KEY POINTS:
Katharine Price is 94 today and still lives in her own home, next to her daughter, Christchurch author Felicity Price.
More than any bach at Paihia with a beamer out front, Price represents our deepest Kiwi dream: to stay vital and independent into our very old age.
Price's late husband, Eric, wasn't so lucky. In his 80s he was mentally vital, good-humoured, engaged in the world, but his body was slowly withered by multiple sclerosis.
Before he moved into a rest home, Felicity would help Katharine, a former nurse, look after him, between her full-time PR job and two school-aged children.
The experience inspired two novels about being the meat in the sandwich generation, torn between the needs of children, ageing parents and paid work. "It's a whirlwind of juggling and stress and guilt."
Home support services like visiting nurses help, "But it's the stresses and strains in between, and the only person who can do that is the wife or husband, or adult child".
Thousands of families like the Prices are facing _ or shirking _ tricky and often expensive choices about how to provide for their elderly relatives as they slide towards dependence.
Rest homes currently charge on average $100 a day. Government subsidies are means-tested. Marie Bennett from Age Concern describes the case of a couple who had saved $250,000 for their retirement.
"She went into care and he ended up with none himself."
And public confidence in rest homes has taken a blow from revelations of alleged maltreatment and neglect.
First, there was the cellphone image of an elderly woman with her mouth taped shut, allegedly by a worker, in Belhaven rest home in affluent Epsom.
Since then, three more rest homes have been placed under temporary management following complaints: Villa Gardens Home and Hospital in Christchurch, Ranfurly Manor home in Feilding; and Birkenhead Lodge Retirement Home on Auckland's North Shore.
Last Thursday, two major unions presented a petition signed by 10,000 members calling for minimum staffing levels in residential aged care homes and hospitals.
The Nurses Organisation says short-staffing is endemic in the sector and is severely compromising quality and safety.
Says spokeswoman Huia Welton, "Without requirements, there's no guarantee that the care being provided is at an adequate level."
Also undermining quality are patchy training and low pay. The industry minimum for caregivers is $12.55 an hour, and rest home nurses earn 20 to 25 per cent less than nurses in public hospitals.
Critics say rest home auditing fails to catch problems. Homes are given notice, which gives them time to stack the roster and catch up on paperwork.
Union organiser Lynley Mulraine says it's a "standing joke" that rest homes become a hive of activity the week before the auditor arrives.
Another weakness is the focus on paperwork, which may be fabricated. A rest home nurse tells of a case where caregivers had ticked a form recording half-hourly checks on a patient for three days after she died.
Health Minister David Cunliffe denies there are "widespread patient safety issues" but is signalling major changes to the audit system and pay in the sector. He's seeking Cabinet approval for the introduction of spot checks, making audit results public and eventually linking wages to qualifications.
However, rest homes in their current form may be all but extinct within the next 20 years. Industry surveys predict rest home beds will be full within a few years, yet the industry body knows of no new stand-alone rest homes being built.
Health planning is now geared towards "ageing in place", where the aim is for people to remain in their homes, if theychoose, as long as possible and for tailored services to come to them.
Meanwhile, retirement villages, which differ from rest homes in that they're designed for independent residents, are expected to boom as people sell up family homes and shift into them for companionship and security.
There are almost 400 retirement villages containing 20,000 units and some 25,000 residents.
John Collyns of the Retirement Village Association, which represents 80 per cent of villages, says 16,000 more units are planned in the next six years.
Generally, residents buy the right to live in a unit (rather than freehold) and pay a regular tariff for facilities such as pools and gyms. The median capital cost is $250,000, but can be as low as $80,000 in older, church-run villages or as much as $1 million in privately run waterfront villages.
At the Prime Life Peninsula Club in Whangaparaoa, north of Auckland, villas range from $255,000 to $600,000, and the weekly tariff is $115.60 a week.
Collyns says the typical resident is in their 60s, active and sociable.
For those who can't afford, or aren't attracted to village living, there is a growing home-based care industry to fill the gaps in state-provided care.
Neil Farnworth is the managing director of home-care agency Home Instead Senior Care. He says the average client spends less than $100 a week for two, two-hour visits. Round-the-clock care costs upwards of $1000 a week. While the state-provided care tends to physical and domestic needs, he says, his care-workers also provide companionship.
"There's a real problem with feelings of isolation because families aren't visiting as often as the seniors would like, and they might fret about going out on their own."
Another real threat is exploitation by family or others when you become incapacitated. Lawyers encourage people to donate an enduring power of attorney to someone they trust, but Age Concern, GPs and others have highlighted cases where the power is abused to embezzle or misuse assets, or where welfare obligations are neglected.
Says family lawyer Alistaire Hall, "I've been a family lawyer all my working life so I'm used to parents fighting over children in custody cases. Increasingly you're getting the phenomenon of children fighting over parents."
The power is split into personal welfare and property, and takes effect when the donor loses the capacity to handle their own affairs. Experts recommend sharing the powers between two or more people and considering the Public Trust for the financial side.
Christchurch family lawyer Peter Eastgate says law changes that take effect in late September are expected to make it more difficult for the powers of attorney to be abused.
Chances are, baby boomers with their higher expectations will reconfigure the old-age landscape.
"We're more aware of looking after ourselves," says Age Concern's Marie Bennett. "People are more active and involved, and we're more likely to stand up for ourselves."
