A place to call home

Jessie Norman enjoys the resources available to her as a resident of Elmwood Rest Home. Picture / Greg Bowker

We used to run orphanages," says the head of Presbyterian Support Northern, Winsome Stretch. "We don't lock children up merely because they don't have parents anymore," she says. "And merely because people are old is not a good enough reason to lock them up."

Last year, after more than 50 years of caring for the elderly, Presbyterian Support sold its seven retirement complexes from Warkworth to Tauranga because it no longer believed in them.

"We couldn't continue to provide rest-home care to people who were telling us very clearly that they didn't want it," Stretch says.

"New Zealand, of all developed countries, has one of the highest rates of putting its old folk into rest homes. It's not the 21st century way of looking after people."'

Stretch started a trend. Her Presbyterian counterparts in the upper South Island have sold their five complexes to the same Blenheim-based company, Qualcare, that bought the seven northern rest homes.

In November, after 70 years, the Salvation Army put its 13 retirement centres from Auckland to Dunedin up for sale.

Last month, after 62 years, the Methodist Mission Northern decided to sell its centres in Mt Eden, Mt Albert and Pukekohe as businesses, while holding on to the properties. This week the 45-year-old Roskill Masonic Village also went up for auction.

These last three groups are selling not on principle but for financial reasons. They are losing money because, they say, the Government is not paying them the full costs of caring for old people.

Private investors are buying because the homes sit on choice land.

"I have picked up Presbyterian Support Northern for a mixture of reasons - to get exposure in the North Island, and to have a very prime land bank," says Greg Tomlinson, the Blenheim engineer who started building townhouses for the elderly before he built up Qualcare.

So are rest homes destined to follow orphanages into the history books? Who will care for those who can't afford whatever private services replace them?

Many lives are at stake. In the 2001 census, 29,100 people, or 6 per cent of the 450,000 people aged 65 and over, lived in either rest homes or hospitals. Above age 85, the proportions reached 24 per cent of men and 31 per cent of women.

A recent study placed New Zealand eighth out of 21 developed countries in the proportion of those aged 65-plus in residential care in the 1990s, at 6.7 per cent.

Australia, Canada, Germany and Luxembourg were virtually the same at 6.8 per cent. Only Denmark, Sweden and the Netherlands had significantly higher numbers in care, ranging from 7 to 8.8 per cent.

However, an Auckland University aged care specialist, Dr Matthew Parsons, says the figures for Scandinavia and the Netherlands include people in independent flats in retirement villages, who are not counted in the New Zealand figure.

"Where most countries are going down, we are staying static," he says. "That suggests that community care in New Zealand is inadequate and inappropriate."

He says 80 to 90 per cent of people in rest homes are clinically depressed. People admitted to a rest home die, on average, six months later. In private hospitals, it's three months. "They stop doing the washing, dressing, housework, making cups of tea. Even if it's the best standard of care, they still don't do all the activities that they used to do."

Simply standing up many times in a day to cook, clean or chat to a neighbour can keep older people strong and independent.

"Social networks are very significant," Parsons adds. "If someone maintains their social integration in the community, they are far less likely to be depressed."

Before he moved to New Zealand seven years ago, Parsons set up three teams in South London to support old people in the community. Here, he has inspired a Presbyterian Support programme in Hamilton and Tauranga called "Community First" or "Enliven".

Support workers visit each client one, two or three times a day.

For Nelly Bell, 86, who is missing a hip joint after she got septicaemia and nearly died during a hip operation, this means a one-hour visit in the morning when the support worker helps her shower and do the housework, and another in the afternoon "to do anything that is dying to be done".

Although her husband Ron, 88, can no longer handle her wheelchair, he can drive her anywhere where her walker will be enough to get around.

A former national president of the Clerical Workers' Association, Nelly Bell was still busy yesterday as secretary of a society that promotes drinking in moderation. She and Ron have lived in their house in Hamilton for 56 years and can look out from their sitting room at trees they planted.

"You are so much better in your own surroundings," she says.

In a council flat in nearby Dinsdale, Don and Linda Andrews, aged 80 and 78, have just celebrated their golden wedding anniversary. Both have had spells in intensive care, one for a broken thigh bone and one for pancreatitis.

As a result, Don needs a support worker to help him bathe. She also helps with housework and checks their medications.

A physiotherapist comes on Mondays, and on Fridays both Don and Linda attend a Community First activities centre. Occasionally friends take them to bowls.

