingdom United States Germany Japan Ireland 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 OECD 2007 New Zealand Netherlands • In ~2006, over Sweden Iceland 8% of older people Switzerland France in New Zealand Norway Australia reportedly lived in Denmark institutions Belgium Luxembourg Canada • highest of 26 United Kingdom Ireland OECD countries United States Germany Hungary Japan Austria Finland Spain Czech Republic Poland Slovak Republic Italy Korea OECD 2008 0 1 2 3 4 5 6 7 8 9 And in place of death of 65+s … Hospital Residential aged care Other incl. private home Japan (Kyushu) 2000-04 69 12 19 Korea 2009 67 3 31 Malta 2001-10 66 16 18 Wales 2001 62 19 19 Czech Republic 2009 61 17 21 England 2005-07 59 18 22 Ireland 2000-10 58 14 28 France 2005-06 57 13 30 Singapore 2006 57 7 35 England & Wales 2008 57 21 23 Australia 2005 54 32 14 Belgium 2001 54 24 23 Iceland 2007-09 53 38 9 Austria 2009-10 52 18 31 Canada (Manitoba) 2006 51 32 17 Canada (Ontario) 2002 49 30 20 Croatia 2009 47 12 41 USA 2003 44 28 27 Cyprus 2007-09 44 15 42 USA 2005 42 29 29 New Zealand 2003-07 34 38 28 0% 20% 40% 60% 80% 100% Broad et al, Int.J.Pub.Health in press Bigger picture Mark Todd (aged 56) on Campino Photo by CARL COURT/AFP/Getty Images OECD definition “long term care beds” Beds in nursing and residential care facilities are for people… • requiring ongoing health & nursing care due to chronic impairments and a reduced degree of independence in activities of daily living (ADL) • in establishments … providing residential care …with either nursing, supervision or other types of care … • the care can be a mix of health and social services, i.e. accommodation and long-term care as a package Residential aged care in New Zealand… Residential long-term care (RAC) for older people in New Zealand (NZ) is classified as: • private hospital care – need 24-hour nursing care • rest home care - need support, but not 24-hour nursing Subsidies for RAC are available for those with demonstrated needs and low income / assets General approach… What do reports say is the percentage of older people living in residential aged care (RAC) in NZ? Why does counting matter? • With each 5-year increase in age over 65, rates in care approx. double, e.g. Auckland 2008, by age group • Population is 100 ageing 90 Women 80 73.3 • Life expectancy Men is increasing 70 60 50 55.4 • Older people are 40.0 getting older 40 30 22.1 Percent in in care Percent 20 23.0 • Projections 8.3 15.3 10 3.5 1.5 forecast large 0.7 6.6 0 growth in 65-69 70-74 75-79 80-84 85-89 90-94 95+ demand Age group Broad et al, Age Ageing 2010 As place of death, RAC doubles with each 10 years of age… 60 New Zealand 2003-07 Australia 2005 50 Canada (Manitoba) 2006 Canada (Ontario) 2002 40 USA 2005 England & Wales 2008 Wales 2001 30 Netherlands 2003 Austria 2009-10 20 Czech Republic 2009 Iceland 2007-09 Australia 2005 10 Singapore 2006 Percentage Percentage of deaths residential in aged care South Korea 2009 0 65-74 75-84 85+ Broad et al, Int.J.Pub.Health in press 85+s was 73,000 in 2011, will double to 147,000 by 2031 Grey tide coming Peter Burling and Blair Tuke Photo by REUTERS/Pascal Lauener Research questions: • What collections of data describe residential aged care use for NZ, and why? • Who reports use of residential aged care? • If the reports are inconsistent, can we determine which are more realistic? • How to improve reporting? Methods. • printed and online reports o years 1988 onwards o reporting use (rates or counts) of RAC for all NZ • convert to percentages where necessary • simple charts over time • Then, compare Auckland survey data with census data to assess differences in counts Round and round Simon van Velthooven Photo by Getty Images 13 reports. • National census: census-night dwelling type from 5-yearly censuses • publications – reports of older people • data tables – customised dataset & 2006 microdata online • Disability surveys conducted after censuses • OECD: • publications various LTC, health etc • database – online • Press releases provided by Ministers • Miscellaneous others Data sources • national census • 1991, 1996, 2001 & 2006 censuses • in 2006, changed from ‘residential care home’ => ‘residential long-term care’ • subsidy payments data • ~ 60% of residents receive funding support • counts may be scaled up for private payers • disability surveys – population-based • some unstated 10.0 Picture very muddled…. 