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Knowledge Lab - Making Life Easier

Using the website

Genetics and life’s experiences have landed us where we are today. Some things we’ve been able to work on and change, but others have remained resistant, despite the very best of intentions. So, where we are now, is working with the toolbox life has given us. Those who have the toolbox that enables them to complete university degrees or strike a frightening ballet pose in their nineties are the exception. Most of us have learnt, as we got older, that life’s not a competition. If it is, it’s with ourselves. We can all aim to live the very best life possible, given the tool kit we have. ‘Making life easier’ is about giving you options so that you can choose what’s going to help you to live the very best life possible for you.

All information in the Knowledge Lab is intended for general information only and should not to be taken as personal advice. While we have consulted with experts in their fields, checked with relevant government agencies and their websites, providers of services and a wide range of groups and organisations; change happens and errors and/or omissions may occur. We do not take responsibility for these as we urge you to seek appropriate or professional advice on all issues.

The wizard

Searching for some help but not sure where to start? Our online wizard walks you through several different scenarios to get you started on your journey. Choose who you’re looking for – whether it’s yourself, a loved one or even a client – and what stage of life they’re at, and the wizard will provide a range of practical resources and information specific to your situation. The results may help you to begin developing a plan of action or they may make you re-evaluate your current thinking. You can then explore our extensive directory of services, organisations and groups around the country to help make your life easier.   

Eldernet

Life is about change and whatever your next step, Eldernet is here to help you make decisions that are right for you. Search New Zealand’s most comprehensive directory of rest homes and specialist residential care – including up-to-date vacancies. While you’re there, why not order yourself a free copy of our book Where from Here, New Zealand’s ‘older person’s bible’? It’s full of useful and practical region-specific information for whichever stage of life you’re in.  

Retirement Villages

If you’re thinking that village life might be for you, retirementvillages.co.nz should be your first port of call. Here, you can view the largest selection of retirement village properties in New Zealand. Filter by price, location, and property type, then use the open day tool to plan your viewings. We’ve also put together a downloadable checklist to help you with any decision making.

Making Life Easier

We want to empower you to use your voice and to make decisions that are right for your future - because you matter. There are three ways to make the most of the Making Life Easier site:

  • Browse our directory and discover a huge range of care and support options, community and advocacy groups, and service providers throughout the country to help make your life easier.
  • Not sure what you’re looking for? Our wizard walks you through several different scenarios to help you start your journey, providing practical and useful information whether you’re searching for yourself, a loved one or a client.
  • The Knowledge Lab is where we explain the important things you need to know - and answer the questions you might not have even thought about. Here you’ll find short answers and longer reads, as well as links to videos, blogs and other helpful resources.

Definitions, key terms and concepts used in older persons’ health services

ACC: Accident Compensation Corporation.

Assessor: A trained, qualified health professional who conducts assessments. Includes: NASC, DHB Clinical Needs Assessors, those based in the community, in home based services or residential care homes.

Carer/care partner: Someone who cares for you in an informal sense. Usually an unpaid family/whānau member.

Caregiver: A formal often paid role. Usually provides personal care.

DHB: District Health Board. These are to be disestablished in 2022.

Domestic assistance: Assistance with household tasks.

EPOA: Enduring Powers of Attorney. Also referred to as EPA.

GP: General practitioner or doctor.

Healthcare service: A community-based facility where different health professionals and other relevant services are located. Usually includeS doctors/GPs, nurses, administrators, pharmacy etc.

interRAI: A computer-based assessment and care planning programme.

MOH: Ministry of Health. Changes to this service are to be made in 2022

MSD: Ministry of Social Development. MSD provides a range of support
services, including additional financial assistance to those who meet the criteria for eligibility.

NASC: Needs Assessment Service Coordination. Often your point of contact for your older person’s service. May also be called Needs Assessor.

NZ Super: New Zealand Superannuation.

ORA: Occupation Right Agreement.

Personal care: Assistance with personal hygiene and the care of your body.

RV: Retirement village.

Service coordinator: A person who arranges and coordinates services, usually following an assessment.

Support worker: A formal role. May provide personal or practical support.

Work and income: A division of the Ministry of Social Development.

Ageism

All older people will understand this question as it’s either happening to them, or they’ve seen it happen to others. It’s a complex issue and could be answered from a number of perspectives. We offer some factors to consider.

The pace of life and intergenerational differences?

Our priorities and interests change over our lifetimes. Often the point at which people feel the need to have a say in older people’s lives occurs when there is a clash of these world views.

There are a multitude of things involved in these intergenerational interactions including the pace of living of each generation, differing views of where responsibilities lie, and a lack of understanding of the older person’s experience and perspective (which we can only fully know when we’ve completed life's journey!).

Ageism

The World Health Organization (WHO) Definition of Ageism –Ageism refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age.”

 How much responsibility do we take for our own actions, for not examining how much ageism actually affects our thinking, or for not challenging ageism when we see it?

It’s clear that a type of unrecognised type of ageism runs through society. The WHO states: "Ageism can change how we view ourselves, can erode solidarity between generations, can devalue or limit our ability to benefit from what younger and older populations can contribute..."

So, what to do?

In its most kindly form, we can explain this situation as people being well meaning. This does not however address the deeper issues. Older people aren’t quite ready to be ‘organised’ by others nor do they want to be left to their own devices. Just as the feminists before them, they want to be included, valued and contributing members of society i.e., to be seen as equal.

As older people we should ask ourselves – Have I swallowed the ageist bait? How have I been influenced by ageist thinking?

Everyone should ask themselves - Is my concern about an older person based on subconscious ageism? Would I behave this way with a younger person? What sort of messages do we want to give our future generations?

As has commonly been said ageism is discrimination against our older self. Let's look on that older self with the same regard as we look back on the younger self.

In our minds Ashton Applewhite is the guru of anti-ageism. Her blog discusses current issues looking through an anti-agesit lens.

‘Yo is this ageist?’ is for those who really want to challenge themselves and learn how to do better.

 

Local community

We call the places where people can meet up easily and naturally, 'bumping places'. Examples of bumping spaces include cafes, clustered outdoor seating areas, free community events, museum, and art gallery areas, etc.  The trick is knowing where to find them as every community is different. Start at your local libraries, cafes, and organisations such as Age Concern, Citizens Advice Bureaux or Council. They often have information about all sorts of things that might interest you too.

One of the best places we’ve come across to find out about what’s going on in your community or to introduce yourself is the local library. In the past they were more like big bookshops. Not anymore, they’ve kept pace with modern society so that now all sorts of other things happen there, from talks on topics of interest, to book readings, computer hubs (you can ask for assistance if needed), historical displays, brochures on all sorts of local events etc., and in some libraries, even cafes.

Another place to keep an eye out for are café’s that serve your favourite coffee and look like they’re attended by your sort of person.  You might have to visit a few to find one that suits you. Great café staff will always make you feel welcome.

Volunteering, whether in a formal or informal capacity brings you into contact with others. Contact Volunteering New Zealand or a local organisation you might be interested in joining.

  • As local businesses are often locally owned, you’re financially supporting another community member, who, in turn, puts money back into the local economy.
  • You’re helping to provide employment opportunities so that people don’t need to move away to find work.
  • You’re helping to build community with every personal interaction you have.
  • You’re helping to address climate change issues by reducing unnecessary travel.

While those services that offer Gold Card discounts expect you to let them know of your eligibility we ask you to think twice about asking for a discount if it’s not offered. While the business might feel compelled to agree to this, they usually can’t afford it, eventually making it unprofitable to continue.

This, combined with the advances in technology that enable people to work remotely, means it is much easier for people to remain living in smaller communities (including rural communities) if they want to. In the past they may have had to move into town.

 

Some communities wont know about this type of service as they are scattered around the country and not necessarily available in all areas.

Community houses (sometimes known as ‘one stop shops’) are usually large buildings tenanted by various social service and other related agencies. For example, you may find a local Age Concern, Citizens Advice Bureau and a Work and Income branch all in the same building. As you can imagine it’s often useful to have these services located together. There are usually one or two onsite staff members at each agency so your questions can be answered, and appointments made. Opening hours vary according to the agency.  

We live in a society where many people have highly valued privacy and individual responsibility and freedom, to the extent that it has almost created a ‘hands off, don’t interfere’ attitude. It’s something that research, and to some extent COVID-19, has shown us doesn’t always work in our favour. We are social beings and most of us respond to the warmth of human contact. So, we say: Knock on your neighbour’s door. (Don’t be too influenced by appearances, they often hide a different person inside.) You’ll find the right words; something along the lines of “I haven’t been over to say hello yet/for a while” might be a start.

Remember however that people may choose to to live as they wish (with very few exceptions). They are adult and can make their own decisions. If you believe however that your neighbour is unable to make her own decisions, or you have real concerns for her, contact Age Concern for advice. They have skilled staff who can deal with such issues.

If you fear that your neighbour is at immediate risk. Ring 111 and ask for the police.

Statistics about ageing

The statistical odds that you might need residential care (or go to a care home) are low. These odds do increase with age if combined with significant health and/or other needs, by which time it’s often a perfect solution.

The percentage of the population living in a care home (interRAI New Zealand 2017/18):

  • between the ages of 65-74 = approximately 1%
  • between the ages of 75-84 = approximately 6%
  • and from the age of 85+ = approximately 27%.

If you need support at any stage on your ageing journey, it more likely care will be provided to you in your home in the community. Bear in mind too that residential care is continuing to change and that it can often be used in a flexible way e.g., you can stay for a while and then go home. Care homes may also offer palliative and end of life care; providing essential services for some people. 

Demystifying who lives in care

According to statistics from interRAI New Zealand, 31, 600 kiwis currently live in aged residential care (2017/2018).  That means that less than 5% of people over the age of 65 call a residential care facility home (according to data from Stats NZ 2019). People who move into residential care don’t do so because they hit a certain age; it’s because they require a higher level of care and support. In fact, the average of a person living in residential care is aged 85.

Basically, age on its own does not determine whether you need to move to a care home or not.

If you do need extra support as you get older, however, a care home is the perfect place to be. Residents in care homes across the country receive a great level of care, specific to their needs. Importantly, moving to a care home does not mean you will be lonely or isolated either. Based on interRAI statistics, 69% of residents spent most or some of their time involved in activities and 91% have strong and supportive family relationships.   

Population stats

In New Zealand, the number of older adults is steadily increasing (while the birth rate has been decreasing for the past few decades). According to 2019 data from Stats NZ, there are currently 759,800 people 65+ living in New Zealand, while modeling suggests that has already grown by an extra 50,000 in the past two years.

In fact, it is predicted that sometime in the next decade there will be more people aged 65+ than children aged 0-14. By 2034, people aged 65 and older will account for more than a fifth of the population.

We are also living longer than any previous time in history too – and as health outcomes in general continue to improve, so does our life expectancy. For example, the number of people aged 85+ is predicted to double by 2034 – from 86,800 in 2018 to 178,800 (Better Later Life He Oranga Kaumātua 2019 to 2034).

This brings with it some good things:

  • Nearly one in four Kiwis over 65 are in paid employment
  • By 2036, it is predicted that those over the age of 65 will contribute $50 billion of consumer spending to the economy, $25 billion worth of unpaid or voluntary work, and $13 billion in taxes.
  • As our population ages, it is also getting increasingly diverse. By 2034: the number of Māori will more than double (to 109,400) as will Pacific People (46,700). The predicted growth is even bigger for Asian communities, tripling to 171,900 while combined Middle Eastern /Latin American/Africa will quadruple to 18,000.

