Options for responding to the projected shortfall of carers in an Ageing Society

Transcription

1 Options for responding to the projected shortfall of carers in an Ageing Society Prof Peggy Koopman-Boyden CNZM Dr Patrick Barrett Presentation to PANZ conference, Auckland, 28 November 2011 NIDEA 1

2 Overview Ageing and the gap between demand and supply of formal and informal care Current policy re long-term care Options for New Zealand s future formal and informal care provision Other countries OECD international comparisons, Asia/Oceania comparisons. NIDEA 2

3 Projected Change by Broad Age Group Total NZ Series (4.6%) 65+ Years All other age groups combined 19.1% 2.4% (12.8%) 61.0% 5.4% NIDEA 3 Stats NZ (2009) Series 5 = TFR 1.9; ANM 10,000 3

4 But what will be the future demand for care? And what will be the supply of those caring for the older people? NIDEA 4

5 Actual and projected number of paid carers needed for NZers (65+ years) Year Actual and projected number of disabled older persons requiring care (65+) [demand?] Actual and projected number of paid care workers needed [supply?] Percentage change per annum ,700 75, , ,700 17,900 24,500 34,600 48, % 3.5% 3.4% Dept Labour, 2009, Table 6, p19. NIDEA 5

6 The Issue? A gap between demand for care and supply of carers. Why? Greater longevity Changing family structure* Smaller cohort of potential carers after the baby boomers Geographical dispersion of family members Longer working life of middle-aged and older women* Ageing-in-place policy*. NIDEA 6

7 Changes in Household composition of Japanese needing health care, aged 65+ (%) (Okamoto, 2011) Households of the single 2 Nuclear households - include married couple, and households with married couples and unmarried children only 3 Three-generation households 4 Other NIDEA 7 Source: Ministry of Health, Labor and Welfare, Japan Comprehensive Survey of Living Conditions of the People on Health and Welfare 7

8 Percentage Informal carers not so available? Employment/ Population Ratio NZ Women aged Years Stats NZ, HHLF Survey NIDEA 8

9 Percentage Increasingly older women still in paid work Employment/ Population Ratio for NZ Women aged 65+ Years Stats NZ, HHLF Survey NIDEA 9

10 Trends in rates of long-term care in Auckland, 65+years (Broad et al 2011 NIDEA 10

11 Options for responding to the projected shortfall of carers NIDEA 11

12 Current policy arrangements for long-term care in New Zealand Four main types of care: Public or private long-stay hospitals (or nursing homes) Residential care in rest homes Home-care services (public and private) Informal care provided by family or friends. Eligibility for tax-funded subsidised care is based on need and is means-tested (with an asset threshold of $200,000 in 2010). NIDEA 12

13 Recent New Zealand developments in formal home-based support care National Health Board leading a review of national home based support services by June Workforce for the care of older people, Health Workforce New Zealand, February Office of the Auditor General, report on Home-based support services sector, May Introduction of restorative model of home support care at District Health Board level. Possible spin off to informal carers? NIDEA 13

14 Current policy supports for informal carers Possibility of income support: Domestic Purposes Benefit (Care of sick or infirm) Possibility of flexible work arrangements (Employment Relations (Flexible Working Arrangements) Amendment Act 2007). Respite services. NIDEA 14

15 Policy Implications in New Zealand? More training and support for carers* Recruiting migrant workers* Greater use of technology* Improving working conditions* Questioning the ageing-in-place policy Long-term issue do we pay informal carers? Options in other countries.* NIDEA 15

16 Supporting growth and capacity of informal carers The 2008 NZ Carers Strategy listed five key areas for support: providing information protecting the health and wellbeing of carers enabling caregivers to take a break providing financial support for caregivers providing training and pathways to employment. NIDEA 16

17 The use of migrant carers - in the UK The UK experience home care provision relies on a significant number of migrant care workers role of migrants should therefore be planned, not be an unintended consequence of low pay and poor working conditions unattractive to other job seekers the implications of their contribution should be addressed not ignored in the consideration of future immigration and social care policies. needs to be greater coordination between government migration and social care policies, to the mutual benefit of employers, older people and the migrants who care for them (Migrant Care Workers in Ageing Societies, 2009). NIDEA 17

18 The use of technology Caring robots Personal health monitoring and communication, including telehealth and mhealth models Use of Information and Communication Technologies (ICTs) to improve efficiency in organising and planning caregivers services. Environmental smart technologies enabling the older people in their homes. NIDEA 18

19 NIDEA 19 How is it in other countries?

20 OECD comparisons Workforce policies to increase the supply of carers, 2011 Recruitment measures Public funded training Wages and benefits increases Improvements in working conditions Raising status/job profile Management improvement Career creation Workforce certification Workforce planning Other retention measures. NIDEA 20

21 Workforce policies to increase the supply of LTC services Recruitment measures Public funded training Australia X X Canada X Wages and benefits increases Improvements in working conditions Finland X X Raising status/job profile Germany X X X X X Japan X X X X Netherlands X New Zealand X X X Norway X X X X United Kingdom X X X United States X X X NIDEA 21

22 Workforce policies to increase the supply of LTC services Management improvement Career creation Workforce certification Workforce planning Other retention measures Australia X X Canada Finland Germany X X Japan Netherlands X X X New Zealand Norway X X X X X United Kingdom X X X X X United States X X X X X X X X NIDEA 22

23 Family caregivers (Kalyani Mehta, 2011) In Singapore, the family caregiving system is under a great deal of stress (little training and support provided) Grandparents who are ageing are also looking after grandchildren. They should be recognised, supported and trained for their child minding roles More research on spousal caregivers is imperative (tend to be taken for granted) Too much reliance on imported labour. NIDEA 23

24 Better quality control (Sung-Jae Choi, 2011) In Korea, lack of appropriate means of quality control Lack of independent quality control machinery Effectiveness in quality control of facilities/programmes with lower-salaried care workers: can cause problem of exploitation Low staff ratio to consumers. NIDEA 24

25 Invest in the workforce (Iris Chi, 2011) Over the Asia/Oceania region, carer profile is: female, middle age, low education, working long hours, low pay. - Shortage of professional staff - Shortage of care workers. Changes needed: recruitment and retention of staff at all levels, shorter working hours, lower turnover rate, education and training, better pay and career path. NIDEA 25

26 Clearly we need to know more about the gap between the demand and supply of formal/informal carers of older people AND the aged care sector has a range of workforce challenges, both in New Zealand and elsewhere! NIDEA 26

27 THANK YOU NIDEA 27