“Getting old is not for the fainthearted.” Tania Kiwara smiles but she’s not joking.
As a social worker for Age Concern in Hastings, she sees it all – lonely, isolated, depressed old people, sometimes suffering physical violence or financial and emotional abuse, topped off by their inexorably deteriorating health.
There are 22,000 elderly people — defined as aged 65 and over — in Hawke’s Bay, constituting 13% of its population. They’re a relatively low-profile but highneeds sector of the community, absorbing 37% of the region’s annual health budget, mainly through hospital stays and emergency department visits.
Caring for our elderly to an acceptable standard is a challenge, but the systems are coping.
However, the reality is that things in that neck of the woods are going to get a little scary. Within a mere 15 years, the number of officially-old Hawke’s Bay residents is set to rise to 36,000. That’s 25% of the regional population, as the population bulge of Baby Boomers join their ranks. During the next 30-40 years, these Boomers, born during the 20 years from 1946 -1964, will form a demographic tsunami, putting taxpayers and service providers through the wringer for cash and services.
That raises the question of how well Hawke’s Bay is already looking after its elderly, and how it can prepare for such a radical demographic change.
The Boomers are coming
According to Health Hawke’s Bay’s report Improving Health Services for People in Hawke’s Bay, we must start right now. In 15 years, the elderly will be using up 50% of national public health funds. About 40% of over-65s have chronic health issues such as diabetes, cancer, or heart or kidney problems. By the time they’re 75, about 34% of them have two or more of those conditions.
Ageing Baby Boomers are generally healthier than their parents and grandparents at retirement, but other problems are beginning to surface and make it difficult to plan accurately for future demand.
Diabetes is rampant among our obese population. Hawke’s Bay Health chairman Kevin Atkinson says it is going to present the health system with “a crisis”.
The NZ Alzheimers Society says Baby Boomers are starting to suffer from this form of dementia in their 40s and 50s. No one knows why, although it’s a phenomenon not confined to New Zealand. In the US, 10 million Baby Boomers (one in every eight) are predicted to have Alzheimers by 2050.
Apparently, many Boomers will also suffer from osteoarthritis as a result of their too-heavy bodies being over-stressed by activities such as jogging and high-impact aerobics. Their children will get it in their hands from excessive texting and computer-related carpal tunnel conditions.
Then there is migration. An estimated 250,000 Kiwi Boomers live overseas. If even half of them decided to come home to retire, the taxes of a diminishing number of working-age Kiwis would have to pay another 125,000 pensions, and potentially 250,000 more hip replacements and 250,000 more cataract operations.
In the meantime though, Kiwara and her manager Ruth Lockley say Hawke’s Bay is doing relatively well in caring for its elderly. “We’re lucky. Hawke’s Bay Health has listened to the voice of older people. It’s being heard at board level,” they say.
There is a range of volunteer and professional support organisations providing everything from companionship and hot meals delivered, to lessons in using new technology, advocacy services, or social and physical exercise programmes.
It can be hard out there in the community for vulnerable elderly, says Kiwara, who hears of about ten cases of financial abuse every month. Usually, it’s been perpetrated by family members. It can be on a small scale, such as a youngster using a grandfather’s eftpos card to put petrol in his car. Or it can be large scale, with “significant amounts of money rorted” through misuse of powers of attorney. Sometimes the elderly are pressured into re-mortgaging their homes or guaranteeing loans to other family members.
“Or sometimes the children might move back in with them and live off them and not contribute anything. That’ abuse,” says Kiwara.
Transport and housing for the elderly are both areas that will need a lot of improvement as Baby Boomers nudge into the ranks of elderly, says Lockley. Those with family scattered overseas face a dilemma when they give up driving. Without transport they become isolated and depressed, and their general health goes downhill.
The Gold Card that allows them free bus rides during off-peak periods is “good if the bus comes down your street” and you’re mobile enough to climb up and down the bus steps, says Kiwara.
Another option is the mobility scheme run by the Hawke’s Bay Regional Council, which provides a 50% subsidy on taxi fares. However, qualifying cardholders often find it difficult to come up with the other half of the fare, says Lockley.
A stoic bunch
Today’s seniors tend to be a stoic bunch – undemanding, trusting and politically unassertive. They were raised to be polite, law-abiding, hard-working, thrifty and community-minded. Their lives were shaped by the 1930s Great Depression, then many lost fathers and brothers to the Second World War.
