History of Ageing in New Zealand

On a National level during the 1860s there were charitable institutions set up by charitable aid boards to help older people in New Zealand. But prior to the 1880’s, the New Zealand government did not have health or welfare policies aimed towards older people. Mortality rates then were high than it is today. The service delivery for aged care in New Zealand historically developed on a regional basis causing variable differences in the type of delivery and services for the health of older people.

In 1885 the Hospitals and Charitable Institutions Act made a policy that distinguishes the connections between ageing , illness and impairment which led to ageing becoming a medical terminology.

Then in 1889 the first publicly provided pension was created and called a pension for “ persons of good character” that were aged 65 and above. It was seen as a better alternative than the exiting “civil list” which relied on grace and favour which meant that only a few people will be able to get it. This reform was made to recognize the contributions of Maori and Pakeha in the land wars and this was handled mostly on a Regional level where government handled the funding , the local courts decided the eligibility and the post office sent out the payments. This strengthened the institutionalisation as the best way to care for the elderly and 65 was the statutory age for for retirement and pension has become a source of income which also led for ageing to be assessed medically for an older person to be eligible for support.

Nationalisation for the welfare of the elderly was realised with the creation and passing of the Social Security Act of 1939, by this time New Zealand was world renowned for it’s advanced social welfare policies including old-age pension. It introduced free healthcare services to the elderly and and provided a wide range of welfare benefits. The establishment of the act made it less restrictive for older people to receive their pensions and medical benefits. The Act introduced a concept that every New Zealand citizen had a right to an appropriate standard of living and that it was the responsibility of the community to make certain that every member is safe against the pitfalls of a struggling economy from which the people cannot protect themselves. It was thought of as a solution that will end poverty in New Zealand. It had three main objectives: as a substitute for the existing system of non-contributory pension system and change it to a monetary benefits system where its citizens would be contributing according to their means and could take from according to what they need; to provide a nationalised superannuation or pension; and to start a universal system for the delivery of medical care benefits.

In 1949 subsidies and grants was offered to religious and welfare organizations to build and run rest homes which resulted in the growth of services available for older people in particular to residential care.

In 1955 the Advisory Committee on the Care of the Aged was established but changes were still far from being made as the care for the elderly is still focused on medical issues so it remained institutionalized. But in the 1960s, subsidies increased to help for the care of the elderly and it was recognised that support in the community level was needed.

The 1970s and 80s saw the change in funding for elderly care and it moved away from charitable and voluntary to the private sector which led to more than 30% increase in the number of licensed rest homes in the country.

The Geriatric Hospital Special Assistance Scheme was introduced, this scheme allowed hospital boards to put patients seeking public care into private ones and by the end of 1985 81% of patients in Auckland’s elderly population was under the GHSAS.

In 1993 the Regional Health Authorities was established and introduced a division between the health care providers and purchasers. Funding was separated into acute and chronic care. The RHA contracted with public providers regarding acute care, rehabilitation and clinical services and religious or welfare while chronic care was contracted to private providers. This saw a marked in increase in the establishment of rest homes reaching up to 460% in some areas.

In 2002 a new certification system saw the deregulation of the aged care industry and allowed facilities to develop their own staffing ratio. This year the Health of Older People Strategy was drafted, the strategy sets out a program to refocus health and support services to meet the needs of older people in the current and future situations. It is designed to be a guide to providers, planners and funders of health support services in the integration of the continuum of care. This ensures that the right services are provided at the right time in the right place by the right provider. This calls on everyone in the health industry to work together in the interest of providing quality health services for older people.

Policies , Strategies and Funding

New Zealand’s Health of Older People Strategy outlines policies, strategies, guidelines and how funding will be provided in the care of older people. The strategy has eight core objectives:

1. Older people and their family/whanau are able to make well-informed choices on their options for a healthy living, healthcare and their support needs.
2. Quality health and disability support programmes will be integrated around the needs of older people and they will be helped by policy and service planning.

3. The funding and service delivery will provide promotion of prompt access to a quality integrated and disability support services for older people, their family or their carers.

