Survey on Health Care and Support Services for Older People and their Carers

Executive Summary

In 1999, NCWNZ members expressed concerns about current funding and delivery of health care and services for older people and the lack of strategic policy development and planning in this area. As part of the organisation's strategy for 2000, the Health Standing committee initiated a questionnaire to its members seeking information from people 75 years and older or their carers about health care and support services they received. The aim of this survey was to collect information to better understand issues affecting the care of the elderly in the community.

Our survey, in the form of a one (double-sided) questionnaire, asked key demographic questions such as region, community type, gender, ethnicity, living arrangements and whether the older person had a community service card or not. Other questions sought information on needs assessments effected, its affect on accessing services, knowledge of needs assessment and difficulties accessing services. Four categories covering use of nursing services and nine categories of support services were also canvassed. A copy of the questionnaire is attached as Appendix I.

This report covers results of that survey. Information was gathered from an estimated 630-700 people aged 75 years and older between May and July 2000. Because most of our sample numbers identified as European/Pakeha, results do not reflect Maori, Pacific Island and other minority ethnic group use of services. Quantitative demographic data are presented in table form within the report and the attached Appendices detail many of the qualitative responses.
Data gathered covered most of the regional council areas in New Zealand. However, it should be noted that over half of our survey responses were from people living in Northland and Waikato. Data from other regions were not representative of their older populations. Our survey results cover people aged 75 and older who live in cities (31 per cent), large towns (21 per cent), small towns (32 per cent) and rural areas (13 per cent). Over three quarters of the participants were living in their own homes and had received a Needs Assessment. Nearly 90 per cent were women and over 40 per cent of the participants responded on their own behalf.

A large number of participants had little or limited knowledge about Needs Assessment. Responses to this question are shown in Appendix III Medication and Podiatry were the two medical services mostly used by our respondents. Cost of regular podiatry care ranged from $10-$40 per visit. Other costs mentioned under Nursing services included Doctor visits and personal alarm fees.

In the ten categories of support services canvassed, housework was the most widely used assistance given - to 70 percent of the survey participants. Assistance with gardening, shopping and transport were received by around 40-50 percent.
Agencies and Carers were identified as the predominant assistance providers of for showering dressing and housework (70-74 per cent). Meals on Wheels, agencies and carers were meal providers to over 50 per cent and assistance with gardening was given by private contractors (51 per cent) and carers (23 per cent). Spouse or family members provided 22 percent of meals, 29 per cent of assistance with lifting, 29 per cent of assistance with shopping, 32 per cent assistance with transport and other supervision.
In most cases bathing, dressing and lifting assistance was provided at no cost to the recipient. In regions where Meals on wheels were available, prices ranged between $3.50 per meal and $8.50 per day. Housework assistance through agencies and private contractors ranged between $9.30 and $15 per hour. Lawns and gardening service costs ranged between $10-$15 per hour or $10 and $30 per fortnight. Shopping assistance cost between $5 and $10 per with many listing 'taxi' or 'half taxi fare'
in their response.

Our survey asked about difficulties in accessing nursing and support services and also asked what additional services would improve their quality of life. Only half of the respondents had no problems and a similar number offered comments on service improvements.

Nearly 90 per cent of our survey numbers indicated the older person had a Community Services Card and had a satisfactory relationship with their health professional.

Only 38 per cent of our survey responded to our carer support question about respite care, day care, night care and holiday care. May commented on the reduction of their respite care entitlements.

Our questionnaire also asked about whether they received enough information about available support services and provided for comments on how information dissemination might be improved. Many comments reflected a need to know what services were available and how to access them with 20 per cent recommending that some form of pamphlet/brochure be distributed to medical rooms, chemists and through district nurses. Suggestions made are also attached as an appendix.

While our survey results do not reflect a representative sample of people in New Zealand aged 75 and older, they do represent a large sample of between 600 and 700 of these older people and the health care and support services they and their carers use. There is evidence that transport and shopping may be a problem if no family members are available and that respite care entitlements may not be sufficient relief for carers. We consider that there is also a large unmet need among older people for information on the purposes of a needs assessments and access to information about their entitlements, access to and availability of support services to assist them to remain independent in the community.

Although data has been collated on a regional basis, constraints on funding and time have precluded detailed analysis of data by region being included in this report.