DHB spending on services for older people

Older people use more health services than younger people

Older people use 42% of health services (they make up 15% of the population). Population ageing without health improvement will cause this share to increase.

Share of health services used by people aged 65 and over

Graph showing the projected increase of DHB demographic funding for older people compared to their overall demographic funding. In 2015/16, funding for older people was 42% of overall funding. In 2025/26, it is projected to be 50%.
Source: Ministry of Health, estimate of future demographic-based funding for DHBs based on population growth alone

Spending on services for older people is increasing faster than other expenses

Over the last 10 years, DHB spending on services for older people has increased twice as fast as their overall expenses (68% cf, 27%) and 5 times as fast as the consumer price index (CPI).

Expenditure increase 2005/06 to 2015/16

Graph showing that expenditure on support in the home increased 124% and expenditure on residential care increased 52%, while payments to district health boards increased 28% and the consumer price index increased by 12%.
Source: Ministry of Health, the Treasury, Statistics NZ

Rest home care is a large part of the budget

DHBs spend $983 million on support services for older people. 60% of this goes to aged residential care.

Proportional spending on types of support service for older people

Graph showing the proportion of DHB expenditure on different areas of older people's health. 60% was on residential care. 19% was on support in the home. 3% was on support for carers. 15% was on hospital-based rehabilitation. And 3% was on assessment, coordination and other services.
Source: Ministry of Health, based on DHB financial returns 2014/15 selected expenditure codes

The number of older people needing care will increase, but not the proportion

The number of older people needing care will grow, but the proportion of older people needing care is expected to reduce.

Changes in the number and proportion of people in aged residential care

Graph showing the number and percentage of people in aged residential care. In 2006/07, the number was around 26,357, while the percentage was 11%. In 2014/15, the number was 27,556, while the proportion was 10%. And in 2021/22, the number is projected to be 31,712, while the percentage will be 9%.
Source: Aged Residential Care Demand Planner, Central Region's Technical Advisory Services (TAS)

Older people have been using acute hospital services less

Acute hospital bed days for people 65+ (number and rate)

Source: Ministry of Health, National Minimum Dataset

Older people are getting comprehensive clinical assessments

Older people needing support at home or in residential care are receiving comprehensive clinical assessments (interRAI assessments).

InterRAI assessments alert care homes and providers to issues that need to be addressed in the care plan or by referral for further assessment and treatment.

Number of comprehensive clinical assessments in the Jan–Mar 2016 quarter

Graph showing that in this quarter, there were 4461 contact assessments, 8643 home care assessments, and 13,315 residential care assessments.
Source:National interRAI Data Analysis and Reporting Centre, Central Region's Technical Advisory Services (TAS)

Examples of issues to be addressed from the 13,467 assessments in residential care in Jan–Mar 2016

Graphs showing what proportion of assessments triggered issues for pressure ulcers, pain and urinary incontinence. For pressure ulcers, 89% of assessments didn't trigger anything, but for 3%, there was a stage 2 ulcer, for another 3%, they were at risk and had a stage 1 ulcer, and for 5%, they were at risk but had no ulcer then. For pain, 87% of assessments didn't trigger anything, but for 8% they were medium priority and 4% were high priority. And for urinary incontinence, 20% of assessments didn't trigger anything, 34% were continent, another 34% were marked to prevent decline, and 12 % were marked to facilitate improvement.
Source: National interRAI Data Analysis and Reporting Centre, Central Region's Technical Advisory Services (TAS), excludes assessments completed in hospital

Examples of issues to be addressed from the 6948 assessments for home care in Jan–Mar 2016

Graphs showing what proportion of assessments triggered issues for physical activity promotion, mood, falls and cardiorespiratory conditions. For pressure ulcers, 51% of assessments didn't trigger anything, but 49% did. For mood, 57% of assessments didn't trigger anything, but 17% were medium risk and 17% were high risk. For falls, 63% of assessments didn't trigger anything, but 27% were medium risk and 10% were high risk. And for cardiorespiratory conditions, 37% of assessments didn't trigger anything and 63% did.
Source: National interRAI Data Analysis and Reporting Centre, Central Region's Technical Advisory Services (TAS), excludes assessments completed in hospital
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