4. The health and well being of older people will be promoted through programmes and health initiatives.

1. Older people will have access to primary and community based health services that will promote and improve their health and functioning.

1. Access to health services in a timely mainly to improve and maitain the health of the older people.
2. Integration of general hospital services with any community based care and support.
3. Older people that has high and complex health and disability needs shall be given access to flexible, prompt and well coordinated services and living options that will take into consideration the needs of their family and carers.

The Ministry of Health and the District Health Boards is responsible for implementing the Health of Older People Strategy. The District Health Boards need to implement these strategies by 2010 and each of the District Health Boards will need to determine on when and how these strategies will be implemented. A few number of DHBs, especially those with a high number of older people in their population have already began and established working groups to plan and develop integration of all services for older people. They work closely with the Ministry of Health to ensure that continuum of care for the elderly is achieved. The Ministry of Health will be the monitor to the DHBs progress in implementing the Health for Older People Strategy against the plans they have set out on a yearly basis. They will also initiate a review of the progress every three years that will coincide with the status reports for the implementation of the Positive Ageing Strategy from the Ministry of Social Development. The Ministry will also undertake three-yearly reviews of progress to coincide with Ministry of Social Development status reports on implementing the Positive Ageing Strategy.

The Ministry of Health will provide advice to the government on future funding for older people’s health and disability support services including the level of public funding and individual contributions and incentives for clients and service providers. The Ministry of Health is the one undertaking the responsibility of heading three funding projects to contribute to this strategy.

Terminology for older people

Older people

– Aged 65 years and over and where superannuation or pension starts

Baby boomers

– refers to people who were born after World War 1 and World War 2 where there was a marked increase in births per year

Ageism

– the negative stereotype or discrimination against people of older age

Age Discrimination

– the unfair and unequal treatment of people on the basis of age.

Gerontology

– is the study of social, psychological and biological aspects of ageing

Geriatrics

– the study of diseases in older people

Elderly

– advanced beyond middle age

Senior

– a person who is more advanced in life

Attitudes , Stereotypes and Barriers Towards Older People

In general people have negative views and attitudes towards older people. Like ageism which can be defined as systematic way of stereotyping and discriminating against people just because they are considered of old age. They are typically stereotyped as frail, weak, ill, that they are suffering from mental health issues and mental deterioration, they are poor and dependent, they are called senile and ancient, elderly are thought to have no sexual desires . On the other hand some people view old people as people living in extravagant lifestyles and that they just take from the welfare of the state. In addition to this since old people have benefits that they can get from the government especially special services from the health and welfare sector people see old people as a burden to society. These stereotypes are in fact in direct contrast to the reality that in fact the majority of older people are leading fit, healthy and independent lives.

It is said indirect forms of discrimination, such as barriers to access of services where older people are not being prioritized when they are accessing some form of service like for example wanting to have a phone line connected, inadequate transportation as a form of structural barriers where elderly does not have access to convenient ways of transportation, waiting in emergency or outpatient departments in hospitals and community services that are underfunded and frequent. There are cultural barriers in meeting health needs like for example for the Maori, they perceive health in a holistic approach and they have the four cornerstones of Maori health that includes the mind, the spirit, the body and the family, and they believe in the practice of rangoa or traditional Maori medicine, often times this becomes a barrier because health care providers does not take this into consideration and therefore Maori are not able to access health services because they believe that Pakeha does not understand how to treat them. Financial barriers are also experienced by the elderly especially if they have no family to support them and they have no savings to use. Another type of barrier is the communication barrier wherein the younger generation does not understand how to deal with the older people. It is often that some practices that were not done in the past are being accepted today , like for example male carers caring for female elderly, this causes a barrier in providing care for them.

The Governments Positive Ageing priorities are outlined where the The Minister for Senior Citizens has identified three priority areas that are linked to the goals of the New Zealand Positive Ageing Strategy which are :

• Securing employment opportunities for mature workers where they are given flexible working hours
• Encouraging a change in attitudes towards ageing and older people by promoting intergenerational programmes and to reinforce the important contributions of older people to society
• The protection of rights and interests of older people by raising awareness of the abuse of the elderly and the prevention of neglect

The New Zealand Positive Ageing Strategy helps promote and reduce barriers experienced by older people. They also improve services that older people can access.