They, too, want to stay out of old people's homes. "Those people with those homes are making millions out of old people," Linda says.

Some of those living in rest homes see it quite differently. At Elmwood in Hill Rd, Manurewa, one of the homes Presbyterian Support sold to Qualcare, 88-year-old Bobbie Smith says her first three months have been "three months of heaven".

"It's like a home away from home. I have everything I need here. Other people living here are caring for you too."

Janet McGinn, 68, came into Elmwood after a stroke 10 months ago affected her walking. She lived alone and feels older people need more than just visiting support workers.

"I think the time people worry about is night time. That is the loneliest time, from 6pm to 8am. Loneliness is a big factor, and people tend to have to stay at home and can't go out and can't drive," she says.

"There is someone here all the time - not that you are looked after all the time, but you have a call system that puts everyone much more at ease."

Jessie Norman, who still gets about with a walker at 98, has been in the home for 10 years. She has filled her room with mementoes of her long life, and says the sale to Qualcare has "made no difference".

The 76 rest home residents do "Grey Power aerobics" for half an hour a day and can take part in singing, cooking, bingo, bowls, Bible study and doing a crossword drawn on a whiteboard and solved as a group.

Residents can come and go as long as they tell staff. A seated footpath scooter is available.

Manager Lynn Stacey says Elmwood refuses to lock people in as some homes do, even though it is on a busy road and has some people with dementia. "We manage it. We have good staff. There is a lot of training goes into it."

Her new boss, Tomlinson, says he has kept the same staff "on the floor" as under the Presbyterians, but has "streamlined the top-end functions". Accounts, staff pay, training, purchasing, property maintenance and quality control are handled centrally.

He got into the business because when he built townhouses in the 1980s, the elderly buyers used to ring and ask, "Greg, could you call by to hang a picture on the wall?"

"More often than not it was a cup of tea and a gin with them," he says. "It was more of a companionship thing."

He realised that older people needed somewhere that provided that companionship, and became a pioneer of the retirement village with rest home attached. His first resident was his own grandmother.

He counts himself lucky to have got "a very soft purchase" from the Presbyterians. "I have purchased the intellectual property, basically, that is many generations old."

Tomlinson is sitting pretty, despite Government funding that he says is 20 per cent below costs. Either that funding increases, making his care business profitable, or he can use his land for something else.

"I have a huge land bank, but I'm at a point where I can't say that I'm going to put extra beds on. I cannot make that financially viable," he says.

"If you can't get a return on investment, that's when you have to look at alternative uses. That's what the industry will face."

Max Robins, president of the Private Hospitals Association, says the funding covers rest homes' operating costs, but leaves nothing for upgrading or rebuilding or for pay rises for nurses to match the 20 per cent hike in public hospital rates.

Robins is chief executive of the Christian Healthcare Trust, which has sold its surplus properties in the past six years to pay for upgrading its four Auckland long-stay hospitals and three rest homes. "We have sold the family silver," he says.

The Methodist Mission is selling its rest home operations for the same reasons - to fund its home care services and for eventual upgrading of the properties. The mission lost $600,000 last year.

Its northern superintendent, the Rev Keith Taylor, says a corporate buyer will get economies of scale from running its three homes as part of a larger group.

The Salvation Army's national manager of services for older people, Major Alistair Herring, says the army's rest homes were built with dollar-for-dollar subsidies, which ended 15 years ago. It could not afford the $25 million needed to upgrade its buildings, so was selling them to fund home care services.

Yet Herring and Taylor insist that rest homes are still needed.

"I have met people who say, 'My caregiver comes in twice a day for four or five hours to help me shower and make my lunch, but I spend half the night awake at night just in fear of what might happen to me,"' Herring says.

"We see those people just absolutely blossom when they enter into a small community [a rest home] where there is a lot of ability for people to have their own space but there is also a real sense of security and companionship."

Taylor hopes the churches will help to build up that sense of community again in the wider world, where most older people still live.

"One of the things a local parish can do is to be much more aware of people in its surrounding community," he says.

His mission is also building up its home care services to help people in their homes and take them shopping.

But he believes there are people, such as those with dementia, who will still need 24-hour care.

"There is a danger of throwing the baby out with the bathwater," he warns.

"I think there is a place for rest homes. As much as we say people want to be in their own homes, at what cost, ultimately?"