As well as more challenging things:

  • Older people are currently more likely than any other age group to own their own home but this is dropping for those aged 50–64. For older people who do own their home, the numbers with mortgages are increasing – from 6.8% in 2004 to 13.9% in 2018.
  • As a result of families increasingly become displaced, coupled with people having fewer children, it is estimated that by 2034, people 65+ will make up 55% of all people living alone.
  • Ageism continues to be a problem, with 20% of people aged 50 or older suggesting that they have felt invisible because of their age.

interRAI stats

interRAI is an internationally recognised computer-based assessment programme and is used to assess the level of care and support an older person needs. Assessments are done in person in your home, aged residential care facility, hospital or elsewhere in the community and occasionally over the phone. As well as benefiting the individual being assessed, information from the interRAI assessments is used to improve services for all older people.

In New Zealand, there are five assessment instruments: Long-term Care Facilities assessment (for people in aged residential care); Home Care Assessment (for people living at home with complex needs); Palliative Care assessment (for end of life care in aged residential care or in the community); Community Health Assessment (for people living at home with less complex needs); Contact assessment (an initial assessment). After being stripped of names, addresses and any other identifying information, the data helps policymakers, healthcare professionals and researchers find out more about the needs of older people.

Here are some statistics taken from interRAI’s 2019/2020 Annual Report that help show what an important tool interRAI is.

  • In 2019/2020, over 122,400 interRAI assessments were completed throughout New Zealand. That is an average of 335 a day!
  • In total, more than 670,000 assessments have been completed and are stored in interRAI’s data warehouse.
  • In 2019/2020, 13% of women and 8% of men aged 65 and older have had at least one interRAI assessment.
  • Every resident in aged residential care and every person receiving funded home care in New Zealand is assessed using interRAI.
  • Of the assessments completed in 2019/2020, more than half were completed in aged residential care facilities (approx. 70,500). The 31,300 Home Care assessments were also completed, accounting for 25% of total assessments.
  • Throughout the country, there are more than 5000 trained interRAI assessors. In response to the Alert Level 4 announcement in March 2020, interRAI services trained 329 new assessors in three months.

Health care in the community

Those who keep well are not going to need to see their health advisor as often as someone who has more complex health needs. Opinions vary as to how often you should have a health check-up but once a year is a common standard for older people.

As our health systems changes to a model where health professional collaborate and draw upon one another’s skills more, you may find it’s not the doctor you’re best advised to see. Often it’s a practice nurse (who will escalate any concerns up to your doctor if needed) and if it is more convenient then a telehealth check might be all that required. There are two very good reasons for a having a regular health check-up:

  • It is beneficial if you are known to your local healthcare centre should you ever require more or urgent health services in the future.
  • We can all fall into the trap of ignoring our ‘so called minor ailments’. The longer we live the more time we’ve got to accumulate health problems, some of which might have crept up on us and made themselves quite at home. Many older people consider some symptoms such as an increase in tiredness, foggy thinking, painful joints, or difficulty in managing tasks of daily living, to be just part of ageing. They may be more important than you think and may be treatable so it’s wise to have them checked out.

A regular visit to your health professional allows them to monitor your health over time, pick up on those overlooked issues, and where possible address them and treat them.

Firstly, be prepared. Prior to the consultation brief the practice nurse about anything that’s troubling you and that may impact on your health concern. Let the practice know if you have cold or flu like symptoms.

  • Write down and take a list of symptoms and medication you’re taking (or take the containers with you).
  • Take a support person if this would be helpful.
  • During the consultation be honest about your condition, ask questions if you don’t understand things and repeat information if you don’t think the doctor has heard it.
  • Make sure you understand what’s going to happen next and any instructions you’ve been given.
  • Be open to new ways of doing things e.g., seeing a nurse might actually be a better option than seeing a doctor.

All health professionals want you to have as positive an experience from your contact with them as possible. People who are informed about their health conditions and who are involved in decision making are more likely to comply with a health plan or regime and are also more satisfied with decisions that are made.

The way general medicine is practiced is changing. While its more understanding of the clients perspective and journey, it’s becoming more collaborative and inclusive of a wider range of health professionals. Increasingly sole practitioners are joining with other doctors/GPs and associated health related services to create health hubs. Many practices have set up processes to determine how urgent your situation is, who is best to see you at various times in your health journey, whether investigations such as blood test results, x-rays etc. are needed prior to your visit, so that when they meet with you, they are more informed and prepared.

You can also help by being well prepared.

  • Have a member of your family/whanau or a friend as support if you feel comfortable with them hearing and/or being part of the conversation. Two sets of ears are usually better for remembering what was discussed.
  • If you’re having problems at home, are under financial pressure, have housing problems, managing addictions etc. then you may not be in the best place to take on or follow through on what the doctor is telling you. Health professional need to take these into account when working with you, so tell the doctor, social worker or practice nurse at the beginning of the consultation if issues like these are concerning you.
  • Advise the practice (if you are visiting) if you have cold or flu like symptoms.

Write down and take a list with you of:

  • your symptoms and how long you've had them,
  • any medication you are currently taking (prescribed or otherwise), noting the dose and how often you take it, or bring the bottles (Your medication might be different to what your doctor believes you are talking.),
  • any questions you want to ask (its easy to forget them once you’re in the room).

During the consultation:

  • If your doctor/GP does not already know about your medical and family history, tell them. It is important information for them to know about.
  • Be truthful about your symptoms, any changes with other conditions and what’s going on for you. You might feel embarrassed, ashamed, frightened or nervous, etc., however, remember the doctor is a professional; you can talk in confidence. (It’s likely too that they have heard it all before. Knowing this can help you distance yourself from those feelings that might hold you back.)
  • Tell them also what you know, suspect, or have found out about your condition. (Some people are very informed about their condition/s before they walk in the door.) Doctors/GPs understand that you may have googled the symptoms and landed on a diagnosis which may of course, be wrong. Most doctors/GPs will appreciate that you want to be a participant in your care and will listen to what you say and then add their expertise and knowledge. This way you can work together more effectively. By better understanding your condition and possible treatment choices you’re more likely to feel in charge of your health and satisfied with the outcome.
  • If you don’t think you have been understood properly repeat it until you believe you have been heard.
  • Before you agree to any service or treatment you should always be informed about your condition, tests, and treatments etc. that might be needed and the pros and cons of any options.
  • Let the doctor/GP know if you’re unhappy with any part of the consultation including any advice or treatment.
  • Ask for a recap of what’s been discussed and/or decided so that you’re clear about what you need to do or what’s going to happen next, (if anything). Get clarification if necessary.

Finally:

  • Ask the practice manager to note any important religious or cultural beliefs you have.
  • Ask whether the practice provides access to a patient portal and if so, how you can access it. The patient portal gives you secure online access to view your own health information, increasing your ability to manage your own health care.
  • Telehealth or virtual consultations may be options for some people and some practices. If this type of consultation would work well for you, make enquiries.
  • Some doctors/GP or their associates, have gained additional expertise in specific areas e.g., diabetes management. If you believe their specialty applies to you or you would like to consult them, make further enquiries.
  • Remember doctors aren’t perfect. Like the rest of us they may need time to get things right for you.
  • If you are dissatisfied with your doctors/GPs advice or treatment you can ask for a second opinion.

A patient portal allows you to see your own health information. It is accessed via a secure website. While not yet available at all practices you can enquire about it. You can generally join up via your health care providers website or enquire about it when you next visit. It usually allows you to:

  • request repeat prescriptions
  • book appointments
  • see your lab results
  • see your GP's clinical notes
  • see your current diagnosis
  • see a list of your medical conditions
  • see a list of the medications you are on
  • see your immunisation and vaccination history
  • receive reminders and recalls from the practice team
  • send and receive secure messages to and from your GP or a practice nurse.

The greatest benefit of using the patient portal is that it helps you feel much more in control of your own healthcare. No longer are you a recipient but a participant in your own health care. It’s a big change in the way things have been done in the past and many people find it very empowering.

You’re right, yes the service you want is often located at your local public hospital, but not always. When a referral is made to them (usually by email or occasionally a phone call from your health service – you may also contact them yourself) a type of triage system swings into action. In order to decide how your needs might be best met you’ll need to answer some questions and possibly undergo an assessment. (See the section on assessments for more details.)

These services are known by different names, commonly NASC (Needs Assessment Service Coordination), Care Coordination Centres or Single Points of Entry.  Your contact for these services is shown here. 

It’s a timing thing really. Our community health services were quite fragmented in the past and it’s since been found that a collaborative community health approach usually works better for everyone. It’s likely these types of arrangements will become more common.

Our health system is undergoing major changes and more attention is being placed on staying well and avoiding hospital as much as possible. To do this community resources need to be used in a more effective way.  Over recent years many health professionals and other associated services have been working more collaboratively. In some areas this has resulted in the establishment of health hubs where a number of doctors and health services are now situated together along with others such as pharmacy, physiotherapy, blood services, perhaps even x-ray services.

Other models have also been developed such as HealthCare Home. “The Health Care Home model is designed to deliver an improved and more sustainable primary care service in New Zealand. It enhances a patient and whanau experience, creates a more attractive working environment for the workforce and supports better value for the health dollar.”          

Our health system and public hospitals

ACC is a no faults injury scheme in which ACC may pay for costs related to your injury. Following an injury it is important to speak to your health professional about making an application to register the injury with ACC. ACC will then decide whether to accept the claim. You will get a letter informing you of the decision. If you do not agree with the decision you can ask for a review.

Depending on your injury ACC may pay a proportion of medical costs, provide assistance with home help, special aids or equipment, transport, modifications to your house or car, education, training, therapy and support.

You may have to pay for some treatment before the outcome of ACCs decisions so keep receipts as you may be able to claim these back if your case is accepted. Use ACC approved providers for any services related to your injury. ACC will not make payment to non-approved providers.

Personalized, precision or functional medicine is a developing area of medicine where information about your genetic makeup helps inform your health professional about what’s required to keep you healthy and, if you are unwell, then what treatments and interventions might be most successful for you. It may also determine how well specific medication might work for you. It’s a bit like a health road map designed just for you. Ask your doctor or health advisor if you would like to find out more.

Hospital emergency departments are for emergencies. If it’s an emergency phone 111 and ask for an ambulance. If you’re near the hospital and the situation is serious but not life threatening you/the person may be taken by car to the hospital. (As long as the driver knows where the hospital’s emergency department is.) If you are unsure whether your situation is an emergency ring Healthline freephone 0800 611 116 and they will advise you.

You can go to a public hospital if you are seriously unwell, and it is an emergency. For all other times you need to be referred by a health professional, usually your doctor. Public hospitals are the main providers of emergency, specialist medical, surgical, and other specialist services in New Zealand and are not an alternative to your local doctor. Unless a situation is an emergency be guided by your doctor or after-hours clinic. If you are not sure whether your situation is an emergency ring Healthline freephone 0800 611 116 and they will advise you.

A list of Public Hospitals can be found here. https://www.health.govt.nz/your-health/certified-providers/public-hospital

Currently 20 regional District Health Boards (DHBs) provide or organise health services across the country. The way our health system operates and where attention is focused is about about to change. It is expected that the necessary legislation to support these changes will be passed in mid 2022. We will keep you updated.

In the meantime, the following applies.

  1. Primary and community based services are the services we are most familiar with, especially our local general practices. They are staffed by a range of health professionals including doctors, nurses etc. As these services are usually privately owned, they can set their own fees. Services may be government subsidised i.e., free, or low cost to those who meet specific criteria including their ability to pay. Other community-based services include physiotherapy, occupational therapy, pharmacy, home support services, residential care etc.
  2. Secondary services which include emergency services, specialist services including medical, diagnostic, surgical and some maternity services are based at the main public hospitals. Unless the situation is an emergency then a referral from a health professional is required. These services are generally free.
  3. Private hospitals offer surgical, diagnostic, and maternity services. These are available only to those who privately pay although there are a few exceptions e.g., some maternity and diagnostic services in some areas.