Kiwi society during their childhood was well-ordered. Crime was rare. Household doors and windows could be left wide open day and night during summer. Few families had cars, so most people walked or cycled everywhere. Families were close-knit. Discipline was strong, money tight. Toll calls were made only when someone had died; handwritten letters kept families in touch. Clothes were home-made, often from recycled fabric including flour bags. Food came from large backyard vege gardens, chooks and fruit trees. There was no television; children played outside in backyards or roamed the local countryside.
It was a simple world, light years away from the modern, electronically-driven, rush-rush society they now live on the edges of, but, says Kiwara, it gave them a huge advantage. Facing the vicissitudes of old age, they have resilience; and living on a tight budget, they have financial discipline that has not been required of their children and grandchildren.
“It will be hard for the next generation, who have two incomes but live from week-to-week,” says Kiwara. Many haven’t got savings in the bank, or a mortgage-free home. “So they can end up two people living in private rental accommodation. That costs $260 a week, then a spouse dies. How do you maintain that?”
The fact is, Baby Boomers, through sheer weight of numbers, have always been a problem.
They filled post-war infant classrooms to overflowing, 45 to a teacher, while education officials scrambled to build new schools. They have challenged the established order and re-written the rules all the way.
They lived the golden years, when Britain bought every pound of butter, mutton and wool we could produce. They had genuinely-free education, plenty of good food, and free access to modern medicine that took the terror out of illness. Their expectations are high, but they’re in for a shock. The Peter Pan generation is about to get old.
According to a recent study by Auckland’s AUT University and the housing charity Abbeyfield, people aged 50 or older do not feel or see themselves as old. Most feel 20 years younger, and believe others see them as younger than they are. At the same time, though, nearly half had experienced age-discrimination, and many were concerned about the prospect of loneliness, lack of retirement income, health problems and costs, boredom, the cost of living, and feeling that they were ignored or not taken seriously by younger people.
Boomers with dinner-table stories of the Great Depression still ringing in their ears have in fact bought their own homes and saved for retirement. The problem is, many lost a lot, and some lost everything, when sharemarkets, finance companies and businesses collapsed in 2008.
Greta Wham, co-ordinator for the Hastings Budget Advisory Service, is helping such people prepare for old age with nothing more than National Superannuation to live on.
Some owe large amounts of money into the bargain, says Wham. Another group have worked hard but never earned enough to be able to buy a house or save for old age.
“A lot of Baby Boomers have made provision. They will find it easier. But you have to have the money while you’re working, to make provision. Some can’t. There is Kiwisaver, but we are seeing a large number of people wanting to withdraw their savings because they can’t manage. They don’t have the option of hanging in there for longer-term gain. They need that money to solve some immediate problems.”
Wham says it will be “interesting” in about 30 years to see whether the Boomers’ children have changed their attitude to money as they, in turn, approach retirement.
At the moment, “their expectation is that they can have whatever they want by borrowing money”, she says. “Older people are far better at living on low incomes. They have grown up having to make do. That’s not an attitude with younger people.”
The Boomers began turning 65 and handing in their retirement notices in January this year, while we were all preoccupied with the Royal Wedding and impending World Cup.
But Kevin Atkinson, chairman of the District Health Board, is ready and waiting for them.
The board is well down the path of reorganising the way it offers healthcare to elderly people, he says. A disjointed array of general and specialist services is to be replaced by fully co-ordinated clusters of care services, linked with a geriatrician, effectively acting as one-stop health shops. Atkinson expects this new mode of service to be in trial “before the end of this financial year”.
It is vital that more emphasis goes on preventing acute illness and keeping people out of hospital and rest homes as much as possible, he says. The board is already spending $40 million a year on subsidised care in rest homes, compared with $44 million on pharmaceuticals and $90 million (21% of its budget) on primary care for the whole regional population.
The most intensive users of hospital beds and services in Hawke’s Bay are the 2,860 people aged 85-plus. In 15 years, there is likely to be about 4,780 of them — a 60% increase.
The financial consequences of that for the health sector could be eye-watering, but Atkinson is not panicking. There are two reasons, he says.
Firstly, today’s 65-plus seniors are far healthier than their forebears. They go to the doctor at an earlier stage of illness, rather than waiting until it becomes serious and they need hospital care. The predictions made in 2000, of a crisis in the health sector by 2011, simply haven’t happened. “It’s difficult to extrapolate the health needs of past generations with those in the future,” says Atkinson.
In health terms, 85 is going to become the new 65, and 100 is going to become the new 85, he says. We will have a much healthier elderly population. Even now, only 20% of those 85 and over in Hawke’s Bay are living in rest homes. “The preference of all ages is to live at home as long as possible, so we need to be constantly looking at ways to assist that.”
