Work together for elderly

OPINION: Southland District Health Board chairman Paul Menzies responds to public concerns about domestic support cuts.

When we talk of healthcare issues, emotions run high. Particularly so whenever care of our children or our elderly are mentioned.

And that's fair enough, because our young and our old are vulnerable and we need, as a society, to look after them. Unfortunately, the emotion surrounding the current discussion over domestic support for older people has caused a lot of our elderly to be upset unnecessarily, so, for a moment, I want to deal with the facts.

Currently, the Southland District Health Board is funded a set amount, based on our population, to deliver a huge range of health services, based on a level of services to be provided nationwide.

This year we have budgeted for a deficit of $8.9 million and are looking down the barrel of an $11.8m deficit, $3m worse than budget.

We have no ability to increase our revenue and face increasing demand on all of our services, including emergency department services, community pharmaceuticals, primary care costs (that includes your GPs) and hospital services, as well as for services for the elderly.

We currently spend 15 per cent above the national average on elderly services. This means that because we are overspending on elderly care we are unable to allocate funding to provide services in other areas where there is need, such as the children or youth areas, all of which are also crying out for more resources.

So, for nine months now, we have been working to find ways of reducing what we spend on elderly care, while making sure we are looking after our older people appropriately and keeping them safe.

When we talk about elderly care, this includes long-term hospital-level care, resthome care, daycare, personal care, home help and domestic assistance, as well as district nursing and the like.

Personal care is care with bathing, showering, dressing and so on. The board is not touching that.

Domestic assistance consists of household cleaning and domestic chores. Anyone who receives domestic assistance plus personal care will continue to receive both.

What our staff have proposed is to stop providing house cleaning to those who receive house cleaning only for up to 1.5 hours per week.

Customarily, some care has been allocated to patients when they leave hospital after an assessment or an operation. On occasions this care has remained long after recuperation. Sometimes care has been allocated and not withdrawn when the need has disappeared. Elderly members of the public have confirmed this to us anecdotally, suggesting that they were late to get to their bowls match because their cleaner took too long. Clearly that is not the case for the majority but just as clearly we cannot afford to provide help for such people.

We want to make sure we keep safe any people who have a high risk because their mobility, vision or memory is significantly impaired or they have a history of falls or other complex health needs. So our staff will be looking at the files of the just under 2000 people in Southland and Otago who receive up to 1.5 hours of house cleaning and making sure letters are not sent to the people who have exceptional circumstances. That's thought to be around 350 people.

Those who do receive a letter during the next four weeks indicating they will no longer receive house cleaning will have the right of appeal and the DHB will review their case.

People who receive higher levels of domestic support will also have their hours reviewed, but that will involve a one-to-one review.

As well, we're trying to keep more people in their own homes for longer so they don't have to go to a resthome until absolutely necessary. That's because most people want to stay in their own homes for as long as possible, and it costs less for the DHBs. But that might mean some older people actually receive more care and support than they have in the past.

So, the board is not being heartless. Nor are our staff. We are focused on providing help for those who need it and we cannot simply allocate that help on the basis of entitlement. We cannot afford that and neither can the taxpayer.

In the meantime, DHB staff are talking with providers, Age Concern, Grey Power and other stakeholders about how we provide really effective services to our elderly in the future.

We have recently announced a merger with the Otago District Health Board and together as Southern District Health Board we think we have a brighter, more financially sustainable future.

It is pleasing that Dick Stark, the New Zealand spokesman for health for Grey Power has a good understanding of our predicament and what we are trying to achieve and is keen to continue to engage with us and assist with the direction we are going to ensure those who need the help will continue to receive it. Mr Stark's attitude is one we should all applaud. We are all in this together and only together as a community can we achieve the necessary outcome. If someone gets a larger slice of the cake, then someone else is left with the crumbs.

This is not a time for political mileage-making but one where we must all put our shoulder to the wheel. If my mum had a choice of getting a cataract operation or getting her house cleaned, I would be cleaning her house. I hope my neighbour would do the same for his or her mother.

- © Fairfax NZ News