Note:

  • Phone Healthline freephone 0800 611 116 if you cannot afford a service and/or need advice.
  • The Accident Compensation Corporation (ACC) provides compulsory insurance cover for personal injury for everyone in New Zealand, whether a citizen, resident, or visitor. Depending on your injury ACC may pay for some of your medical costs, other injury related costs and for approved support.

Transport

Transport is a critical part of staying connected. Remember in your early years when you didn’t have a license yet? While none of us want to go back to those days, the problem solving we used then, might be worth reconsidering now, particularly if you consider that the  benefits of getting out outweigh the alternatives.

  • Accept offers of a ride. There are often people who are happy to take you along too if you’re both going to the same place.
  • SuperGold Cardholders can get free off-peak travel on public transport in many areas around New Zealand and while buses in particular aren’t always convenient they are a reasonably priced option.
  • Do you qualify for the ‘Total Mobility Scheme’ which offers cut price taxis and transport services?
  • Taxis, specialised driving services or Uber have the benefit of taking you door to door.

Interestingly, all these options are cheaper than running and maintaining a car.

Technology

Technology is great these days and many modern devices have ‘leapfrogged’ the need to know how to really ‘use’ a device and are now quite intuitive. Simple smart phones and basic tablets often are all that’s needed. Contact your local SeniorNet to see if your relative can go and try some devices locally before committing to purchase.

Not everyone wants to go online. You can obviously see the benefits (and are likely to be able to manage the disadvantages) but as you have found, your enthusiasm isn’t contagious enough for him to make the move.

There are a number of reasons why people don’t want to go online, such as cost, security issues, physical constraints such as eyesight, concern about their ability to learn the necessary skills etc.. Sometimes too, it’s absolute disinterest and sometimes it’s a timing thing.

Respect his decision, let it go but keep an open mind being prepared to assist should he change his mind in the future. When older people see more of their friends gaining these skills it often gives them the confidence to give it a try too.

Physical health

Latest information seems to show that, for the majority of us we experience some cognitive decline as we get older and surprisingly this often starts in our 20s. A smaller number of people appear to have some protective features that prevent decline. For everyone however, regardless of which category they fall into, there are things we can do to keep the brain in good functioning order – it’s the healthy lifestyle.

“As we age, the volume of the brain shrinks, neuronal networks operate less efficiently, neurons and synapses are lost, changes in cerebral vasculature and metabolism occur and inflammation levels in the brain increase. The way we live also changes as we age; physical activity often decreases, social networks may become smaller and many people are less cognitively active once they retire. These physiological and social changes begin in our 20s and 30s, collectively resulting in noticeable alterations in cognitive function in the decades that follow.” 

A car that runs well, is looked after. So too with us; how we function depends on the maintenance of the vehicle that carries us along. While our genetic makeup and our past lifestyle plays a part, there is a lot that can be done to not only maintain our health and wellbeing and in some instances, we may actually be able to improve it. Whatever you do, the message is to stay active in all spheres of your life and retain as many skills as you can.

Nutrition. Healthy eating is a major factor in keeping us well. Our appetite may decrease as we age but it is still important to eat three meals a day, healthy snacks and foods of high nutritional value. Planning, preparing and cooking meals and keeping regular mealtimes are important for retaining skills and bringing routine to your day. Share a meal with others if you can. This has health benefits as it seems to make the food taste better, you eat more and make better nutritional choices. If you need help with meals, you may be able to access home support services or Meals on Wheels, or you can buy readymade meals from specialist providers or your supermarket. Your local health service may provide occupational therapists to advise you about specialised equipment for use in the kitchen, and dietitians for nutritional advice.

Exercise. The type of exercise most suitable for your body type may be very different to that which is best for your friend; some of us are built for endurance while others are built for short sharp bursts. Whether you have any health conditions also needs to be considered. What’s safe for one person may not be for another. That why information about many exercise programmes warn us to ‘Check with your doctor first to see if this is right for you’.

It’s common nowadays to see older people at the gym, in the swimming pool, out cycling or in a walking group. These people have discovered the benefits of exercise. Their health and mobility improve, they feel better, they sleep better, their mood is brighter, they stay in touch with their community and they’re having fun. They are doing things that help them stay independent.

High Intensity Interval Training Evidence is emerging that High Intensity Interval Training (HIIT) can benefit many older people. If you are considering a new exercise programme such as this, ask your doctor or sports medicine expert about it to see if it’s right for you.

Bone health. As we age, we can maintain and build bone density. Good bone density means that your bones are less brittle and more resistant to breaking. Retaining bone density is especially important for women, who are more prone to brittle bones. Strength-building and weight-bearing activities such as weight training, walking and heavy gardening help build bone density. Research shows that a bone-healthy diet can also be effective – eating lots of leafy greens (both raw and cooked) and high protein and calcium-enriched foods may be helpful. Some people have great faith in supplements for building bone health. If you want to take these, it’s advisable to talk to your doctor or health advisor first.

Foot care. Ensuring your feet are well cared for is important for maintaining mobility. If you suffer from foot pain or problems, you should consider seeing a registered podiatrist for treatment.

Eyes, ears and teeth? See the next questions.

Brain health. Exercises and activities that are good for the heart are good for the brain. Do word and number puzzles, use written and spoken language, go to cultural activities, be creative and do household activities. Have a healthy diet and drink plenty of water. Get regular health checks including blood pressure, cholesterol, weight, hearing and sight tests. Protect your head – reduce the risk of falls at home.

Sexual health. Older people are not immune to sexually transmitted infections so if you are sexually active use recommended precautions and protections. Sexual activity as we age is as varied as the individuals we have always been; some will and some won't be having sex at any given stage of life’s journey.  

Emotional health. Look after your emotional health and maintain your social networks.

Don’t dismiss the value of keeping a pet for company. They help to keep their owners active, bring meaningful activity into the day and keep their brains sharp, all of which improves quality of life. Sometimes caring for a pet can become too difficult. If this becomes the case, adoption is a good choice. If you can’t arrange this within your network, ask your local SPCA for advice.

Alcohol. We used to think having a little drink was relatively harmless. It turns out it’s not. Many people are unaware that as we age our bodies are less able to to cope with alcohol. It affects cell repair, can alter the effect of medications, and worsen medical and mental health problems. Drinking less is always a good choice.

Your medication. Taking medication incorrectly can be more serious than many people realise. It’s often a factor in hospital admissions of older people. Some people have a confusing number of pills to take. Others may not know what their medication is supposed to do, how long they should take it for or what the side effects may be. This can be compounded by eyesight problems and other disabilities. It’s therefore not surprising that mistakes are made. Talk to your doctor or pharmacist about your medication so you understand it, and inquire about medication management systems or services that might help.

Our eyes and ears can be indicators of our health and may be more implicated in wider health issues that was previously thought.

Hearing

Good hearing has a far greater impact on our health than has previously been understood. Research suggests a link between hearing loss and mental decline and a risk of dementia. It is important therefore to get regular hearing checks and any recommended hearing aids if needed. Independent free hearing tests are available from Life Unlimited Hearing Therapy Services, which is publicly funded (freephone 0800 008 011). Many hearing clinics also offer free basic hearing tests and promotional offers.

Eye sight 

Your eyesight is valuable, and its loss can be traumatic. Even if you already see an optometrist you should request a full, dilated eye examination every two years. Preventable conditions such as macular degeneration and glaucoma can strike without warning or symptoms. Some degenerative brain conditions can also be picked up, allowing for early diagnosis and treatment that can delay their progression. Protect your eyes from sunlight too as this is a major cause of eye complaints.

Having good teeth as you age not only means you look better, can smile freely but you probably chew and enjoy your food more too. The dental health of older people has attracted more attention these days as the potential impact of poor oral health on our general health is under the microscope. Some studies show suspected links between poor oral health and poorer health outcomes. While there is plenty of information online about oral hygiene, with recommendations to see your dentist regularly, sometimes the damage has been done and you can’t afford the dentist. So, what to do?

This information on the government website explains that, depending on your situation, you may be able to get assistance with treatment and/or these costs. Ask your dentist if there are reduced fees for those with a Community Services Card or Gold Card. 

In our opinion, and given the implications, we think the cost of dental care should be included in general health provisions (as for general practice).  

  • Exercise,
  • Get enough sleep,
  • Stay connected with other people,
  • Keep your brain active,
  • Eat a healthy diet,
  • Stop smoking and reduce alcohol,
  • Manage your health conditions and regularly review your medication with your doctor.

Exercise needn’t be a burden. Many activities that you do each day as part of your routine may in fact be exercise. A good day in the garden will let anyone know that they have been exercising but even more gentle daily activities such as taking a brisk walk or playing with the grandchildren are sufficient to maintain a good state of fitness.

Many local authorities run exercise programmes for older people which include activities such as gym, exercise groups, swimming and pool jogging, yoga, bowls, walking groups, Tai Chi etc. The general rules are ‘Stay Active’ and ‘Use it or lose it’. Start exercising slowly and build up to a level you can sustain.

A regular exercise routine that totals 30 minutes per day brings real health benefits. The benefits of exercise include; improvement in mobility, improvement in mood, lowering of blood pressure, reducing risk factors associated with heart disease, maintenance of bone strength etc.

See your doctor if you experience any unexplained pain or shortness of breath during activity or if you are unsure what amount of exercise you require.

 

Mental wellbeing

Socialising improves our mood, our mental health, and indirectly our physical health. On those counts alone it’s worth it.

Perhaps you’ve lost a partner, or friend who used to accompany you or who you used to meet up with. Just getting out gives you yet unknown opportunities that you wouldn’t have if you stayed home. Being prepared to be a friend to someone else in a similar situation, increases the friendliness quotient in your community making it a nicer place for everyone.

Do you have a low mood, is there an untreated medical problem, or are you having hearing and visual problems? Check in with your health advisor if you haven’t already. During the consultation you may be referred for an assessment (see the article on assessment) or a Green Prescription given i.e., written advice about the type of physical activity suitable for you. Strength and balance classes are perfect opportunities for meeting people with the added benefit of helping you stay as fit as possible.

If disability issues are holding you back it could be useful checking out mobility and equipment providers. There are usually samples of mobility aids and other equipment in stor. The most helpful shop assistants or mobility advisors are those who make sure that equipment is right for you and that you can use it safely. Ask whether you might be eligible for subsidised equipment.

If transport is an issue, be willing to accept an offer of a lift. It gives others a chance to be a helpful neighbour or friend.  If necessary, make use of specialised driving services such as those listed on this website.

Support at home

The government’s consumer protection website advises the following to those who engage a tradesperson:

  1. Get estimates and quotes
  2. Check your tradesperson is registered
  3. Ask the right questions
  4. Make sure the brief is clear
  5. When the work is complete – get the sign offs, warranties/guarantees, and keep the compliance certificates and relevant documents such as receipts.

Some Age Concerns have lists of trusted local home maintenance and tradespeople, so enquire there. Sometimes a recommendation from a friend is a perfect solution, especially for the smaller, less costly jobs. Remember the above advice. It still applies.

There are websites too, some of which are New Zealand based and others overseas based, that offer a matching service where you place a job, and the tradespeople come back to you with a quote. You may get many or few responses. Before committing to these services, be mindful of the advice above, read reviews of the website and the reviews of individual tradespeople. The lowest price may not mean the best service. If you feel anxious about this, get a friend or family/whanau member to go through the process with you – from beginning to end if necessary. 

