Are New Zealand’s Home and Community Support Services in peril?
Written by Tom Varghese
Home and community support services (HCSS) includes a range of services available for people who need support to live at home. Services include personal care, household management, nursing treatment, and complex care for people with serious needs. Community-based agencies and companies employ support workers, caregivers and health care professionals to provide these services. Home support for those living with disability and injury related needs can also be provided by family carers. Funding may come from the Districts, ACC, the Ministry of Health Disability Support Services, or the Ministry for Social Development.
Every year the HCSS provides clinical and support services to over 100,000 New Zealanders, including patient assessment, goal setting and plans, personal care, household management and equipment.
The large majority of these services are for older people to support the ‘ageing in place’ policy (with other client groups being younger people with disabilities, and people who have had accidents). The number of people aged 65 and over is expected to double between 2011 and 2036. By the late 2030s, people aged 65 and over will comprise almost one-quarter of New Zealand’s population, meaning that many more people will be living with multiple long-term conditions.
Most people are still interacting with the health system through a traditional episodic model of care. This approach will not provide the care needed for the ageing population. In line with ageing in place, the health system is increasingly funding and providing more complex care in the home setting. Age-related long-term conditions are challenging health systems globally. In response, policy makers and HCSS providers are redesigning service delivery models for older people.
The role of HCSS providers in providing care and support for people to remain in their homes and communities will become increasingly important in ensuring cost-effective care, moderating demand for acute and residential care, and coordinating care across settings and providers. HCSS providers are increasingly delivering care that is clinically complex, and supports the management of chronic diseases. The opportunity to grow HCSS’ role in delivering clinical care will require a sustained focus on digital technology (e.g., point of care testing; remote monitoring), training and clinical supervision to equip the non-regulated workforce to contribute to delivery of care in the community.
Some of the key issues facing HCSS in New Zealand include increasing demand in numbers and complexity, inconsistent, fragmented service delivery, funding arrangements that create inefficiencies in the system, high HCSS workforce turnover, and insufficient funding to increase supply to a level that will meet the growing demand. There have been calls for new ways of working in home and community support services (HCSS) to respond to the multiple and growing demands on HCSS.