Home-based care: Coordination between care providers
Written by Tom Varghese
Most people experience a decline in health and ability as they age. Just over half of New Zealanders aged 65-74 and nearly 2/3rds of those aged 75 years and over have two or more long-term conditions. Improving the health and wellbeing of older people through home-based support is not an easy outcome to achieve.
Home-based support for older people is a significant policy issue in light of two trends. First, NZ’s population is ageing. Coupled with increasing health needs as people age, this indicates an increasing demand for health services. Second, an increasing proportion of older people live in their own home. While 28% of people aged 85 years or older lived in aged residential care in 2006/07, this number dropped to 23% in 2013/14.
Support services for older people at home come in other forms, including ACC rehabilitation services for older people suffering an injury, and home visiting services for isolated older people.
The principal source of government-funded support for older people at home is the health system. During 2013/2014 DHBs spent approximately $217 million on home support services, comprising over 10 million hours of support to about 75,000 people. Currently, 70 NGOs provide home/community-based support services for DHBs. 37 of the providers are not-for-profit and 33 are for-profit.
Most DHBs purchase home help from providers using a “fee-for-service” model of contracting. Under this model, a DHB will refer an older person to a home-support provider following a needs assessment, and the DHB will pay the provider for the number of hours of support it provides. The other DHBs purchase home help from providers using bulk funding.
Studies raise a number of concerns in relation to NZ workforce development for home-based support of older people. These concerns include a high turnover of staff, inadequate training, lack of support and supervision and worker dissatisfaction with pay and scheduling. In NZ, the ‘restorative home support’ (RHS model) focuses on developing a minimum standard of education and training as well as a career path for support workers, assessment, goal setting and enhanced communication. There is evidence that with careful management, changes in contracts and contracting processes can lead to better services and better service management.
Around the world, the pandemic accelerated "hospital at home" programs, which uses remote monitoring and telehealth technologies to provide patients with hospital-level care in their homes. Scaling up the existing hospital at home programs means two difficult feats: maintaining safety amid rapid growth and recruiting enough medical staff.
Home-based care requires coordination between care provided by different organisations and individuals. Effective service integration depends on different service funders and providers having good information about other services, and sharing values that emphasise the importance of integration.