Generally, when someone has had surgery and there are no indicators that they have a long-term disability then the type of support they might get on discharge is short term, perhaps for about six weeks. Sometimes it might be shorter or longer. If this hasn’t been arranged for you, ask about it. Assistive equipment may also be available on short term loan. (The type of support you get may vary if your surgery is ACC related.)

The purpose of the assistance is to help you get your confidence back and to make sure you get back up on your feet again and are safe doing so. You’ll find you will make great progress in that time although full recovery after surgery often takes a long time.

If you require ongoing assistance after that period an assessment will be done to determine what your needs are.

If your home isn’t set up with safety equipment it’s a good time to review this when you get home. Nonslip shower and/or bath mats, and grab rails in both the toilet and bathroom are sensible measures at any time

Housing options

Downsizing usually means moving house, and regardless of age is a challenging time. There are plenty of things to consider and it’s not a decision you should rush. First, ask yourself…

  • What is the cost of staying?
  • And the cost of moving? (It’s likely to be much more than you think.)
  • Is this the right time to be making this decision? (It’s best to plan ahead when things are settled, not if you’re grieving or in crisis mode.)
  • What do you like and dislike about the options you are considering?
  • What services and support can you get now and what could you get if you were to move? (e.g., family/whānau, friends, access to health services, chemist, shops, home support services, interest groups, recreational areas and other important places.)
  • If you don’t do anything, what is the worst that could happen?
  • Are you just ready for a change?

Downsizing options may include: moving to a smaller place, getting an ownership flat or 60s plus unit, sharing accommodation, moving in with family or to a suitable cottage on family property, moving to supported living or a retirement village. All options have their pros and cons.

Moving home is stressful, even if you’re looking forward to it. Older people commonly find themselves considering such a move after a health crisis or the death of a partner. The ideal time to make big decisions is not when we are grieving or in crisis. Sometimes added pressure comes from family/whānau or friends who, with best intentions, suggest you move into a retirement village or get a smaller house. The best way to avoid making decisions under pressure is to plan ahead. Figure out what’s important to you.

Your friends will have had their own reasons for downsizing and your family/whānau well-meaning, however your decision is best based on your own circumstances.

Goodhomes, a New Zealand service, is a great place to start. Their information toolkit My Home, My Choices – Ngā Kete o te Whare, gives people lots to consider when deciding whether to stay in their current home, or to move. Their service also provides lots of information about home repairs and maintenance.

Good house design nowadays incorporates accessibility, adaptability, useability, suitability, and safety features. Know what to look for. See: https://www.lifemark.co.nz/useful-tips/(see homescore) and https://goodhomes.co.nz/

Staying put

There are often benefits in staying in a place where you are known, especially if you have the support of people who are important to you and/or those in your community. Equipment and/or adaptations to the home can make it safer and easier for you to live there.

Downsizing

Moving to a smaller place may be a good answer if your home is no longer suitable due to its location, stairs, too many rooms or garden too difficult etc. Downsizing doesn’t necessarily give the gains you might expect, e.g., your choice of home may be newer and require less maintenance so whilst it might be smaller it may cost more. Investigate fully and do the sums. If you own your home and the sale price is likely to be much more that the new home, this may be an opportunity to release equity to improve your lifestyle.

Ownership flat or 60s plus unit

Moving to an ownership flat or 60s plus unit is a compact option and, if it’s relatively new, usually has the advantage of being easily maintained. Over-60s units offer cluster-type housing. They usually operate on a body corporate model where you have unit title. Intending residents must meet entry age requirements. Check for annual costs such as rates, insurance and body corporate levies. You’ll probably be relatively close to neighbours and this has pluses and minuses

Sharing accommodation with people other than partners

This flatting-type of arrangement seems to appeal to friends or brothers/sisters. Financial arrangements vary widely from joint rental, unit title vested in one person, tenants in common etc. Expenses and household tasks are usually shared. Generally, each person has their own private space with some common areas. Some people also take in boarders. Clear house rules are important for the success of this option.

Moving to a ‘granny’ type cottage on family land

These cottages are usually on a family/whānau property, allowing you to live near to family yet independently. The purchase price is generally much lower than other housing options. To be suitable for older people these homes need to be self-contained, safe, easily accessible, and warm.  Most are transportable. Contact the local council regarding consent.

Moving in with family/whanau

Moving in with family/whanau or them moving in with you can work well for those where: there are shared values and culture, everyone is respectful of one another and where clear, open communication is practiced.

Moving into a retirement village

This is an increasingly popular option for those looking for age-friendly homes and lifestyles. Pricing options vary considerably. www.retirementvillages.co.nz provides extensive information.

Private rental

While many older people own their own home, an increasing number now rent. Given New Zealand’s housing crisis just finding a home is the most pressing issue for many people. This urgency can leave people feeling vulnerable and with little choice. The law governing rental properties changed in 2020 and 2021 giving more security to tenants. To understand what it might mean for you see https://www.tenancy.govt.nz/law-changes/  New Healthy Homes Standards are also being applied from 2021-2024. If you do have some options for renting, try to make sure your landlord is someone you can have a good working relationship with. For market rental rates see: Tenancy services.

Supported living/boarding

These are often family/whānau style homes where residents are independent yet able to live harmoniously with others. Each resident has their own room/unit, with shared communal areas. Because of the supported nature of this housing option there may be help with some tasks, e.g. housework or meals. Board or a weekly rental usually applies. An example of such housing is an Abbeyfield home. Abbeyfield have carefully thought through their model making it a sought after option. It would be fair to say there aren’t enough Abbeyfields to go around. A few residential care facilities in New Zealand also provide supported living in houses adjacent to the home.

Public housing

Finding suitable and affordable public housing can be difficult. There are often shortages of houses and strict criteria around assets, income and need apply. Kāinga Ora is the government agency responsible for housing. Public housing may also be provided by your local council or religious/ welfare organisations such as RSA or Freemasons. Contact Age Concern for information about housing availability in your area.

  1. Take a piece of paper and draw two columns down the page.
  2. On one side make a list of the things that are a problem with your current situation. (If you want to, ask the family to contribute to the list too.) Examples of what you could put in the list include: poor bathroom design, narrow doorways, uneven or slippery paths, garden too difficult, clothesline access is tricky, too many steps etc.
  3. You could rank them according to how worrying each of them are.
  4. On the other side match each problem with a possible solution e.g. remodel bathroom or get some rails fitted, widen important doorways if possible, redo paths, put large parts of the garden into grass and get a gardener, take a different route to the clothes line or use a rack dryer, install a lift or ramp etc.
  5. Turn the paper over and write down all the things you love about where you live. Include things like memories, friendships, proximity to important places and shops etc.
  6. What does it look like? You’ll pretty much have your answer in front of you.

Legal & other related issues

From 7 November 2021, those over 18 who experience unbearable suffering from a terminal illness will be able to legally ask for medical assistance to end their lives (under the End of Life Choice 2019 Act).

The legislation sets tight controls about who can access the option but the crucial term here is ‘unbearable suffering from a terminal illness’. This means that to be eligible for assisted dying, a person must be already dying; therefore, normal or chronic illnesses or diseases as a result of old age – including depression – would not meet the requirements.

The other important thing to remember is that the decision to receive assisted dying is entirely your friend’s. They should never feel pressured by anyone including a friend, family member or health professional.

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.

The End of Life Choice Act 2019 comes into law in New Zealand on 7 November 2021. From that date, those over 18 who experience unbearable suffering from a terminal illness will be able to legally ask for medical assistance to end their lives. The legislation sets tight controls on who can avail themselves of the option.

The decision to receive assisted dying is entirely yours. This is a big decision so it’s highly likely you may want to talk to a close friend, family member or trusted health care professional – although it is completely up to you. You should also never feel pressured by anyone.

If you have decided that this is the right option for you, you must first raise the subject with your doctor as they are not permitted to raise it with you. If you find that your doctor is unwilling to assist you through this journey, you have the right to choose another one who will help. You can find detailed information about your rights under the Act on the Ministry of Health website. You can also change your mind at any time.

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.

Enduring Powers of Attorney (known as an EPA or EPOA) are legal documents that allow you to appoint someone you trust to make decisions for you if you are no longer able to do so yourself. There are two different kinds of EPA/EPOA: one for personal care and welfare matters; and one for financial and property matters. 

It’s great that your trust your family members; you can appoint one or more of them to be an attorney (as the tasks are often quite diverse, you may want to choose more than one) but they do not need to be the same person.

Others may not want to appoint family members however, for a variety of reasons. The truth is that not all family members see eye to eye about every issue. Before you choose someone, talk with them first about what your expectations would be for your personal care/welfare and financial/property matters if someone were to speak on your behalf. These can be difficult conversations, but they are important ones to have. 

You could choose a close friend or even someone independent (such as specialist lawyer, accountant or trustee company) to act on your behalf instead. The important thing is that you choose people you trust to do the right thing by you. As circumstances can change, you should also appoint successor attorneys; that is, a person or people that can step into the role if your original attorneys are unable or unwilling to act for you.

If you lose mental capacity and you have not appointed an EPA/EPOA, your family or others concerned with your wellbeing must make an application to the Family Court for the appointment of a person or persons to act for you. This process comes with an emotional and financial cost, is complicated, must be repeated at prescribed intervals, and there is no guarantee that the person appointed will be the one you may have preferred as your attorney.

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.

Enduring Powers of Attorney (known as an EPA or EPOA) are legal documents that allow you to appoint someone you trust to make decisions for you if you are no longer able to do so yourself. Some people set an EPA up when they buy their first home or start a family for example, but there is no time like the present. 

There are two different kinds of EPA/EPOA: one for personal care and welfare matters; and one for financial and property matters. You can appoint a family member, trusted friend or an independent person (such as a specialist lawyer, accountant or trustee) but they do not need to be the same person.

For your personal care and welfare, you can appoint only one person/ attorney at any time. You cannot appoint an organisation to act in this role. An EPA/EPOA in relation to your personal care and welfare can be activated only if you lose the mental capacity to make your own decisions. The law says you are presumed to be competent, or mentally capable to make your own decisions, unless an assessment by your GP or another qualified health practitioner shows otherwise.

For financial and property matters, you can appoint one or more attorneys and you can specify how and when they will act. If you want someone independent, you can engage the services of a specialist such as a lawyer, accountant or trustee company. A finance and property EPA/EPOA can be set up to be used by your attorneys while you still have mental capacity or to come into effect only if you lose that.

The legislation includes many safeguards, and the rules about how your attorneys can operate are well defined:

  • Attorneys can be restricted as to what property and personal matters they can and cannot act on.
  • Your attorneys can materially benefit from their role only if you have made provision for that.
  • Your attorney must consult with any other attorneys you have appointed. This gives more oversight and is a good reason to appoint more than one.
  • You can revoke your attorney, unless you have lost mental capacity.
  • The attorneys must provide information to others if they request it, if they have a right to see it (your accountant or doctor, for example) and if you have made provision for that.

You should also appoint successor attorneys. These can step in if the original attorneys are unable or unwilling to act for you.

Once the EPA/EPOA is in place, give your attorneys, successor attorneys, doctor, accountant, bank and family copies of the relevant documents. If you move into residential care or a retirement village you will be asked for these documents. The EPA/EPOA needs to be activated for those going into dementia or psychogeriatric care.

You will need a special EPA/EPOA form. Those who are advising you can supply the form, or it is available online from the Super Seniors’ website (search ‘EPA’). Read through the forms before you have any meetings, to ensure you’re well prepared (and to save time and money). Your signature on the form must be witnessed by an authorised witness; they need to certify that you understand what you are signing and what the risks are, and that you are not being pressured.

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.

