Keeping faith with the independence streak

By CATHERINE MASTERS

Old age in itself is not an illness, despite often being seen as one, says Kerry Blackhall, business manager for Auckland Healthcare's A+ Links, the Home and Older People's Health unit.

"It's just a normal process and the majority of people grow old well. They don't need services - or not until a later stage in life."

But when they do, one of the first things to do is to make sure they see a GP for a check. The GP may, however, refer the person back to a service such as A+ Links, which works closely with the needs assessment and service coordination team at Auckland Hospital.

Most elderly clients are aged 85 and over and if they are frail but without major medical conditions they will be referred to the assessment team for a close look at what they need in the home in terms of help and how it can be provided.

Wayne Campbell, head of the assessment team at Auckland Healthcare, says people's needs are likely to include a desire to remain as independent as possible - and to have their needs met in a culturally appropriate manner.

"For example, they might need assistance with showering and there might be a son there for a mother but often, in most cultures, that's not culturally appropriate, so there's a gap; there's no one available in their normal system to provide the care," Mr Campbell says.

The assessment will look not only at what their needs are and where the gaps are but what is already provided by family and friends.

Next, the service coordination staff come up with a package of care to meet the needs and close the gaps.

Some of the most common gaps include issues of safety and personal health.

"Safety can mean a whole range of things. It might mean for some people they have to have someone there to be looking after them, keeping an eye on them.

"Or it might mean something a lot different. They might need to have a ramp or some rails or a special showering arrangement and not any actual home help but just those things to keep them safe."

Personal health care needs generally involve showering, dressing and hygiene.

Other issues include maintaining the house at a reasonable standard, and home care may be able to be allocated to supplement what help the people already have. That may include keeping the house tidy or preparing meals.

Some people only need someone to cut up food and prepare frozen meals.

"Our aim is to maintain people's independence," says Mr Campbell, "so we wouldn't be going in to provide services that they could provide themselves and we would encourage people - even if it requires some rehabilitation - to continue doing what they can."

If they do not do as much as they can for themselves, people tend to become rapidly more and more dependent.



Another big need is support for the caregivers. They can get worn out and programmes exist to give relief.

Carer Support is a flexible system where carers are allocated limited time off when they need it, and with Respite Care the relief is more planned and the elderly person may go into a rest-home for a certain time, then return home.

Other support is available through day-care of various types, church organisations and organisations for various conditions such as strokes.

So, much help is available - but Mr Campbell says the budget is limited and elderly people may not get everything requested. And while much of the help is subsidised, they will have to contribute.

"People have talked in the past about being eligible for certain services.

"All we can really say now is that people are eligible for assessment.

"We then have to look at their particular needs, and the needs of others, to try to give a fair delivery."

The service can also tell people about subsidies or whether they are eligible for taxi vouchers or personal alarms.

As a last resort, the team will talk elderly clients and their families through the pros and cons of residential care.