03.01.03. Public long-term care system | New Zealand
03.01.03. Public long-term care system | New Zealand
15 Sep 2022
Long-term care may be provided in an institutional setting or at home and may be formal, informal, or a combination of these. Much long-term care is provided informally by family members. The Government’s role may involve direct delivery of care services, the provision of respite services and carer support, or financial assistance.
Aged residential care
Aged residential care facilities are mostly owned by private firms and non-profit organisations. Providers operate within a fixed-price environment, with different fees for different levels of care, rest-home care being the lowest level. A resident’s contribution towards the cost of their care is capped at a maximum amount (unless they choose to purchase additional services). The maximum amount is based on the fixed price of rest home level care, regardless of the amount of care required. This covers a range of services, including accommodation and assistance with activities of daily living, food, laundry, nursing care, GP visits, and prescribed medication and healthcare. It does not cover spectacles, hearing aids, dental care, unfunded medical treatments, or personal items such as toiletries. Residents with assets over a threshold pay the cost of their care, up to the maximum amount. Their DHB pays for the additional cost of dementia, hospital, or psycho-geriatric care. Residents with assets below the threshold qualify for the residential care subsidy. People who fail the asset test because they own their own home may qualify for an interest-free Residential Care Loan. The loan is repayable when the home is sold or 12 months after the person’s death, whichever is earlier.
Home based support services:
Home-based support services for older people fall into two main categories: household management support, which provides help with activities such as housework and shopping, and personal care, which covers care needs, including assistance with showering and dressing. A person wishing to receive home-based support services funded by a DHB must first have their needs assessed by NASC. Personal care services are provided free regardless of a person’s financial position, while household management support is means tested and generally limited to people on low incomes holding a Community Services Card.
Disability Support Services
Disability Support Services for most people aged under 65 and their families, are centrally funded by the Ministry of Health. Services include home-based support, residential care, supports for carers in the home, and respite services. Provision of services is subject to a needs assessment carried out by NASC. Income and asset testing does not apply.
Long term care following injury
Long-term care needs resulting from accidents are dealt with by ACC through its National Serious Injury Service (NSIS).
Other support services:
Respite care services may be allocated as part of the service co-ordination process following a needs assessment and can take the form of residential respite in an aged care setting, or authorisation of a certain number of days of Carer Support Subsidy, or day care, including dementia day care. Where Carer Support Subsidy allocations are made, the older person requiring care, or the informal carer, makes their own arrangements for respite either in-home or in a residential care setting.
The Carer Support Subsidy is funded by a DHB to provide subsidised funding to assist informal (unpaid full-time) carers to take a break from their caregiving role. The Carer Support Subsidy contributes toward the cost of alternative care (e.g., in-home care, residential respite care, day care) for the client, for a specific number of days per year based on the assessed need (Ministry of Health, 2011; The Treasury, 2013; Ministry of Health, 2019).
All NASC assessments are carried out using the interRAI – a suite of clinical assessment instruments designed to comprehensively assess individuals’ abilities and functioning (Ministry of Health, 2018). For the 2019/2020 year, 13% females and 8% of males aged 65+ had at least one interRAI assessment completed. The median age for home care assessments was 83yrs and for long term care facilities (LTCF) was 85yrs. Those aged 85+ years accounted for almost half (47.5%) of all interRAI assessments.
Table 32 shows the proportion of the different types of interRAI assessments carried out and table 33 displays the proportion of each type by ethnicity. While the number of Māori and Pacific people getting any interRAI assessment approximates their proportion of the 65+ population, they are slightly over-represented in home-care assessments and under-represented in LTCF assessments (Table 32) (interRAI, n.d.).
Table 32: Proportion of interRAI assessments by type (interRAI, n.d.)
|% of total assessments|
Table 33: Proportion of interRAI assessments by type and ethnicity (with proportion of 65+ population as a reference (Ministry of Health, 2018)
|% of 65+ population||85.7%||6.7%||2.8%|
Long term care costs in NZ were estimated by Treasury in 2013 to be ~1.5% of GDP and accounted for ~18% of the health spend for the country (The Treasury, 2013). This expenditure is projected to rise as the population ages to 2.3% of GDP and 21% of health expenditure in the next 30 years.
interRAI. (n.d.). Data visualisation. interRAI New Zealand website. Available from: https://www.interrai.co.nz/data-and-reporting/.
Ministry of Health. (2011). Needs Assessment and Support Services for Older People: What you need to know. Wellington Ministry of Health.
Ministry of Health. (2018). interRAI. Minstry of Health website. Available from: https://www.health.govt.nz/our-work/life-stages/health-older-people/needs-assessment/interrai#:~:text=interRAI%20is%20a%20suite%20of,and%20in%20aged%20residential%20care.
Ministry of Health. (2019). Long-term Residential Care for Older People: What you need to know (revised 2019). Wellington Ministry of Health.
The Treasury. (2013). Long term care and fiscal sustainability. New Zealand Treasury. Available from: https://treasury.govt.nz/sites/default/files/2013-07/ltfs-13-bg-lcfs.pdf.