A Will is an important document as it allows you to stipulate what happens to your estate after your death. It is advisable to consult a specialist when looking to make a Will. Ask about the cost; some organisations or lawyers may do this for free if they are also named as the executor of the estate. However, often administration costs are more than if you had paid for this in the first instance.

You can also make a ‘do it yourself ’ Will (such as via the Public Trust website), but you need to investigate this fully and comply with certain criteria in order for it to be deemed valid.

To be considered valid, a Will must be written by someone of sound mind who is not being coerced or unduly influenced. It needs to be signed by the person making the will and dated and witnessed by at least two people who are not beneficiaries of the Will.

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.

If you die without having made a Will, your property is distributed according to the terms laid down in law, which may not be as you would wish. This is usually more costly to your estate and a slower process. The people you care about most may not be looked after, and it could take a long time and cost a lot of money to resolve matters. This could cause extra distress for your loved ones, during their time of grief.

Having an up to date Will allows for the administration and distribution of your estate (everything you own) after your death. It is important you do this so your wishes are known.

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.

It is recommended that you review your Will every year to ensure it’s still up to date. If your circumstances have changed, you should definitely make changes to your Will. This could include a change to your relationship status (leaving a relationship or beginning a new one), an addition to your family (such a s a grandchild), the purchase of any appreciating goods, or a beneficiary named on your Will has changed their name or passed away for example.

Note: your Will is likely invalid if it hasn’t been signed and witnessed correctly or if it hasn’t been updated since remarrying. There are other circumstances where your Will may be invalid too – see the Public Trust website.

It is advisable to consult a specialist when looking to make a Will. Ask about the cost; some organisations or lawyers may do this for free if they are also named as the executor of the estate. However, often administration costs are more than if you had paid for this in the first instance. You can also make a ‘do it yourself ’ Will, but you need to investigate this fully and comply with certain criteria in order for it to be deemed valid.

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.

Financial information older people should consider

The financial world is evolving and as we age, we will come across situations we may not be ready for, such as how we access our money, where it’s held and how we can use it such as, the changes to banks and banking processes, cryptocurrency etc.. Some will remain in paid work after retirement age, some will want to pass on an inheritance, some will want and can afford specialised financial advice and others won’t. What we have in common is wanting to spend our later years as financially secure as possible.

As we get older our financial goals change too, so how we organised things in the past may not work now. Each person’s circumstances, financial situation and the management of their affairs is unique. Some may find that ageing has affected their attention to detail and ability to understand new concepts. If so, then perhaps it’s time to simplify, centralise and make a plan for the future. If you’re familiar and confident with managing your own finances however and the environment in which you do so is relatively stable, then it’s likely that you will want to continue doing this.

This overview gives you the opportunity to consider your future financial planning. It is not personal advice.

Bank branch closures and the phasing out of cheques. Banks have closed many of their branches over recent years. They are also phasing out cheque use without having fully prepared for solutions or alternatives for all their customers.  Some banks are committed to some extent to improving services for older people. Westpac for example is rolling out a dementia-friendly service in branches around the country. If these banking changes have disadvantaged, you contact them to find out how they propose to provide for banking services and support for you.

Budget advice and day to day expenses. Many older people struggle to meet rising housing or living costs or have other obligations that make it hard to manage. If you are in contact with a budget advice service, more discretion may be given if you get into hardship.

Donations and bequests. Charitable organisations often rely on donations and bequests and many older people like to assist their favoured charity in such a way. If you plan to leave a large bequest it’s wise to let family/whanau know.

EFTPOS cards Many cards now have a payWave function (the card has a fan symbol on it). This allows you to make purchases up to a set limit by resting your card on the EFTPOS terminal. It makes everyday purchases easy but is easy money if it falls into the wrong hands.

Credit cards. These allow you to borrow money from the issuing financial institution/bank. You have to replay the money with interest. General advice about these cards is to pay back the amount owed at the end of each month. The Sorted website has great advice.

Debit cards. These allow you to draw down your own money to pay for things and to make online purchases. You don’t pay interest as this is your own money.

Equity release or ‘reverse mortgages’. These may free up capital (see the article on this).

Gifting or helping family/whānau out. Be careful about giving financial gifts; you may need the money yourself. Being a loan guarantor for family/whānau members is risky. While a gift seems safer, in the event of a relationship breakdown your family/whānau member could lose half. A loan may offer more safeguards as written terms can spell out repayment expectations. Keep in mind; if you ever need a Residential Care Subsidy your ‘gifting’ will not be overlooked and may impact on your plans later. Get financial advice.

Investments and assets. You may wish to rationalise or review these, especially if your circumstances have changed.

Kiwisaver. Once you reach 65, your employer does not need to contribute to your fund but you can do so. As your circumstances change it’s a good idea to review whether you are comfortable with your fund’s risk level, and whether you wish to withdraw some of it. Careful consideration is needed. 

Managing debt. Increasingly, older people are entering retirement with debt, often after helping out other family/whānau members. Debt can quickly escalate so get financial advice.

 Monitoring your bank account. Check your statements each month. Watch for spending discrepancies, cashflow and automatic payments. You may find it helpful to ask a trusted family/whānau member or your Enduring Powers of Attorney for Property to do this with you.

In general, make a plan for the future. The New Zealand Society of Actuaries has devised Decumulation ‘Rules of Thumb’ that are useful for those not getting specialist advice. See www.actuaries.org.nz  

Centralise information about your financial matters, plan for the unexpected, develop a plan for transferring responsibility if/when required (involving trusted advisors/Enduring Powers of Attorney, partner/spouse/children) and make sure any partner/spouse/children or others who need to know, understand your financial situation.

The Sorted website has a number of tools to help with your financial planning. 

Home Equity Release (otherwise known as a reverse mortgage) allows older people to access the capital they have in their homes. Many are asset rich but cash poor and could enjoy a better life if they were happy to borrow on their home. There are fishhooks though. Financial advisor Martin Hawes explains.

Some worry about the interest rates these schemes charge, that people could end up losing their homes or significantly reducing their future options. Can you comment?
It’s true, borrowing using home equity incurs greater interest, usually about 2% above variable mortgage interest rates. This is because the lender is not getting payments in cash; rather, they will have to wait until the property is sold. There is also more uncertainty for them. All reputable Home Equity Release lenders will give you a ‘No Negative Equity Guarantee’ so that at no time will you be required to leave your house or your estate be forced to surrender any other money to the lender. If you draw down on your house, your children interest will compound, adding to the total debt to be repaid. Your options can indeed be limited. For example, should you move to a retirement village, you will usually find lenders do not lend on Licence to Occupy premises, which is the most common type of tenure in villages. If you need equity to fund aged residential care, some village operators may offer assistance.

What happens when someone has drawn down an amount under an Equity Release and later wants to move house, perhaps downsizing?
As long as there is enough remaining equity, you could transfer the amount to the new house. However, it would be more likely that the borrower would repay what is owed because freeing up some cash would be one of the purposes of the downsizing and it would make financial sense to use some of that cash to repay the loan.

What do people use them for?
Lots of things. Home repairs and maintenance, access and safety upgrades to the house so they can stay there longer, buying in more care assistance, replacing a car, medical or surgical treatment, or on visiting family/whānau.

What else do you advise?
You should discuss this with your family/whānau or advise them of your intentions, to avoid any potential issues in the future. In any event, older people should not feel guilty about not leaving an inheritance. After all, it is their money. Before signing with a lender, you should get some advice from a lawyer.

Finally, what do you think about older people borrowing from their families, with their home being the security?
Yes, I like children standing in for the bank but it has to be agreed to by the whole family/whānau and then very well-documented. Again, you should see your lawyer.

 

CASE STUDY: MRS G
Mrs G, an 87-year-old widow, owns and lives alone in her own home. It is worth around $595,000. She has no car and $10,000 in savings. Mrs G has been assessed as requiring a high level of care and receives publicly funded support as well as assistance from her daughter, Susan, who works and lives on the other side of town. Susan is no longer able to help. A reassessment is done and resthome care recommended. Mrs G doesn’t want to live with her daughter or go into a rest home (about $1150 a week). Susan wants to support her mother’s decision. How can Mrs G structure her finances to achieve her goal?

Martin Hawes says: Mrs G could stay at home and use a Home Equity Release to pay for additional care. Withdrawals are structured according to each bank’s level of lending. Depending on the age of the borrower, this could be 20% to 40% of the home’s value. The loans often allow smaller amounts to be drawn down as needed. Over time Mrs G could spend down to the Residential Care Asset Threshold (page 153). Under the residential care means testing regime she would have to spend down to this anyway to be eligible for a Residential Care Subsidy. With agency-supplied help costing $1000 a week, it would take about seven years to spend down to the threshold. Mrs G should hold on to the $10,000 for emergencies.

 

Disclosure: Due to his support for Equity Release, Martin Hawes has been a paid speaker at seminars run by Sentinel and Heartland Bank, previous and current suppliers of this product. He receives no ongoing remuneration. This article is class advice, not personal advice. Martin recommends you take professional advice for your own situation. Martin is Chair of the Summer KiwiSaver Investment Committee. Summer KiwiSaver is managed by Forsyth Barr. A Product Disclosure Statement is available on request. www.martinhawes.comor those who might inherit will receive a lesser amount. Remember it’s not just the capital you draw down that must be repaid.

Useful equipment

There is some Ministry of Health (MOH) funding available for hearing aids. There are two funds. Access to these funds is based on the type of hearing loss you have and your circumstances. There might be other options if you do not meet the MOH criteria.

MOH assistance for hearing aids

  • Hearing Aid Funding Scheme
  • Hearing Aid Subsidy Scheme

Your eligibility depends on what type of hearing loss you have and your circumstances.

The subsidy scheme may be available if you do not qualify for the funding scheme. The subsidy for each aid of $511.11 (inc. GST) is available only via an approved assessor every six years.

If you do not qualify for either of these schemes but meet other criteria, you may be able to get help towards the cost of hearing aids through ACC or Veterans’ Affairs.

Many people are not aware of the equipment and mobility solutions on the market. You may only need one or two pieces of equipment to make all the difference between managing and feeling unsafe. Find out as much as you can. Ask your friends and family, go online, get brochures and visit a mobility shop. The disability equipment sector is very innovative so you may find there’s something suitable for you and your situation that you’d never thought of.

If you meet eligibility criteria some equipment or home modifications may be subsidised. An assessment is involved. It’s worthwhile going through the process as it helps you understand the sort of equipment that might be useful for you too. The assessor may also be able to tell you about other things that might interest you too e.g., fun exercise programmes to help you build your physical fitness.

We suggest visiting a mobility and equipment shop first; just to get a broad idea of what might be available. You will find some mobility and equipment providers on this website.

Unless you are requiring equipment from ACC as a result of an injury, then the Ministry of Health (MOH) Equipment and Modification Services are likely to be the services you are referred to or who you can contact. To qualify for subsidised equipment from these services, a specialised assessment by a suitably qualified health professional is required to access loan equipment and home modification services. Contact equipment provider Enable, freephone 0800 171 981 or your older person’s service/NASC for advice.                          

Loan equipment

To be eligible for MOH loan equipment you must:

  • have a disability that will last longer than six months,
  • need specific equipment to help you manage,
  • meet residency requirements, and,
  • not have access to other funding, such as ACC.

Items that costs less than $50 are generally not part of the loan scheme and if you want them you will have to buy them.                    

Home modifications

While modifications to the home, such as changes to a bathroom, putting in a ramp or domestic lift are often useful, you will probably have to pay for these yourself. The qualifying criteria for home modification services is tight and if approved the ‘wait time’ can be significant.

If you can afford it, buying your own equipment or arranging your own home modifications is often a faster option that gives you more choice. Get expert advice. A good retailer will assess your ability to use equipment correctly and safely. Not all equipment suits all people.