They have Ten Goals which are:

1. Income –

provide adequate income for older people

2. Health

– fair, prompt and accessible health services for older people

3. Housing

– provide an affordable and proper options for housing to older people

4. Transport

– provide transport services that older people can afford and have adequate access to

5. Ageing in the community

– older people can be safe and secure as they age within the community

6. Cultural diversity

– older people are given choices that are appropriate for cultural diversity in the community

7. Rural services

– when accessing services in the rural communities , it will ensure that older people are not disadvantaged

8. Positive attitudes

– to ensure and propagate awareness so people of all ages have a positive attitude towards ageing and older people.

9. Employment opportunities

– it aims to eliminate ageism and promote work opportunities that have flexible work hours for older people.

10. Personal growth and opportunities

– to increase opportunities for personal growth for the older people

Up to today even if there are strategies and programs being rolled out by the government to increase awareness about understanding people with old age but because of these negative attitudes, stereotypes and barriers older people perceive that they are denied to participate in making decisions about their life and their health. Elder abuse in the form of physical, verbal , emotional and neglect is common in the home and in residential facilities because of the wrong way people think about the elderly.

Service provisions and access frameworks

Older people find it hard to cope on their own especially if they do not have any family to support them. The Ministry of Health along with other agencies has service provisions and access frameworks that older people can utilise to help maintain their independence and quality in life, be able to stay in their own home as long as they can, and to be able to participate in their respective communities. Support services are funded and can be accessed through District Health Boards and these services are supplied by the Ministry of Health Disability Support Services, DHBs and Accident Compensation Corporation that usually hires a private contractor to provide services. These services include assistance with personal cares, household support, support for the older persons carer and support with equipments that older people may need to help with their safety at home. To be able to access these support services an older person must be a New Zealand citizen or resident who is eligible to receive publicly funded health services and they must meet the criteria after needs assessment. Older people who wish to access the services can coordinate with their local DHBs to be able to assessed on what support they are eligible for.

The Ministry of Social Development also has service provisions and frameworks that are put in place to benefit older people like:

• Providing policy advice , research on retirement income and advice on a whole range of issues that affects the older people
• Promoting positive ageing
• Providing income security for veterans
• Administer SuperGold Card, Community Services Card and Residential Care Subsidy
• Provide funding for services that reduces the occurrence of elder abuse and neglect

References

Auckland District Health Board. (2013).

Health of Older People.

Retrieved from

http://www.adhb.govt.nz/planningandfunding/health%20of%20older%20people.htm

Ministry of Social Development. (2007).

Older People.

Retrieved from

http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/corporate/statement-of-intent/2007/older-people.html

Ministry of Social Development. (2001).

Positive Ageing Goals and Key Actions.

Retrieved from

http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/planning-strategy/positive-ageing/goals-and-actions.html

Ministry of Health. (2013).

What can you expect from home support services.

Retrieved from

http://www.health.govt.nz/your-health/services-and-support/health-care-services/services-older-people/support-services-older-people/what-you-can-expect-home-support-services

Ministry of Health. (2014).

Health of Older People.

Retrieved from

http://www.health.govt.nz/our-work/life-stages/health-older-people

Ministry of Health. (2002).

Health of Older People Strategy.

Retrieved from

http://www.health.govt.nz/publication/health-older-people-strategy

New Plymouth District Council. (2010). Positive Ageing Strategy. Retrieved from

http://www.newplymouthnz.com/CouncilDocuments/PlansAndStrategies/PositiveAgeingStrategy.htm#nz

Oregon Department of Human Services. (n.d.).

Myths and Stereotypes of Aging.

Retrieved from

www.oregon.gov/dhs/apd-dd-training/EQC

Training Documents/Myths and Stereotypes of Aging.pdf

Jaqueline Villaflores Civil ID 13161001