No place like home

Elderly people helped to stay in their own homes for as long as possible can live longer than those who enter resthomes too early. PENNY WARDLE reports on how this is being achieved in Marlborough.

A new model of home-based care is helping elderly people in Marlborough and Nelson to stay in their own homes, while saving money for the Nelson Marlborough District Health Board.

The new "restorative" model helps people aged 65 and over to enjoy life for as long as possible in their own homes, says the board's health of older people portfolio manager, Mark Garisch.

Rather than simply doing housework, home-based care providers now work with clients to keep them up and moving. Regular assessments ensure that care is adapted to meet changing needs.

Clients requiring the highest level of care are assessed the most frequently. Sometimes, care will be increased – for example, if someone has a progressing degenerative condition like dementia or multiple sclerosis, says board service development manager Jane Large, who oversees the health of older people. In other cases, their needs might reduce, and care can be cut back or taken away.

The idea is to identify need so support can be provided before health and independence deteriorate, she says.

"There is a large amount of evidence that if people can be kept well and mobile in their own homes, they tend to live longer," says Mr Garisch. There comes a time when it is appropriate for people to go into residential care, but the board wants to avoid this happening too soon.

While the board has allocated the same amount of money to home-based support for the elderly this year as it did last year, it is estimated that the restorative model will cost $700,000 less than the previous system of straight home help, says Mr Garisch. The money saved can be spent on specialist support that clients need, such as occupational therapy.

"This is not a cost-cutting exercise. It is about efficient targeting," he says. "We've all heard the stories under the previous system of people receiving housekeeping help who were out and about."

As the board changes to the new model, it intends to analyse the impact on costs and the number of people being admitted to residential care.

Elderly people are a significant and growing proportion of the Marlborough community compared with Nelson, says Mr Garisch.

Eventually the approach, known as an InterRAI assessment tool, might be extended to other areas such as hospital emergency departments and mental health, he says.

The approach uses a probing method of geriatric assessment developed by InterRAI, an international collaboration of specialists committed to improving health care for elderly and disabled people.

Josie Eade is one of those who has been helped, and she acknowledges that it's "good to be home".

"I don't know where the old people would be without home-based care, especially those who couldn't otherwise afford it," says Mrs Eade.

"There's nowhere like home," says the 82-year-old, who despite health problems lives independently with help from husband Tom and Healthcare of New Zealand.

Mrs Eade has received funded home help since having a triple bypass heart operation 25 years ago. In that time, the quality of care has improved considerably, she says.

"At one time, a housekeeper would rush in and out with barely a time for a hello or goodbye." Now help is given when it is needed, by care providers who have become friends.

In Mrs Eade's case, she qualified for three hours of housework and help with one shower each week. A major reassessment last spring saw the housework cut back to 1 1/2 hours but showering boosted to twice a week. An occupational therapist visited her home and arranged for a walker, a shower seat, adjustable shower attachments and a hand rail.

A goal was for Mrs Eade to be accompanied on a regular walk, "but we always run out of time".

Home-based care not only keeps her at home – it also takes a load off her husband. This gives him time to work in their garden and to enjoy a couple of rounds of golf each week.

While Mrs Eade is unable to vacuum, clean floors or clean windows, she enjoys some of the good things in life, including driving her own car and a recent trip to the races.

Doreen Connell, who helps Mrs Eade with showering, says that in the 16 years she has worked for Healthcare of NZ (previously Nelmar), her job satisfaction has improved. The training now offered is good, but especially useful is the access to expertise, including occupational therapists, physiotherapists and support groups like the Stroke Foundation, she says.

Home-based care providers are enjoying helping their clients to help themselves, says the southern region general manager for Healthcare of NZ, Kathryn Jones.

The company provides community-based health and disability services throughout New Zealand, with 325 district health board clients in Marlborough.

Using the restorative model Marlborough has "shifted the emphasis from doing things for people to doing things with them to increase their independence", says Mrs Jones. Earlier, the company helped to introduce restorative care at the Capital and Coast DHB.

In the past, assessment was based on ensuring that clients were happy with the help they were given.

Now the focus is on setting and achieving goals.

There is greater access to occupational therapy and physiotherapy, which was not previously available through home-based care programmes.

Some clients found the change to restorative care challenging, says Mrs Jones. But most now accept that rather than sitting in their chair watching someone clean their house, they might be asked to help.

The new model is flexible and not fully focused on the home and garden, she says. For example, someone with limited mobility who receives two hours' help with housework and laundry each week might instead opt for four hours every two weeks, including a walk to the RSA, which provides physical exercise and social contact.

Not all home-care workers offer the competence, understanding and willingness to undergo training now required, said Mrs Jones. Some have opted to stick with traditional household management services still contracted to ACC by Healthcare of NZ, at a lower rate of pay.

Mrs Jones complements the Nelson Marlborough board on its good relationship with providers, which she says is essential to successfully introducing change. While tensions arose when including the new approach in provider contracts, "the DHB has come to the table with an open mind towards working out issues", she says.

The board says the cost of caring for a person with very high disability support averages around $70 a day, compared with $104 to $175 a day for aged residential care.

There is a large amount of evidence that if people can be kept well and mobile in their own homes, they tend to live longer - Mark Garisch Nelson Marlborough District Health Board health of older people portfolio manager

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