Palliative care provisions

You may have access to specialised equipment if you are receiving palliative care.

Organisations such as the Lottery Grants Board may fund scooters or other aids.

Rights

When receiving a health or disability service you have the right:

  • To be treated with respect.
  • To be treated fairly without pressure or discrimination.
  • To dignity and independence.
  • To receive a quality service and to be treated with care and skill.
  • To be given information that you can understand in a way that helps you communicate with the person providing the service.
  • To be given the information you need to know about your health or disability; the service being provided and the names and roles of the staff; as well as information about any tests and procedures you need and any test results. In New Zealand, people are encouraged to ask for more information to help them understand what is going on.
  • To make your own decision about your care and to change your mind.
  • To have a support person with you at all times (rare exceptions).
  • To have all these rights apply if you are asked to take part in a research study or teaching session for training staff.
  • To complain and have your complaint taken seriously.

 

If you have concerns about any of the services you are receiving, you have a right to complain. Advocates and advisors are there to help you through the process. You don’t have to put up with a service you’re not happy with.

Problems can arise even with the best services due to misunderstandings or miscommunication. That’s why there are mechanisms and procedures you can use if you are at all dissatisfied with the service being delivered. You have a right to complain and to have your complaint taken seriously. The Nationwide Health and Disability Advocacy Service is part of a group of consumer protection measures provided by the Health and Disability Commissioner Act 1994. It is for all users of health and disability services in New Zealand.

The service provides independent health and disability advocates all over New Zealand.

Their role is to inform consumers about their rights when using health and disability services, helping consumers who have concerns and want to make a complaint, and offer education and training about consumer rights and provider duties to the providers of health and disability services.  

The service is free, independent and confidential. Community visits are made to areas where there is no advocacy office. Freephone 0800 555 050, visit the website, or email advocacy@advocacy.org.nz

Scams and other worrying things

Common sense and a healthy dose of scepticism can keep you safe from those who want to rip you off. If an offer seems too good to be true, it probably is.

Being fearful of others can lead older people to isolate in their homes. Fear of being scammed can do the same, or lead people to shun the internet, email and other new ways of communicating and staying in touch. Yes, scammers are out there. But common sense and a healthy amount of scepticism can keep you safe from those who want to rip you off.

There’s lots of help available – check out The Department of Internal Affairs, Consumer NZ and the Commission for Financial Capability's Little Black Book for a start. Boiling all the advice down to one thing, it’s quite simple – if it seems too good to be true, then it probably is.

Some scammers deliberately target older people, either by door knock or phone call. Their stories may target your needs, worries, or desire to help a seemingly worthy cause.

Romance scams in particular are cruel and insidious, playing on someone’s sense of loneliness and their desire for companionship. Having established trust, the scammer will ask for money under some pretence, or for help with banking transactions that may in fact be money laundering.

Scammers grow more sophisticated the more that authorities expose their ruses. The level of sophistication can take in even the most wary, so there is no shame in admitting you have been duped. In fact, reporting scams is the best way to ensure they are closed down, as authorities can issue warnings and take steps to block the offenders.

Awareness is our best defence, and we can all play a part in spreading the message. Raising the subject with friends and family is a good place to start – it’s highly likely people in your circle have been targeted by scammers, if not taken in. Forewarned is forearmed, and sharing these stories helps us all to remain vigilant.

In brief - Consumer NZ's Top Tips
  • Never reply to any email asking you to confirm your bank or credit card details. Legitimate organisations will never ask you to do this. The same applies if you’re asked for this information over the phone.
  • Research the firms you’re dealing with. Use the Companies Register to see if the company exists and who’s behind it.
  • Don’t be swayed by cold-callers promising bargain deals or instant riches if you sign up on the spot. Legitimate companies will give you time to do your research.
  • If you think you’ve been scammed, report it to police. If you’ve handed over your bank details, contact your bank and immediately suspend your account. Fraudulent credit card transactions can sometimes be reversed.

Navigating dementia

As we get older, we may start feeling like we’re not as mentally sharp as we were 10 – or even 5 – years ago. While this can be frustrating, it’s unfortunately a normal part of ageing. In fact, we all experience changes to brain functionality as early as our 20s and 30s. Basically, our brain begins to shrink and the networks that send information throughout the body become less efficient; this can result in things like memory loss, an impaired ability understand a new concept or finding it difficult making decisions.

It’s important to understand that experiencing these types of changes does not mean you are developing dementia; these are normal changes we all develop to a greater or lesser degree.

What isn’t a normal part of ageing, however, is dementia. According to Alzheimers NZ, almost 70,000 live with dementia in New Zealand; that is less than 10 percent of the total number of the 759,800 Kiwis aged over 65 (based on 2019 data from Stats NZ).

According to Dr Matthew Croucher (Psychiatrist of Old Age and Senior Clinical lecturer at University of Otago), there are some great strategies we should all be doing to improve our brain health:

  • exercise at least 2- 3 times a week – this could a brisk walk, participating in a social sport or even physically active chores like mowing the lawn.
  • eat a balanced diet full of fresh fruit, vegetables, fish, nuts and healthy fats like olive oil and avocado.
  • stop smoking and minimise alcohol intake
  • engage regularly in mentally active activities, such as a craft, reading, or attending a theatre show.
  • staying socially connected – whether with loved ones or community groups – is a great way to maintain health and wellbeing at any age.

The first thing to know, is that the best thing you can do is to be a friend. While the nature of the friendship will change over time your friend’s partners will continue to value your friendship and support. If it’s possible for you to offer your time to give the partners some time out, you’ll find it’s generally very well received.

The next thing to know is that there are organisations and community services in most areas of the country that can provide support too. If your friends have not been in contact with their local Alzheimers New Zealand or Dementia New Zealand service, offer to obtain information for them or go with them to their first meeting. These organisations really know all about dementia, the issues people face (and the solutions) and how to live as well as possible with it. They also offer a range of support services such as day programmes, memory and coffee groups and fun activities. Education sessions are run regularly for spouses, family/ whānau, care partners and other support people.

Forgetting names, appointments or why we came into a room is something we all do occasionally and is a normal part of ageing. Dementia is more pronounced than simple memory loss and includes symptoms like:

  • Feeling like your brain is fading.
  • Confusion with written and spoken words.
  • Putting things where they don’t belong.
  • Difficulty solving problems that you could in the past.
  • Finding conversations or storylines hard to follow.
  • Mood swings, confusion, lack of motivation, depression.
  • Feeling fearful about going out.

What to do?

New Zealand experts believe the early diagnosis is beneficial so contact your doctor if you or someone you care about experiences symptoms of dementia. Ask for an extended appointment and take a care partner, family/whānau member with you. Your doctor will use a range of diagnostic tests including a full medical to rule out other causes of symptoms. A test called a Mini-ACE may be used.

Who can help?

If you have dementia, you and your care partner will be allocated a contact person in the health system (often known as a navigator). This person will help you access the services and support you need, help you to plan ahead, stay connected with friends, and live your life well. Often they are based at your local Alzheimers New Zealand or Dementia New Zealand service. Their support and advice will be invaluable.

We can’t prevent dementia but there is growing evidence that if we eat healthily, exercise regularly, remain socially engaged and active and maintain good brain health, we can reduce the risk of developing it. We all want to live our lives as well as we can for as long as we can. This includes those affected by dementia.

Grief and loss

Losing a loved one is an undeniably tough thing to go through. Unfortunately, all of us at some point in our lives will go through a significant loss or other traumatic event.

As Dr Lucy Hone, codirector at the New Zealand Institute of Wellbeing & Resilience, eloquently puts it: adversity doesn’t discriminate. Dr Hone also experienced a devastating loss several years ago, after her daughter died in a car crash.  

Everyone experiences grief differently and there is no right or wrong way to feel. Until we are in the midst of it, we don’t know how we will react. The first thing is to ensure you can be an active participant in your own grieving process. Of course, you’ll need loved ones around for support and you may choose to engage with health professionals but don’t be swayed by anyone to grieve in a certain way.

While Dr Hone acknowledges that the pain of her loss will never disappear, she has come up with three strategies that have helped her see a sense of hope - and ultimately, come to terms with her loss.

  • Recognise that the grief is happening to you

It’s important to realise that while the grief you are experiencing is devastating, it is unfortunately part of human existence. It is not happening to you, nor is it happening because of you – it’s just happening. Recognising this stops you feeling discriminated against, allowing you to step away from the anger and to begin processing it in healthier ways.

  • Give your attention to the things you can change

Unfortunately, as humans we’re better at taking notice of the negative things in our lives than the positive. From an evolutionary perspective, this has served us well as it allows us to assess threats and deal with them quickly – Dr Hone uses the example of escaping a Sabre-toothed Tiger, for example. Yet, we’re living in a world where we are bombarded with stresses and possible threats everyday – and unfortunately, our brains tend to treat each one as though it were a Sabre-toothed Tiger.

Resilient people don’t diminish the negative but also actively accept the positives too. Think about the support you have, the things you can look forward to tomorrow, next week or even next year, and give yourself permission to be happy about even the smallest things. “Don’t lose what you have to what you have lost”, as Dr Hone says.

  • Consider whether your behaviour is doing you good or doing you harm

During tough times, it can be easy to get caught up in a cycle of behaviour that you may think is harmless – but it could be keeping you in your cycle of grief. Perhaps you’re looking through old photo albums or revisiting past events in your mind? Ask yourself - is this doing you any good? If not, look for an alternative that does. You can remember your loved ones in ways that don’t do damage to your mental health. This strategy puts you in control of your own decision making.

Watch Dr Lucy Hone’s full talk at the 2019 TEDx Christchurch.

Remember, you don’t have to go through this alone.

  • Freephone or text 1737 talk to a trained counsellor 24 hours a day, 7 days a week.
  • Visit depression.org.nz or call 0800 111 757

Assessment

When people in the older persons’ health sector are talking about an assessment, they’re generally talking about the interRAI assessment. (Other assessments include ACC, mental health, equipment and housing modification assessments.) The interRAI assessment is the standard assessment ‘tool’ (a computer-based programme) used across New Zealand to assess the needs of those who have a disability that is likely to last for at least six months. It’s main purposes are  to determine:

  • what your needs are, how they might best be met and how they might change over time;
  • whether you might be eligible for subsidised services.

There are several types of interRAI assessments and the one chosen for you will depend on your situation.

These assessments are completed by registered health professionals who are trained interRAI assessors and skilled in older people’s health. The assessment considers factors such as your physical wellbeing, health conditions, activities, your mood, medications and living and social circumstances. It focuses on what you can do, your abilities and how you function. It’s a living document which means it can and will be updated as and if things change for you. (Meaning too, that it helps keep everyone involved in your care 'on the same page'.) It will also be reviewed regularly.

At the end of the assessment a recommendation will be made e.g.:

  • for referral back to your GP and possible community support;
  • for specific care/support needs to be addressed;
  • for carer support;
  • for assistive equipment, etc.

What happens to the information?

The information from your assessment is stored securely, is confidential and available only those who need to be involved in your care. General information (excluding anything that could identify you) is also combined with all other interRAI assessments for the purpose of population health planning.

How to get an assessment

Most commonly you will be referred for an interRAI assessment by a health professional however you can refer yourself. Needs assessment and service or care coordination (NASC) services are free to eligible, permanent New Zealand residents and citizens.

CONTACT YOUR LOCAL NEEDS ASSESSMENT SERVICE

The process begins with the assessor talking to you (and your family if you agree) or any carer you might have, about your needs, making observations and referring to other clinical information.