We also have time on our side. Of the 34 countries in the OECD, 14 have higher percentages of their populations aged 65-plus than New Zealand does. They will face the challenge of a rapidly-ageing population before we do, so we will be able to watch and see how they handle it.
In the meantime, “Diabetes will be a crisis. Obesity is impacting on people in their 20s”, says Atkinson.
As people are given more ability to manage their own healthcare, he’d also like to see more discussion around ‘advanced directives’ or ‘living wills’. These can include instructions that an elderly person does not wish to be resuscitated or treated after a serious medical emergency.
“The cost of keeping a seriously ill person alive is astronomical,” he says, and “when you can’t reverse the acuity” (which means the patient is not going to recover), it needs to be an option. “As communities, we have to think about that sort of thing. We need to talk about it more and be more mature about it.”
Atkinson says society must also re-think retirement at 65. With better health and a shortage of people in the workforce and paying taxes, there’s no reason we shouldn’t be providing “a greater role for people in their 70s”.
Housing the elderly
The Hastings District Council adopted its Positive Ageing Strategy in 2007. Napier is in consultation phase.
The Hastings strategy contains a long list of items that affect the elderly, and which the council should take into account in the course of its work. This includes maintaining a network of footpaths suitable for older pedestrians, wheelchairs and mobility scooters.
One of the most important sentences pertains to enabling superannuitants to remain in their own homes: “Commit to maintaining rates as low as possible,” it says.
Rates are based on a property’s land value, and bear no relation to the owner’s ability to pay, or their use of council services. The more desirable an area, the more expensive its properties – and the higher its rates.
Rates go up every year throughout Hawke’s Bay, often by more than the rate of inflation in the national economy. The rates on a typical Hastings or Havelock North home are $1,700-$3,000. Napier’s average residential rate is $1,550; Wairoa’s are more than $2,000 a year on land values a tiny fraction of those in Napier-Hastings. It’s getting harder and harder for pensioners to pay that from incomes of $17,000 a year.
Lockley says affordable and suitable housing for the elderly is already a headache, and it seems set to get worse. Many people loathe the idea of retirement villages and rest homes, but Lockley says there are plenty of lonely elderly stuck out in the community who would love to move into one, but can’t afford to. They haven’t got homes to sell to finance the move.
It won’t be until they are too frail to live unassisted that the taxpayer will step in and pay care fees for them.
Hastings is fortunate in having clusters of privately-owned flats for the elderly close to the inner city, she says. Hastings District Council also owns 220 flats available for rent by low-income elderly, and Napier City Council has 303.
But Kiwara says a lot more planning has to be done around housing the elderly in both cities. “Older people are still a minority focus. If that attitude doesn’t change we are in real trouble, and that’s not unique to Hawke’s Bay.”
Residential care for our frail elderly has become big business. Once provided by churches and charities, it’s now the domain of corporate investors who expect a return on their money. It’s an industry notable for poor pay, staff shortages, high turnover of staff, and some shocking court cases resulting from fatal mistreatment of vulnerable old people.
Currently, there is conflict over the practice of some rest homes charging residents – even those whose fees are being paid by the taxpayer because they have no money — up to $140 a month to use their en suite toilets.
Hastings Grey Power vice-president Ted Duffill says this is creating a two-tier system in which only the wealthy can get access to a toilet at the moment they need one.
The chief executive of the NZ Aged Care Association, Martin Taylor, is reported as saying that only 25% of rest home beds for fully-subsidised residents are currently tagged to such additional charges, but most new retirement complexes are being built with “premium-only” rooms because that is “the only way to get a return that is in tune with the risk”.
An investigation by Grey Power, the Greens and Labour produced A Report Into Aged Care: What does the future hold for older New Zealanders? It paints a picture of an unregulated, short-staffed industry driven more by profit than best care for the elderly, and “fast reaching crisis point”. “Many New Zealanders are receiving substandard care,” it asserts.
In complete contrast, it’s not hard to find people living happy and secure lives within retirement and rest home communities, and families with nothing but praise for the care being provided. Whatever the reality in any particular rest home, it is clear the industry overall has some bad apples and an image problem.
It is equally clear that in its current state it will not appeal very much to the grey-haired tsunami as a final destination in life.
Perhaps today’s 65s will seek an alternative: “Male, 85, keen cyclist, seeks flatmate. Share cooking. Free wi-fi. No loud music.”