At least once a year, usually at Christmas, you can count on a story about 'granny dumping' by callous families wanting a carefree holiday unburdened by elderly dependents.
Such families, so the theory goes, dump their elders on hospital doorsteps, even though they are not sick enough to warrant residential treatment, but are perhaps not well enough to stay home alone while the rest of the household decamps for the holiday period.
This year the story came early, in a Labour day article in the NZ Herald.
The paper commented on a tweet by Auckland City Hospital trainee specialist Dr Sudhvir Singh, a registrar in general medicine.
"Long weekend = many frail old people conveniently dropped off at hospital without acute medical problems because family going away," wrote Dr Singh, who despite making the claim wouldn't provide evidence of the practice or comment further when contacted by the Herald.
Others were more forthcoming, from Grey Power to politicians to Waikato Hospital emergency department clinical director Dr John Bonning, all seemingly accepting that dumping occurs without any critical analysis of why it might happen.
Is granny dumping an open and shut case of cold-hearted families driving up to emergency departments in flash cars, leaving overworked medicos to provide holiday care for frail older people even though they aren't sick enough for admission?
Or could the scenario be more complicated?
I suggest the latter in most cases.
While successive governments have shifted more care costs and responsibilities into the community, thoughtful supports for families with caring commitments have not kept pace. Now, in our ageing society, with almost 90% of the country's family carers of workforce age (15 to 64), the chickens are coming home to roost.
Since moving to Auckland in July, I have discovered how dire the situation is for families living at home with an elderly relative who has dementia.
Here are some pointers for those who are quick to condemn families for dumping elderly relatives at hospitals (if indeed the practice occurs as frequently as they suggest):
- Rest homes and facilities for older people typically have high occupancy rates. This means fewer beds are available for families supporting an older person at home, who need occasional respite breaks to continue providing community-based care without burning out. Respite beds over holiday periods are difficult to find even if you plan months ahead, as Dr Bonning simplistically recommends.
- While some district health boards fund dedicated respite beds, not all do. If a residential facility does not have enough dedicated respite space to meet demand, families cannot access short-term breaks. This is a yawning gap in Auckland.
- The Carer Support Subsidy, used by many caring for elderly relatives to fund respite breaks, is capped at a daily rate of $70-odd. The daily rate to access 24 hours of residential respite for hospital level care is (in our experience) more than $130. Many families cannot afford to top up their CSS to pay for a full day of care. Although Carers NZ and the NZ Carers Alliance of 45 national not for profits have long lobbied for a bulk payment of CSS funding to families so they can purchase suitable relief care, this hasn't happened. Nor has CSS (its rules and daily rate) evolved to meet escalating community care needs. The result? Respite mayhem, carers not getting the breaks they need, and premature entry to residential care when families can no longer cope.
- Short-term respite (weekends, for example) is simply not available in Auckland. We visited six homes within a 45 minute commute from our suburb to inquire about respite and day care availability. Respite is new for us; only recently have we realised that we need breaks from caring if we're to cope long-term. We didn't feel ready for one week or, obviously preferred by the homes, two weeks of respite. We wanted to try weekends, allowing us to regroup after a week of juggling work and care, and to have some family time with our 13 year old, who is adjusting to a new high school following our move from Northland. This would also allow us to establish trust with a respite service, building up to longer breaks. Facility managers could scarcely disguise their disbelief that we would suggest weekend only respite (several smiled cynically). Beds are so scarce that it isn't worth their while to provide short breaks for families who need this service: they prefer bigger dollops of respite cash for 7-14 days. No doubt preparing an admission, a medications and care plan, and other practical coordination tasks are a hassle for just two or three days. This leaves families without the flexible respite options they need to manage community-based care and 'ageing in place'; inevitably this leads to premature residential placement, an option that looms for our family.
- There is a chasm between formal medical services and families juggling caring roles for older people. After our move to Auckland and an unexpected admission to Auckland Hospital, we asked the clinician preparing discharge paperwork how to arrange an assessment so we could access community-based support and respite. He looked at us blankly, and moved on to the next bed. Any medico who engages with older people and their families/whanau should seamlessly refer such inquiries to social workers and assessors, who may even work in the same building.
- Waiting times for assessment measure in the weeks unless you say you need an urgent appointment, something I intend to do this week; I wonder what the response will be? Meantime, we are paying privately for respite visits. The charges are painful on top of family living costs but the alternative (no respite from an escalating caring situation that now involves continence and behaviour support) is untenable.
I applaud the thousands of Kiwi families who are supporting frail older people so they can continue living at home for as long as possible. They are an invisible workforce whose efforts - a finger in the dike of our society's growing care needs - make life worth living for many thousands of older New Zealanders.
Instead of criticising families that cannot easily access the respite they need from caring duties, we call on decision makers in government, the health system, and communities to work with families to create respite solutions that pay more than lip service to trendy policies like 'ageing in place'.
Dr Singh, Dr Bonning, and their medical colleagues also have a role to play: for every case of 'dumping' there is likely a story of poor respite provisioning in their communities. Talk (and tweets) are cheap: look beyond the hospital doors, and help us craft a respite system that works for Kiwi families and their older loved ones.
Laurie Hilsgen is the chief executive of national not for profit Carers NZ and editor of Family Care magazine.