  • Assessors are located in various places within our health service. Wherever possible the assessment will be done where you live.
  • More complex assessments are commonly done by hospital-based assessors who are often members of teams known as NASC (Needs Assessment Service Coordination) or Care Coordination. These assessments can be quite lengthy.
  • Less complex assessments may be done by a contracted home support service provider, registered nurse in a care home or other qualified person.
  • Sometimes a basic assessment or review can be done over the phone. This is done only if it is thought the situation can be properly addressed in this way. If you have problems discussing such things over the phone, ask for a person-to-person meeting.

The completed assessment produces recommendations about how your health, wellbeing, and independence might be improved. If your assessment shows you will benefit from support then this information will be used to help create a support plan for you.

Your support plan will probably be compiled by another health professional, often known as a service coordinator,  using the interRAI recommendations. They will discuss it with you (and those closest to you, as long as you agree). If you are eligible for subsidised services you may be given a choice of service providers.

Once a plan has been decided it will be drawn up showing the formal support you will get and any assistance from family/whānau, friends, the community and other agencies. It may include services such as: personal care, household/domestic assistance, equipment to make things easier for you and carer support.

Several criteria determine what you pay for and what is publicly funded/subsidised. These criteria include: your assessed need, whether the service is considered to be essential and your ability to pay (whether or not you have a Community Services Card is often a factor).

Just what ‘essential’ means has changed over time. Make sure you let your assessor know what an essential service is for you – it may not be funded but it will be noted. If you can afford it, you can pay privately for such services.

Points to note:

  • Those with greater needs are given priority.
  • The assessment should be done as soon as possible after referral but there may be a waiting list. If you cannot manage or need further help during that time, go back to your local older person’s service here or your local healthcare service or doctor. In an emergency, call 111.
  • If the assessment identifies health conditions that require attention, these should be addressed.
  • If after assessment there is a change in your circumstances, including financial, let your older person’s service here
  • You can ask for a review if you do not agree with the outcome of the assessment or the recommendations.
  • Assessment and service coordination are free to New Zealand citizens and those residents eligible for publicly funded services.

Most formal, subsidised services in New Zealand are accessed via some sort of assessment, and most commonly, in this context, the interRAI assessment. The short answer is that if you don’t have an assessment you will have to pay for any services you want or need.

In some areas, especially if you’re considered non-urgent, the wait can be long. During this time, you may find that your situation changes. If this is so then you need to call and let the team know. You can be moved up the list if they reclassify your need as being more urgent. If you are facing a medical emergency call 111.

Worry can be a motivator. Many people find that being clearer about what might be going on for them, such as understanding what health and other issues need to be addressed or better managed, allows them to feel more in control of their situation. The first thing to do is to talk to someone who understands the sort of issues older people face, such as a practice nurse or social worker at your medical practice. You can also contact the older persons’ service at your local hospital. They will ask you a few questions and advise you on the best course of action. They may recommend you have an assessment to help determine what’s going on for you.

After you have had an assessment, and if you are eligibility to receive services, you will probably be referred to someone known as a service or care coordinator. They will discuss the recommendations with you and help organise any services that have been recommended and that you agree to. Amongst other options this may involve arranging home support services, carer support for any carer, or talking through your options with you if residential care has been recommended. They will also give you the information you need and set up the process for entry to care if this is decided.

Some services may be subsidised for those who are eligible (financial eligibility may also apply). You may need to pay or part pay for other services.

Just to make things a bit confusing – some older persons service teams are known as ‘Care Coordination’ teams. So, while they mean that both above are involved with coordinating services and/or care, one is a process the other is the name of a team.

Emergency situations

What with earthquakes, extreme weather, fire and floods, New Zealand can indeed seem like the Four Elements’ playground. It’s natural to fear what is in store next but planning and preparation can make a huge difference to how we cope when bad days come.

Think about who you expect to come to your aid. Talk about this with your family/whānau, friends and neighbours. In a disaster these people may not be able to help you so take account of this.

Prepare a survival kit. Include a torch and a radio with spare batteries for both; a charged cellphone; wind and waterproof clothing, sun hat and strong outdoor shoes; and a first aid kit and essential medicines.

For a prolonged emergency you’ll also need a stock of food and water. Think about what you will need if you lose power, water, sewerage or other basic services.

Pack a ‘get away quick’ bag. This should include sensible warm clothing, footwear and basic toiletries. Make a note to yourself ‘Remember your medication, glasses, hearing aid, paperwork’ (as relevant) and fasten this to the top of the bag. Keep it all handy and in the same place so it is easy to pick up if you have to leave.

For carers

A caring role is often stressful and no matter how strong and capable you think your carer is, they will need regular time out to recharge their physical and mental batteries.

So, who is a carer? While in this instance it’s Sally, a person may be considered a carer even if they don’t live with you. A determining factor for some funding is whether the person provides more than four hours unpaid care per day.

Understanding how important it is for your carer to have a break is a big part of making care at home workable. Initially you may only need assistance with little things but over time your needs may increase. It is important to recognise the change in the household dynamics and to make time often to discuss and take stock of the situation.

Successfully negotiating the changing relationships and roles in the household involves managing the care well and balancing everyone’s different needs. If this can be done successfully, it can be a rewarding time for all concerned and make any potentially difficult times easier for everyone.

Family and friends

The ability of family/whānau members and friends to provide support will vary. Perhaps they live far away, have other demands on their time, lack confidence, or need to be in paid work. While one family/whānau member often becomes the main carer (Sally) – initially it just seems easier and less complicated – it helps for others to be involved too. Family/whānau and interpersonal dynamics often play out at this time, but it is possible to manage the less positive elements.

It’s crucial to keep communicating but sometimes these conversations can be difficult. It’s important therefore, when such conversations are had, that people leave them feeling the discussion has been helpful and that their opinions have been heard. Tips for helpful conversations include:

  • Bringing your goodwill and a positive, constructive attitude.
  • Making time for the discussion.
  • Avoiding important discussions when you are feeling tired or stressed.
  • Listening for longer than you talk.
  • Listening without judging.
  • Letting everyone have their say – unfinished sentences can easily lead to misunderstandings.
  • Being prepared to compromise – sometimes the best solutions are those no-one had thought of beforehand.

Education

Research shows that providing education for carers is beneficial. It reduces stress as it improves the carer’s knowledge of relevant medical conditions and often gives practical training about safety issues such as correct lifting techniques. Carers can learn how the assessment system works and what financial and other assistance might be available. Several support organisations offer these services. They are usually free. If you cannot access a service near you, use the internet to find one or seek out relevant printed material. Ask at Age Concern.

Resources

Think about the practical resources you already have and what might be needed. If you have never been in this situation before, you may not know what could be useful. You can learn a lot by visiting a disability equipment shop to have a scout around and get ideas. Ask, if you’re not sure how various products work. Don’t feel compelled to buy. Getting susidised equipment can be a slow process so if this is something that could be of help to you, link in with your GP, healthcare service and older person’s/NASC as soon as possible to get the ball rolling.

Accessing services

While we are not sure yet how services might change in this COVID environment, some type of assessment to determine eligibility to subsidised services is likely, and those services that were available pre-COVID will probably continue to be offered but with possible adaptations.

Assessment

Access to subsidised services that will help you manage your day-to-day requirements, including personal hygiene and showering assistance, is determined by an assessment. Any support you receive need to work in tandem with that provided by your carer. As there is huge variation in the type of support a carer can provide, it is particularly important that everyone involved in your care understands the level of confidence, skills, strengths and abilities of your carer. This person needs to be recognised as a key member of your team and included in decision-making.

Using the allocated amount and suggested types of subsidised service is a good choice, as regular and routine support is best. The person coordinating your services will also be familiar with the services offered and available in your area, so they are well placed to advise you. There may be financial implications as subsidies may not cover the full cost of everything you want and there may be additional charges for those services. Discuss any concerns about this with your service coordinator. Make sure you are receiving any other financial support you may be eligible for.

Time out

It is easy to get tied up in the day-to-day practicalities and this can become isolating. Try to keep life normal for you both – if possible, go to social events and day programmes, use the Total Mobility scheme if transport assistance is needed and if you are eligible. Accept offers of help.

Caring relationships are usually based on love and all parties need to feel loved. Sally can feel loved by having regular 'time out' to recharge her physical and mental batteries. Remember, a caring role is often stressful and no matter how strong and capable you think your carer is, the relationship can become strained. Time out for you both is important. Current ‘time out’ options include, day programmes, Respite and Carer Support.

Day programmes or clubs are designed to provide interesting and stimulating environments in which people can socialise and get a break from every day living. They are often held at small home-like community facilities or sometimes in areas of residential care facilities set aside for this purpose. In some areas of the country a very small group may gather together in a hosts home for the same purpose e.g., Enliven HomeShare.

People often attend several times a week. Various activities are offered, and morning and afternoon teas and a midday meal provided. Transport may also be offered, for which there is usually a cost. To retain that sense of belonging and being known, group numbers are limited and kept quite small.

A subsidy may be available if you have been assessed by your local older person’s service/NASC as being eligible. It may not cover the cost of transport.

There are currently two main subsidised packages to support carers. Each however generally require some private ‘top up’ funding, which is a disincentive if you can’t afford it.

The Carer Support Subsidy

This is designed to look after your carer. It allows them to pay someone other than those who live with you to care for you while they get a break. Carer Support days are allocated depending on the need identified in an assessment. The allocation is reviewed each year.

The payment rate varies depending on where you live, where you take your care and who provides it. It can vary from approximately $65-$75 per day.

If Carer Support is taken at a care home, a top-up payment to cover the full cost of the service will probably be required. You or your carer should ask about this when booking.

For payment, your carer needs to ensure the assessment is done and allocation approved, keep track of days used, make the bookings and arrange for payment of the relief caregiver. Carer Support claims must be sent to the Payment Centre within 90 days or they may not be paid. Some relief caregivers or service providers may want an upfront payment. If so, a receipt is needed for reimbursement from the Payments Centre. See the Ministry of Health website for more information and for reimbursement forms, or contact the MOH’s Carer Support Line on freephone 0800 855 066.

Respite care

This type of short-term care is, in most instances, provided in a care home. It is accessed via an assessment approved by your older person’s service/NASC.

Usually, you are allocated a set number of days, which varies from situation to situation. You cannot use it for convalescent care or when you are unwell. You may be able to arrange a booking in advance of your intended stay. Payment is arranged via your older person’s service. You may be asked to pay an additional top-up fee to cover the full cost of the service.

For professionals

The data visualization tool in the interRAI website allows you to access data at a national, regional and population level. If more comprehensive data is required, you need to request it.

For daily nationwide bed availability see: www.eldernet.co.nz/vacancies

To view in a table, select a DHB region first then select ‘View in table’ on right side of the screen.  

The report may be filtered by:

Provider, Vacant beds, Short stay, Impending vacancy,

Dedicated Premium room charges, Dedicated Dual use beds,

Care apartment vacant beds, Care Apartment short stay, Care Apartment impending vacancy.

 

Audit reports are available at: https://www.health.govt.nz/your-health/certified-providers/aged-care

A full list of certified rest home (care home) providers in New Zealand can also be downloaded.

The hospice website provides lots of information about end-of-life care. This family/whanau may find A Guide for Carers useful.

The Palliative Care Handbook 2019 provides information about symptom management.

 

The Ministry of Health website has comprehensive information about the implementation of the Act and other relevant information. See also a link to the Act: The End of Life Choice Act 2019 

Complaints

If you have concerns about how a health or disability service is run or the services you are getting, you can make a complaint.

