Delivering care to the 'silent generation'.

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In an ironically tiffed address "Older people need more hospitals--forget primary care!" senior Lecturer in gerontology at Auckland University, Matthew Parsons, paid tribute to a number of initiatives enabling older people to stay at home for Longer and safer.

He described those over 65 as "the silent generation", very different from the "baby boomers" in that they were happy to do what people told them to do, often regarding the doctor as akin to God. The home-based support sector had seen dramatic changes over the last eight years. In 2001, only ten percent of total disability support funding was spent on home care. This had more than doubled since that time, though the average in other Organisation for Economic Co-operation and Development (OECD) countries was just over 30 percent. "We have a long way to go to rebalance our home care spending in New Zealand," Parsons said. "Residential care still gets over 60 percent of expenditure, with assessment, treatment and rehabilitation getting nearly 20 percent. We have a very high rate of residential care admissions compared to other OECD countries. Those over 75 are getting most of this money."

Parsons predicted that by 2050, one in four New Zealanders would be over the age of 65. However, the good news was they might well be healthier, so wouldn't make as big an impact on health care as might be expected. However, the prevalence of dementia was expected to increase. While praising initiatives like Community First, a new way of delivering home-based services now operating in a number of district health boards (DHBs), Parsons pointed to "a complete mix-up and duplication of services" happening elsewhere. With good, co-ordinated home-based services, elderly people were living longer, happier, safer Lives than they would in residential care.

"Eleven DHBs are now using new models of delivering home-based health services, thanks to information learnt from the ASPIRE (assessment of services promoting independence and recovery in elders) project. It is gratifying to see half the country using this system, but we now need to move to the next level, which is to be more responsive to meeting the needs of chronic conditions in the elderly," he said.