Home help cuts criticised

BY SIMON EDWARDS

Cuts to home help hours are short-sighted and will lead to more health problems and budget blow-outs in the future, Rimutaka MP Chris Hipkins warns.

Last month the Labour MP said his electorate offices had been "deluged" with complaints about the way Hutt Valley District Health Board has been "slashing" home help hours for the elderly.

"If our older people don't get the level of help around the home that they need, then more serious health problems could develop and more of them could end up in hospitals or ... full-time care.

"Surely it's better to help people stay in their own homes as long as possible?"

But HVDHB acting chief executive Michael Hundleby says the cuts should properly be characterised as "reviews". The board changed to a new service provider/co-ordinator, the Nurse Maude Association, in 2008. It was found a backlog of home help cases requiring review had built up. Some people's needs had not been assessed for years.

"As years elapse, people's needs may well change. People get sicker, or better. "There could be a turnaround in their circumstances, a family member might come to live closer to them, for example."

Mr Hundleby says between October 2008 and December 2009, reviews of home help to 1950 Hutt Valley elders were carried out. Of those, 320 received more home help hours, 820 had no change to their support, and 810 had a reduction in support.

"Because the reviews hadn't taken place in a while, some should have received more support earlier," Mr Hundleby says.

A system of regular, rolling reviews has now been bedded in.

Asked why a backlog had been allowed to build up, Mr Hundleby replied: "Well, put it this way  we changed the provider."

He emphatically rejects any suggestion financial savings are the primary objective, or that the board set out with a savings target in mind.

He accepts Mr Hipkins' point that if cuts to help with cleaning, bathing, cooking are too harsh, old people might be forced into care.

"The objective of it all is to help people live independent lives.

"Sometimes people get home help because of a crisis they're going through, but often they get back to full health and independence. [With the review backlog] we would have expected there may be, through this process, some savings, but that was not the driving factor. Each client's individual need is assessed."

Mr Hundleby says if there is a financial incentive, "it's to provide an appropriate level of support so that fewer people do need to go into rest homes.

"One, it's better for those people because they prefer living in their own home and, secondly, if they go into a rest home it's obviously going to be more expensive for us."

Asked why, if a backlog of reviews had prompted the changes, similar controversies on home help cuts are cropping up with Capital & Coast Health and in Otago and Southland, Mr Hundleby says the way HVDHB approached the issue is "specific to us".

"Other DHBs may do it differently."

In the 12 months to January 2009, HVDHB spent $3.9 million on home help hours.

In the 12 months to January 2010, the cost was $3.2m.

HVDHB logged 15 complaints about home help cuts last year, including cases raised with former chief executive Chai Chuah at a public meeting by Age Concern.

Mr Hipkins says he's "particularly appalled" some older people had their help hours cut over the phone.

"How on earth can somebody tell from a five-minute phone conversation whether or not it is safe or wise to cut an elderly person's home help hours? Why aren't they talking to the carers? Why aren't they talking to the families?"

Mr Hundleby says the board has not been totally happy with the phone review process either. There is a danger elderly people understate their needs and concerns. After discussions with Nurse Maude Association, a system is in place whereby the elderly person is sent written warning that a review phone call is coming up, and that they are welcome to have a family member or support person present.

An appeal process  which was not initially available  has also been put in place. Of 12 appeals lodged to date,

"I understand all of them have been resolved satisfactorily for all concerned", Mr Hundleby says.

Home care support workers are provided by the likes of Presbyterian Support and Health Care NZ.

Mr Hipkins says it is these people who are in the best position to notice emerging health problems or other issues that can impact on the wellbeing of older people.

"If I was to ask each carer to predict which of their clients was likely to end up in need of hospital care in the next few months, I reckon they could predict that pretty accurately."

He argues the DHB should tap into that knowledge, and should "lift their game" by working on a comprehensive strategy for improving the quality of care for older citizens.

"I find the penny-pinching mentality that the DHB has adopted quite disgusting."

Age Concern nationally has called on Health Minister Tony Ryall to stop cuts to domestic assistance.

RELATIVES: FIGHT UNFAIR CUTS

If you think cuts to an elderly relative's care are unfair, fight them.

That's the message from two people affected by home help reviews.

Wellingtonian Brian Langham says the five hours his frail, 86-year-old aunt, living in Avalon, received each fortnight to help her with grocery shopping were going to be cut in half.   The proposed cut came after a phone call last year that the HVDHB and Nurse Maude Association described as an ''assessment'', but which Mr Langham and his aunt say was no such thing.

''They didn't even ask any questions,'' Mr Langham says.

Mr Langham got the Health and Disabilities Commissioner involved and finally a proper in-home assessment was done.  His aunt ended up with funding for three hours a fortnight.

Mr Langham says his aunt felt intimidated by the process.

''What you worry about is that lots of elderly people are quite vulnerable and maybe don't have anyone to go into bat for them.''

Susan Curtis's experience involves cuts to funding for respite day care for her mother, a Trentham resident who has serious dementia.  Despite her mother's dementia being serious enough for her to be on a waiting list to be put into a secure care unit, the family had to push hard for continued funding for two days' respite care.

They initially received three days a week, and HVDHB wanted to cut this to one day. Mrs Curtis says there is no flexibility to take into account an individual's circumstances in new assessment criteria brought in since the change of Government.

Appeals to cuts to home help should be referred to the Nurse Maude co-ordination centre, phone 04 238 2020.

- Hutt News