New Zealand also initiated an Older Peoples Health Strategy with the following eight objectives:
• Older people, their families, and whanau (Maori expression for extended family) are able to make well-informed choices about options for healthy living, health care for elderly, and/or disability support needs.
• Policy and service planning will support quality health and disability support programs integrated around the needs of older people.
• Funding and service delivery will promote timely access to quality integrated health and disability support services for older people, family, whanau, and carers.
• The health and disability support needs of older Maori and their whanau will be met by appropriate integrated health care and disability support services.
• Population-based health initiatives and programs will promote health and well-being in older age. • Older people will have timely access to primary and community health services that proactively improve and maintain their health and functioning.
• Admission to general hospital services will be integrated with any community-based care and support that an older person requires.
• Older people with high and complex health and disability support needs will have access to flexible, timely, and coordinated services and living options that take account of family and whanau carer needs.
In New Zealand since 2004, funding for disability support services for older people has been devolved to 21 district health boards, which are largely elected community health boards charged with the responsibility of maintaining and improving the health of the populations in their districts. These responsibilities include funding primary health care, community health services, hospital-based services, and long-term support for older people; that is, all people age 65 years and older and those 50 to 64 years of age with complex health needs more commonly associated with older age.
This approach is linked to the establishment of primary health organizations in New Zealand. The concept behind these is for groups of primary health professionals to work together to provide more accessible and affordable primary health care funded by the government.
Needs assessment and service coordination agencies were established to undertake holistic assessments of individual needs and to work with these individuals to develop a support package to meet their needs. These agencies are responsible for managing the transition to residential care and have succeeded in reducing entry rates to residential care to below those of population growth in older age groups. At the same time, the number of people receiving community support services has increased.
The bulk of disability support services funding (approximately 63%) for older people still goes to residential care, compared with approximately 14% that goes to support people at home. Approximately 20% of funding is for assessment, treatment, and rehabilitation services.
However, most people entering residential care are highly dependent, and many have only a short time to live. For example, 22% of people entering residential care in 2000 died within 3 months and 40% died within a year.
Initially, most community and residential care was provided by either public or not-for-profit (usually religious and welfare) organizations. During the 1990s, demand for residential care in New Zealand increased significantly and private for-profit organizations entered the market, building larger facilities with modern amenities. They also diversified into retirement villages that provide a range of accommodations, from independent units to full hospital care, on the same site.
