Before old-age pensions were introduced in 1898, elderly people who became ill or unable to work relied on family support or charity. New Zealand attracted numerous single male immigrants in the mid-1800s, and the gender imbalance in the population meant that many never married. By 1900 there were numerous elderly men without family. Those who could no longer work or live independently often became residents of benevolent institutions, set up by provincial charitable aid boards and religious institutions from the 1860s. Benevolent institutions were often grim, uncomfortable places. They had infirmaries and cancer wards, but inmates suffering from dementia were sent to mental institutions.
Rules and renegades
After the First World War, life for frail older people in benevolent institutions became more strictly regulated. Inmates were required to surrender all belongings, abstain from alcohol, refrain from using obscene language and spitting on the floor, and bathe at least once a week. Despite all these rules, elderly men in particular often found ways of obtaining liquor – one of the few comforts left to them.
From the early 20th century, homes for older people were more attractive. Some were set up for former soldiers, as a ‘reward’ for their war service – for instance the Ranfurly Veterans’ Home in Auckland which opened in 1903. More church-run and private homes emerged after the Second World War, when women began to outnumber men in older age groups. The number of older people who lived in rest homes increased. By the mid-1970s New Zealand had one of the highest rates of rest-home residency in the Western world.
‘Ageing in place’
Older people were keen to remain in their own homes and maintain their connections with family and their communities. From the 1980s onwards older people received more support to continue living in their own homes. This included the provision of Meals on Wheels, mobility aids and household help provided by district health boards. Private providers of home-care services also emerged. The proportion of people over 85 who lived at home rather than in residential care increased.
Various strategies were developed to help older people remain in their own homes for as long as possible. These included 'Ageing in Place' and the 'Positive Ageing Strategy' which were introduced in 2001. Policy with respect to older people increased in importance as the New Zealand population aged. Between 1994 and 2011 the number of people over 65 increased by 55%. The number of people over 80 years old increased even more rapidly. Between 1994 and 2014 the number of people over 80 increased by 80% and over 85 age group is now the fastest growing age group in New Zealand.
Some older people who can afford it choose to live in retirement villages in small units or flats, with a range of optional support services. This helps many older people to be independent for longer. It is also a useful strategy if one partner needs more support and care than another partner and they want to remain living together. Other couples choose to stay in their own homes and access home support.
Despite the policy of ‘ageing in place’, those who become unable to care for themselves often need to move to a rest home eventually. Accessing a Residential Care Subsidy for rest home care depends on an individual's health, income and assets. Those in residential care in 2013 were overwhelming over 80 years old, however, only 15% people 80 and over were living in residential care. The majority of those in residential care were women.
People with age-related dementias such as Alzheimer’s disease are cared for at home, in day-care centres, rest homes, specialist dementia units or psychogeriatric hospitals, depending on the severity of their condition. In 2005 about 70% of people with dementia were cared for in their own homes, and in addition 60–70% of people living in residential facilities had some form of dementia.
In 2016 the estimated number of people with dementia was 62,287. About 70% of them were cared for at home, with the remainder living in residential care.1
The incidence of dementia will increase as the population ages. By 2050, it is estimated that over 170,000 New Zealanders will have dementia.2
The rest home industry
In the 2010s the provision of rest homes was a deregulated and growing industry. While some rest homes were run by churches and charitable trusts, many of the country's rest homes (669 in 2016) were owned by overseas companies, which worked to make profits for their shareholders. All rest homes have to be licensed, are subject to audit by the Ministry of Health and are required to meet defined standards of care.
While rest homes are used as a general category of care for older people outside their homes, this care takes the form of rest home care, long term hospital care, dementia care, and psycho-geriatric care. Some residential facilities for older people provide all these forms of care, others only offer certain forms of care.
Commercially operated and non-governmental residential facilities for older people receive significant payments from district health boards (funded by the Ministry of Health) for the care of older people who are not able to pay for their own care. Whether for profit or not for profit, the organisations providing these forms of care are effectively subsidised by the New Zealand Government.
Access to subsidised rest home care always involves needs assessments, carried out by local Needs Assessment and Service Coordination service (NASC) agencies, which are contracted to do these assessments by the Ministry of Health. Needs assessment is followed by assessment of income and assets in order to determine levels of support for subsidised rest home care.
Assessment of assets for those with partners excludes consideration of the family home, a car and pre-paid funeral expenses. In the 2010s the cost of rest-home care was typically over $1,000 a week, depending on the level of care needed.
People entering residential care do not automatically receive a Rest Home Subsidy. They are assessed as needing this level of care. Assessors look at a person’s mobility, health problems, family and other support networks, and ability to dress, manage personal hygiene, and run a household. If their needs are assessed as ‘high’ or ‘very high’ long-term residential care is recommended; otherwise they are offered support to remain in their own home.
Rest home caregivers
Paid carers are mostly women. Rest homes employed professionally qualified staff, including registered nurses and occupational therapists. While most of the caregiving workforce do not have professional nursing qualifications, larger commercial rest homes often run training schemes for staff without qualifications.
In 2012 Kristine Bartlett, who had been working for 20 years in a residential facility for older people, lodged an equal pay claim with the Employment Relations Authority through her union, the Service and Food Workers Union. They argued that her low rate of pay was a consequence of this form of work being mainly done by women and in breach of the Equal Pay Act 1972. The claim was referred to the Employment Court which supported the claim in 2013. Terranova, Kristine Bartlett's employers, took the case to the Court of Appeal which upheld her claim in 2014. The Supreme Court later declined the employers' right to appeal.
Finally, in April 2017, after 20 months of negotiation between the New Zealand Government and E tū, a union for caregivers, a settlement was reached on equal pay for aged caregivers. It involved increases between 2017 and 2021 in the hourly rates paid to caregivers who were previously only paid the minimum wage. These increases will be funded by the New Zealand government out of Vote Health and allocations to the Accident Compensation Corporation.
Where older people live
The 2013 census revealed that 5% of older people – those aged 65 or over – lived in residential care facilities, and more than half of this group was aged over 85. In contrast, 92% lived in private homes.
People entering rest homes are increasingly older and with high levels of disability. This means that there is a greater need for specialist rest home care. There is also an increased need for housing specially designed for older people where they can live independently with some support.