  • First, talk to the manager of the service. Contact the Advocacy Service for support https://advocacy.org.nz/
  • If the complaint is about a contracted service and it is not responded to or resolved, contact your local regional hospital. Ask for the manager of older person’s services.
  • If concerns are not addressed, contact HealthCERT (freephone 0800 113 813) or Disability Support Services MOH (freephone 0800 373 664).
  • If still unresolved, the Health and Disability Commissioner will consider the issues and may investigate (0800 11 22 33).

Concerns about a home support service? See the Ministry of Health information.

To find out more, talk to Age Concern or the contact person at your local older person’s service/NASC/CCC. They should be able to guide you.

The following are the contact details for service providers professional associations:

Concerns about any service costs can be taken to the Disputes Tribunal. Your local Disputes Tribunal usually has the same contact details as the District Court.

Feeling, down, flat, lonely or depressed? There are big differences

No, it’s not a normal part of ageing but it’s a common experience of ageing. Let us explain some more.

Western tradition has tended to see our physical health as being separate to anything else in our lives. Increasingly though, we are all becoming aware that our physical, mental, emotional, social and spiritual health and wellbeing are all tied up together. The Maori concept of Te Whare Tapa describes these dimensions well: taha wairua (spiritual health), taha hinengaro (mental health), taha tinana (physical health) and taha whānau (family health). At various times the balance between these various parts can be disturbed.

Not only has our western thinking dominated our understanding of our physical health it’s also tended to emphasise the importance of the individual over the group (the social/family dimension). While this can have a negative effect on us at any stage of life, the loss of people we love, and our often-decreasing social circle can make this even more evident as we age. It’s not hard to see then, that there could be a number of factors that are contributing to how you are feeling. For example: depression often involves a complex mix of these issues. It affects many older people and is frequently overlooked or undiagnosed.

What to do

  • If you find that these feelings are not resolving get relevant skilled or professional help e.g., counsellor, pastoral care, and community support services.
  • If you suspect you are depressed or know an unaddressed health issue lies at the heart of your problems, see your doctor.

It’s natural to look back over life and reflect. While our minds want to settle on more positive thoughts, it is all too easy to think about the things we have lost, done or not done, and things we now regret. Feeling lonely at these times is normal but dwelling on these thoughts can tip us into despair. Use the warnings from these emotions to motivate you to act.

  1. A good way to deal with these feelings is to talk. It’s OK to be vulnerable and seek help. Find out what local support may be available. A good place to start is at your local health service.
  2. Check your thoughts. While not denying your feelings, your thoughts can mislead you and are not necessarily the facts. Can you let go of those thoughts for a short time? Try doing something different for a while and focus on that.
  3. Given the person you are now, try setting some different and perhaps more realistic expectations of yourself and others. If you can’t put right some wrongs, you can at least forgive yourself or others.
  4. Do things that give you a sense of self-worth or that make you feel connected to others. Say ‘yes’ a lot, especially to invitations. Smile when you talk on the phone even if you don’t feel like it – smiling changes the tone of your voice.
  5. Try to keep your mind open to new things and opportunities. You can grow new friends. Show an interest in others; ask them questions about themselves. It’s likely they’ll respond positively.

If someone has talked to you and you or they are concerned about their emotional or mental wellbeing, take the situation seriously and advise the person to seek professional assistance. Offer to take them or accompany them to their first appointment.

Most older people will talk to a doctor about a physical condition, but many find it hard talking about emotional or mental health problems for fear of being labelled or being a nuisance. They may not recognise what is happening or think nobody cares anyway. Many don’t believe that pills or counselling could possibly help them. Ageism also makes it harder for these issues to be addressed, with some older people made to feel they don’t matter or don’t deserve help. So, some friendly concern and support from you should help to break down any barriers.

As your question is about depression, we need to address that however there could be a number of issues at play here. A talk with her in the first instance might sort that out however if things sound more complex or you are still worried, encourage that visit to the doctor. You can contact the doctor yourself if you have serious concerns, such as for her safety.

Factors that increase the likelihood of depression may include:

  • physical (a medical condition, unrelenting pain, dementia or genetic influences)
  • emotional (the loss of an important relationship)
  • the side effects of medication
  • other mental health conditions
  • isolation, loneliness, stress, use of alcohol or non-prescribed drugs, or a combination of these.

Older people experience the ups and downs of life just like other age groups. They may also be at more risk of developing depression as losses, ill health, and other factors often compound over their lifespan.

Those experiencing depression often misunderstand it so it is often hidden from those who may be able to help. For these reasons the real rate of depression in older people is unknown but is thought to be quite high.

End of life planning

When we or someone close to us is dying, we want to know this can be done peacefully, comfortably and with dignity. It can be distressing watching a loved one in their final stages of life; the brighter news, however is, that there is help available. The following gives an outline of services and support that may be accessed at this difficult time.

Personal support networks

It’s important to gather together those in your personal support network especially those who you feel most supported by, those who know you and the situation most intimately, and those who can offer expertise and/or support in other ways, like providing meals, transport or friendship. As time progresses family members and/or those closest often become very skilled at understanding the dying person’s unique needs. They may therefore be the best people to provide some advocacy if the need arises. Remember, however, that this is a tough time for everyone, so make sure anyone in a supporting role takes time to recharge too.

The GP and medical practice

It’s important that there is clear, open communication with the GP, as they will help the dying person understand their condition and treatment options. Key questions to ask the GP are whether they will make essential home visits (an important consideration) and their position on assisted dying. It’s absolutely OK to ask for a second opinion and to go elsewhere if services aren’t meeting expectations.

Most people need more specialised support at various times. This is commonly provided by members of a palliative care team. Ask the GP to make a referral if this has not been done. An interRAI Palliative Care assessment may be advised.

Palliative care

Palliative care is a specialist type of care that focuses on the person and their support networks. It takes a holistic approach, incorporating not just medical and nursing care but psychological, social and spiritual components too. The aim is to provide comfort and dignity to people and their loved ones by maximising quality of life, managing symptoms, and offering individualised care and support.

Palliative care is commonly associated with hospice, although it can also be provided by trained hospital teams, some GPs, home-based support services, district nurses, staff at a residential care home, specialist nurses, or hospice staff working in the community. Trained volunteers are often essential and valued members of palliative care teams, undertaking tasks such as driving people to appointments, helping with writing up memory books or sitting quietly with them when needed. 

Palliative care providers will help the dying person understand treatments such as chemotherapy and radiotherapy, assist with the management of any distressing complications, and provide education about what is happening and what to expect next. They understand that emotional rollercoaster everyone is on and are trained to respond sensitively and appropriately. (Some are on different rollercoasters, so the experience is not the same for everyone.) They can provide practical support to the dying person, such as: ensuring they have the necessary equipment, being a listening ear, assisting them to achieve goals, such as catching up with a special friend, and offering support to help families cope during the course of the illness and, later, in their bereavement. Don’t be afraid to ask a palliative care advisor for help.

Hospice

Hospice staff and their associated palliative care and volunteer teams are very skilled at delivering end of life care. Hospice often provide inpatient services for respite, symptom and pain management, or support if their care cannot be provided elsewhere. At the end of life, some people may have the option to spend time in a hospice. While Hospice NZ do not agree with assisted dying they will continue to support people regardless of their beliefs. A practical booklet ‘A Guide for Carers’ and the more comprehensive symptom management resource ‘The Palliative Care Handbook 2019’ can be found at www.hospice.org.nz.

Residential care

 If remaining at home ceases to be an option, a move to a care home may be needed. Payment and funding rules vary. Some regions may subsidise the services for a defined period, after which they require a financial means assessment, just as for a Residential Care Subsidy. Other regions require a means assessment immediately. Funding may also depend on any pre-existing condition. This means that depending on the circumstances, some people may have to pay for part or all of their care. Ask the service coordinator about what applies in this situation. Work and Income can clarify queries on residential care payments.

Assisted dying

The End of Life Choice Act 2019 comes into law in New Zealand on 7 November 2021. From that date, those over 18 who experience unbearable suffering from a terminal illness will be able to legally ask for medical assistance to end their lives. The legislation sets tight controls on who can avail themselves of the option. A number of assessments are undertaken to ensure that the person applying meets the criteria.

The decision to receive assisted dying is entirely theirs. This is a big decision though so it’s advisable to talk to those closest such as a friend, family member or trusted health care professional. It is against the law to be pressured in any way around this decision.

After the person has decided that this is the right option for them, they must first raise the subject with their doctor as they are not permitted to raise it with their patient. If the doctor is unwilling to assist in this journey, the person has the right to choose another one who will help work through the process. It is important to know that if a person has chosen assisted dying they can change their mind at any time.

Detailed information about End of Life Choice Act can be found on the Ministry of Health website.

Thinking about and planning for the end of life is something many of us would rather never do. Yet, doing so can help put your mind at rest – and allow you to get on with the important job of living. A good way to go about this is to set aside some time to think about your wishes – and to talk these through with your loved ones. Being clear about what you want in the future helps those who may be called upon to act on your behalf to do so with confidence. Remember, any plans made need to be reviewed frequently, especially if your circumstances change.

Here are some of the things to consider when putting end of life plans in place:

  • Make or update your Will 

This will ensure your wishes regarding your estate (everything you own) are known after your death.

  • Check or appoint your Enduring Powers of Attorney

Make sure you have appointed trusted attorneys for welfare and financial matters.

  • Make or update your Advance Directives

This can help ensure that your wishes are known if you are not able to convey them yourself.

  • Plan your funeral 

Many people like to have a say as to what happens after their death. Planning gives them confidence that others know about their wishes, and reassurance that they have done all they can to make it easier for grieving family/whānau and friends.

There are many things to consider. If you want a funeral, who will arrange it? Would you use a preferred funeral director or is something informal desired? You can plan it all yourself but this option requires more consideration, investigation (the internet is very useful for this topic) and planning. Even if you arrange for a funeral director to take your funeral, you also need to make your wishes known to those closest to you (writing this down is helpful). Have you any special requests? Do you want to be buried or cremated? Is there a charity you would like to ask people to donate to?

Lack of knowledge about cultural differences and requirements can also have unexpected outcomes for mourners. If this might be an issue, prepare them for the possibility. In Māori culture it is an honour for the deceased to return to their home marae, so extended whānau/family may arrive to discuss this with the bereaved. Other cultures will require a quick burial.

Some people choose not to have a funeral for a variety of reasons. If you choose not to have a funeral and have family/whānau and friends who might expect some sort of farewell, let them know. They may like to arrange something else by way of remembrance.

  • Prepay your funeral

Most funeral companies provide helpful booklets on this and other bereavement issues, some of which are comprehensive and informative. Peace of mind is often a big factor in some people choosing to prepay their funeral. There have however been some allegations of poor practice in this regard, with the result that the government is investigating the need for more regulation of funeral services. We will keep you updated.

Currently a prepaid funeral can be with a funeral director or a trust company. Ask:

    • How secure is my investment?
    • What happens if the funeral company ceases operation?
    • Can the fund move with me if I move to another part of the country?
    • Are there any circumstances in which the estate would have to pay more?

If you are being assessed for a Residential Care Subsidy up to $10,000 for a prepaid funeral is exempt from the asset test. 

Funeral insurance is different to a prepaid funeral. Consumer NZ have concerns about this option and believe they are a 'poor value' product, see: Consumer NZ

 

The information provided in this list of Questions and Answers (Q&A) is of a general nature. It is not intended as a substitute for specific professional advice on any matter and should not be relied upon for that purpose. The Q&A is not an alternative to legal advice and does not replace any requirements under any relevant Act, Regulations, Code of Practice, Rule, Standards or Orders. While we have endeavoured to ensure this information is accurate and as useful as possible, we accept no responsibility, loss or liability resulting from the use of this information. We urge you to seek appropriate or professional advice on all issues.