28/06/2019
According to the 2013 census, 430,000 New Zealanders were identified as carers – 10% of the population. Each week, an average carer provides 24 – 36 hours of support, and this unpaid work is estimated to be worth $7 – $17 billion. The latter figure is more than the total health budget. It is not clear how many of these people care for older people or how many are older themselves. But many are, and the numbers are likely to grow as the population ages.
Intensive unpaid caring, especially for someone living in the same dwelling can be stressful and can threaten the health of the carer. Respite care is intended to give carers a break and a rest, for a few hours, a day, overnight or longer, either in or away from the family home. Respite helps the carer ‘recharge’ and gives the person being cared for a break.
Respite care keeps families together, keeps people out of hospital, reduces the use of funded services, delays the degeneration of people’s physical and mental well being and is, as the Carers Alliance asserts, a cost effective and societally just investment.
Respite services are accessed through local Needs Assessment Service Coordination organisations (NASC), who check eligibility and identify needs. The amount of funded respite support is based on assessed needs. There are different types of services; overnight respite is available some aged residential care facilities, or a paid worker may stay with the person needing support[1]. Those who are eligible for Carer Support/respite days, receive a list of local facilities that hold appropriate contracts. The carer can then contact a facility or organisation to discuss options. A certain number of respite days are allocated each year, and cannot be carried over
I Choose – a new initiative
This year the Ministry of Health is starting a more flexible type of respite support called I Choose. This will provide cash payments to carers who can use the money to buy any respite support or service, as long as it gives a break from the caring role. I Choose is called a ‘flexible respite budget’. Voucher schemes like this already operate in other countries.
Despite these changes, a new report, Respite In New Zealand: We must do better, prepared by the New Zealand Carers Alliance in association with Alzheimers NZ and IHC, documents significant problems facing the system. While supporting flexible budgets, the report calls for service improvement and innovation across the country. While calling for implementation of the I Choose framework, the report also seeks –
- A review of how respite services are funded and commissioned. A fragmented funding environment involving multiple organisations and government agencies is creating duplication and confusion. Streamlined policy settings will help to improve the system and reduce waste.
- Better availability of services – inequalities in DHB investment are leading to variation across the country. Many users are unable to use their full respite allocations.
- A respite innovation fund for providers to improve respite services.
- A cross-sector stewardship group tasked with co-ordinating a system-wide response and creating coherent policy.
- Better quality assurance and monitoring.
An article in the New Zealand Medical Journal[2] concludes
If the government wishes to have more people with disabilities or chronic illness living at home, greater resources are needed to adequately support caregivers. At present this important sector of the population is undervalued and under provided for
Stop Press
A statement from the Ministry of Health, 25th June, 2019
I Choose is on hold while the Ministry of Health works on a sustainable implementation plan to ensure that disabled people and their whānau can continue to get the breaks they need.
[1] http://carers.net.nz/information/advice-give-yourself-a-break/
[2] Jorgensen, Diane ; Parsons, Matthew ; Jacobs, Stephen ; Arksey, H: (2010) New Zealand informal caregivers and their unmet needs. New Zealand Medical Journal 123(1317):9-16
On Research 