2012 Conference Presentation
Objective: Planning for future health services involves more than population projections. Changing trends in population composition and service utilisation, market movements, government policies and inter-dependencies between services are clearly relevant, although difficult to incorporate into projections. In New Zealand (NZ), reports of utilisation of residential aged care (RAC) are not routinely published. However, evidence shows that RAC utilisation in NZ is higher than most other countries. We seek to describe past utilisation of RAC in NZ and to identify variations in reporting in order to better understand information needs.
Data and Methods: Known information sources describing utilisation of RAC by those aged over 65 years in NZ were searched and data from them compared. In addition, for the Auckland region only, rates by age group from census data were compared with regional RAC surveys. These surveys were conducted over a 20-year period in RAC facilities licensed to provide long-term care of older people (about 7,500 residents in each survey).
Results: For national level comparisons, five types of sources yielded relevant, directly comparable information: reports published using national censuses conducted in 1991, 1996, 2001 and 2006 included a description of the dwelling type; summary tables from census micro data were downloaded for the 2006 census; disability surveys were conducted following the 1996, 2001 and 2006 censuses; an international online database compiled at OECD facilitates international comparisons; and finally, a ministerial media statement was found. Estimates for the population proportion aged over 65 years living in RAC at any one time ranged from 2.8% to 8.2% with the more recent domestic reports centred between 5.2–5.7%. In general, census data (reports or micro data tables) were lower than other sources. For Auckland, survey and census data suggest that the proportion in RAC increases by a factor of 2.2 for each 5-year increase in age over 65 years. OECD reports were noticeably divergent from other reports. Some variation is explainable – for 2002, OECD-NZ reports of 8.2% apparently included all those in receipt of any long term care, both home-based and institutional care, overstating RAC care by about 45%. For 2006, OECD-NZ utilisation of 5.6% was for all residents over a one year period rather than cross-sectionally, over-estimating the proportion in RAC by about 16%. For 2009, a rate of 2.8% is implausible compared with previous reports and with Australia 5.5%, Netherlands 5.3%, Norway 4.4% and Germany 3.1%.
Policy implications: Considerable inconsistencies exist in reports describing the proportion living in RAC in NZ. Greater clarity in definitions used and the intended interpretation (particularly of OECD data) may improve reporting. Investment in RAC requires good projections of future demand, these in turn are dependent upon past utilisation rates. In order to avert massive increases in demand due to anticipated population ageing, alternatives to RAC are being sought, and evaluation of options is also dependent upon reliable estimates of need. Although population ageing is predictable, improved utilisation data are needed to inform provision options for care of people needing support towards the end of life.