Caring for the dying

By Simon Wallace, NZACA Chief Executive

19 November 2015

Palliative care is becoming a major issue for aged residential care homes.

The way Kiwis are dying has changed significantly over the past 20 years, with deaths in aged residential care (ARC) homes increasing faster than for any other place of death in New Zealand.

Other key trends include:

  • ARC is becoming an increasingly important setting for deaths from cancer, exceeding deaths in hospitals in 2010
  • ARC is the most common place of death for New Zealand women, regardless of age or cause of death
  • People are entering aged residential care more frail than before

This entrenched shift towards dying in ARC homes is expected to continue, with increased frailty on admission, shorter stays and an increased number of deaths at the oldest ages.

Unfortunately, the way ARC homes are currently funded by Government does not reflect this new reality. This needs to change. It is vital ARC homes receive adequate resources to help their residents ‘die well’, and to provide support to their families through the bereavement process.

While we welcome new Government and individual DHB palliative care initiatives this year, there needs to be immediate action now to bolster support for ARC homes.

As a priority, in our negotiations with the DHB Shared Services for the 2016/17 Aged Related Residential Care (ARRC) contract, we are advocating for:

  • a distinct palliative care supplement 
  • the interRAI suite of assessments to include the palliative care assessment tool to ensure consistent judgements across New Zealand
  • consistent reimbursement for palliative and end of life care across all settings of end of life care, and across all DHBs – currently a person dying in a public hospital or hospice in New Zealand has all their costs paid, while those in ARC homes are means-tested

To support our argument we commissioned an in-depth analysis of both the New Zealand palliative care environment and a review of the UK, USA and Australia experience.

Reforms in those countries highlighted that a higher payment is required for palliative and end of life care. They also showed that providing high quality palliative care in ARC homes delivers benefits to the health system, including reduced costs for hospitals.

An early evaluation of a UK programme to improve the quality of care for people nearing the end of life in ARC homes found a significant reduction in the number of hospital deaths and admissions and a cost savings to the health system of potentially £40,000 - £80,000 per care home per year, depending on home size, turnover and tariffs.

If the New Zealand government improved palliative care funding in ARC homes it would reduce the burden on our hospitals. More importantly, it would also mean that as the number of New Zealanders dying in their care increases, homes have the resources to provide quality care and comfort to residents at the end of their life, and support to their families.