Whangaroa Health Services Review Preferred Model of Care

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In the immediate future, better integration of community nursing services provides the most significantopportunity to improve efficiency and effectiveness. Consideration should be given to: A single governance/management structure for community nursing services Defining core competencies aligned with planned careDefining a generic skill-set for community nurses and a pathway for implementation, including theinterface with specialist nurses.8. Services for older peopleThe NHSP has a key population health performance measure of increasing the proportion of older peoplereceiving home-based support services compared to aged residential care (ARC). This is aligned with thenational policy priority (and clear preference of older people) for supporting ‘ageing-in-place’ – that is, forolder people to live in their own homes or supported housing, rather than in residential care settings.Delivery of ageing-in-place requires availability of the necessary range and quantity of community-basedsupport services, and coordination of clinical and support services across the continuum of care for olderpeople.The ageing-in-place policy has prevailed since 2002, and evidence gathered to date suggests thatcommunity care may achieve better outcomes at lower costs than institutionalised care, and is preferred byolder people even when they are terminally ill (Parsons et al, 2012 8 ). Key service components to amelioratethe risk of older people being admitted to aged residential care include: Comprehensive needs assessment Case management Coordination of support and clinical services Multiple home follow-ups (Stuck et al, 2002 9 ).The Funding and Service Profile analysis and stakeholder engagement undertaken as part of the Reviewindicates that the Kauri Lodge facility operated by WHST is financially non-viable, and is dependent onsignificant cross-subsidisation from NDHB funding streams intended for other services. Demand for KauriLodge services is considered to be almost exclusively local – from Whangaroa residents, and relatives ofresidents. At its current capacity of 20 beds, the facility can provide service for 4.2% of the Whangaroacommunity’s population aged 65 years and over, at an average cost of approximately $59,000 per residentper year 10 . As noted earlier in this report, a recent joint national study by DHBs, the aged care sector, andMinistry of Health suggested that capacity of between 76 and 100 beds is required for strong financialviability.While Whangaroa’s population is ageing, it is unlikely that this will generate the level of future demand tosustain a financially viable ARC service such as is currently provided at Kauri Lodge 11 . Future demand isalso likely to be moderated by increased support for ageing-in-place, which has been shown to reduce therequirement for rest home level care (which is 50% of Kauri Lodge’s total capacity). It appears thatWhangaroa residents currently receive fewer hours of home-based support services than other Mid and Far8Parsons, M. et al (2012). ‘The Assessment of Services Promoting Independence and Recovery in Elders Trial (ASPIRE): a pre-planned metaanalysisof three independent randomised controlled trial evaluations of ageing-in-place initiatives in New Zealand,’ Age and Ageing, 41, pp. 722-728.9Stuck, A. et al (2002). ‘Home Visits to Prevent Nursing Home Admission and Functional Decline in Elderly People: Systematic review and MetaregressionAnalysis’, JAMA, 287(8), pp. 1022-1028.10ARC subsidised rates are $116.51 (excl GST) per bed day for rest home level care, and $204.29 (excl GST) for hospital level care.11A recent attempt by WHST to obtain bank support for investment in expanding ARC capacity to 34 beds was unsuccessful. The WHST Board isyet to determine whether it intends to maintain provision of ARC.21
North populations, have very limited local access to day care, and no local meals-on-wheels access. Afurther risk for WHST exists in the potential for future competition from other ARC providers 12 .WHST has historically used NDHB funding associated with the Rural Health Centre contract to crosssubsidisethe Kauri Lodge ARC service. This situation is clearly not sustainable from a NDHB funderperspective.Refocusing of Whangaroa health services on supporting ageing-in-place is likely to better reflect the needsof the community as a whole, and make better use of the available financial resources 13 . Shifting to a newmix of older people services would include broadening and deepening community support services, andbetter coordinating these with Health Centre and community clinical services. Hospital-level ARC serviceswould be provided at other facilities close to Whangaroa 14 .Supported independent living arrangements could be expanded from their currently very limited base. Kaeocurrently has five ‘Kaumatua flats’ in Turner St, developed by Abbeyfield and Housing New Zealand, andmanaged by TRW. The units are for those aged 55 years and over. Lunch and dinner are provided daily toresidents, but no other services are provided.There is no other supported housing for older people in Whangaroa. However, a planned shift to the ageingin-placemodel of care would include consideration of development of further support housing options inWhangaroa including the potential to develop supported shared living arrangements at Kauri Lodge, andadditional supported housing on the Health Centre campus (or elsewhere in Kaeo). Partnering arrangementswith Housing New Zealand, Far North District Council, TROW and NGO providers would be explored.Currently, a range of health professionals and home-based support workers from multiple organisations maybe involved in the ongoing care of an older person. Coordination and information-sharing between theseproviders will be less than ideal, and result in delays in identifying and responding to the changing needs ofpatients, with adverse impacts on their care and health outcomes, and on efficient resource use. Often, theworkers with the most regular contact with older people will be those least equipped to diagnose andrespond to their health needs. Timely and appropriate care can be improved through risk stratification,needs assessment, care planning, case management models, and multidisciplinary team delivery (seediscussion of planned care above).Goals for improving services for older people include: Implement an ageing-in-place strategy aligned with Government priorities and NHSP Make support services for older people available to a wider number of people in the Whangaroacommunity Align clinical and support services for older people.Key actions include: Develop a plan for scoping and introducing the ageing-in-place model of care commencing withdeveloping an understanding of current client and service issues, particularly in regard to coordinationbetween clinical and support services Scope opportunities to develop new supported housing options (eg, flatting; supported housing units; reuseof Kauri Lodge) in partnership with Far North District Council, TROW and Housing New Zealand12NDHB and WHST were both approached in 2012 by a provider considering establishment of a new ARC facility at Coopers Beach.13It should be noted that more resource intensive dimensions of the health of older people continuum of care (such as dementia andpsychogeriatric care) are already provided away from Whangaroa for reasons of critical mass.14Currently the nearest aged residential care facilities are at Kerikeri, Paihia, Kaikohe and Kaitaia.22
Page 2 and 3: Contents1. Background .............
Page 4 and 5: Figure 2 -TheTriple Aim frameworkFo
Page 6 and 7: 4. Increase sub-specialisation, and
Page 8 and 9: Historically the Whangaroa area was
Page 10 and 11: Table 1 - Funding allocation patter
Page 12 and 13: Table 3 - Option 2 - Maintain the c
Page 14 and 15: 4.2 Preferred pathwayThere was gene
Page 16 and 17: Figure 5 - Stylised overview of fun
Page 18 and 19: The overall goals of shifting to pl
Page 20 and 21: 6.4 Primary Options Programme North
Page 24 and 25: Scope the possibility for WHST to b
Page 26 and 27: 10.2 Information sharing and techno
Page 28 and 29: Table 5 - Implications of the prefe
Page 30 and 31: Appendix 2Significant activities to

Whangaroa Health Services Review Preferred Model of Care

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