9.0 Census tables OECD Health Statistics 2012 8.0 MoH Report Census Table-Builder 7.0 OECD Health Statistics 2011 Disability surveys Statistics NZ report 6.0 OECD occasional reports Policy statements 5.0 Proportion aged 65+ years in RAC (%) RAC in years65+ aged Proportion Chapter: Future demand OECD data series 4.0 ARC Review Auckland LTC studies // 3.0 1990 2010 1988 1992 1994 1996 1998 2000 2002 2004 2006 2008 Too hard to pick Karen Walker Photo by PHIL WALTER, GETTY IMAGES Ministry of Health sources 10.0 Relatively 9.0 stable over time 8.0 ARC included under 65s 7.0 Centred on 6% 6.0 5.0 4.0 3.0 MoH Report 2.0 Proportion aged 65+ years in RAC (%) RAC in years 65+ aged Proportion Disability surveys 1.0 ARC Review 0.0 1988 1990 1994 1996 2000 2002 2004 2006 2008 2010 1992 1998 Statistics NZ sources Census-based 10.0 rates rising 9.0 over time, change in 8.0 definition includes people in other 7.0 non-private residences Online sources 6.0 match printed reports, but 5.0 are higher than 4.0 census tables 3.0 Started at Census tables ~4%, now 2.0 Proportion aged 65+ years in RAC (%) RAC in years 65+ aged Proportion Census Table-Builder 5%-6% 1.0 Statistics NZ report 0.0 1988 1990 1996 1998 2000 2002 2004 2006 2008 1992 1994 2010 Miscellaneous sources 10.0 Auckland region 9.0 surveys decline Includes all those who received a subsidy any time during the year, scaled with time 8.0 upward for non-subsidised 7.0 Ministerial press releases 6.0 seem to agree 5.0 One source 4.0 over 9% - an academic book 3.0 chapter Chapter: Future demand 2.0 Auckland LTC studies Now close to 1.0 5% Policy statements 0.0 1990 1992 1996 1998 2000 2002 2006 2008 1988 1994 2004 2010 Comparison of census with Auckland LTC studies • Auckland LTC surveys all in Auckland geographical region • Auckland LTC surveys 2 years after censuses • closer matching over time, probably due to change in census definition • most recent censal was undercounted only for people aged 75+ OECD sources 10.0 Counts every subsidised person using 1 series 9.0 LTC - both home-based care and RAC consistent, growing steeply 8.0 7.0 1 series markedly 6.0 inconsistent Counts every subsidised person 5.0 using RAC at any time during the year, scaled upward for private 1 series 4.0 payers, & uses overstated very low & population counts inconsistent 3.0 Counts every subsidised person OECD data series using RAC at any time during 2.0 Most recent OECD occasional reports the year, not scaled upward OECD Health Statistics 2011 for private payers, & uses series 1.0 overstated population counts consistent, ~5% OECD Health Statistics 2012 0.0 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 1988 1990 Purpose and Perspectives: to measure, to illustrate, or to tell a story? Mark Todd (aged 56) on Campino Photo by CARL COURT/AFP/Getty Images Bending over backwards Jason Saunders and Paul Snow-Hansen Photo by PASCAL LAUENER/REUTERS What has been done? • Statistics NZ has further clarified census definitions for 2013 o includes e.g. continuing care hospitals & dementia units o excludes independent self-care units & houses in retirement complexes • MoH have revised analysis system & rerun • MoH have supplied OECD with updated counts, now on the website, & old data removed A more reliable, consistent measure // Australia Belgium • In ~2010, 5.1 % Netherlands Switzerland of older people in Iceland Sweden New Zealand were Luxembourg Norway reported in long- New Zealand term care in Slovenia Finland institutions Denmark France th Ireland • 9 of selection of Germany Canada 26 OECD countries Slovak Republic Hungary Japan Israel Czech Republic Korea Estonia Spain Portugal Poland OECD 2007 0 1 2 3 4 5 6 7 8 Recognition, quality, success Joseph Sullivan and Nathan Cohen Photo by EDDIE KEOGH/REUTERS Where to from here - lessons? • To avoid systematic errors, important to clearly state o intended interpretation of data o definitions • OECD & member countries could: o ask about their own reports o continue to note exceptions if data only partly suitable or not quite comparable o consider estimating impact of exceptions o reconcile each new report with previous reports & with countries’ own domestic reports or research papers, to identify those “out of step” Power & large numbers matter – but detail, delivery & clear targets matter too Valerie Adams Photo by KAI PFAFFENBACH/REUTERS Acknowledgements Staff at Ministry of Health and Statistics New Zealand who assisted with advice and data Health Research Council of NZ Grant 10/373 for funding support Travel assistance from Maurice and Phyllis Paykel Trust, and departmental funds New Zealand’s athletes at the 2012 London Olympic Games & photographers [email protected] .
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