Auditor-General's overview

Many of us have older parents, relatives, or friends who benefit from care and support services provided in their homes (such as help with their personal care or help with household chores). These home-based support services can be critical to the continued health and well-being of older people. Assurance about the quality and adequacy of those services is important for the older people receiving them and for those of us who care about people receiving the services.

This report discusses how effectively the Ministry of Health (the Ministry) and district health boards (DHBs) are ensuring that, where appropriate, older people get the care and support they need to remain living independently at home. It follows on from my December 2009 report – Effectiveness of arrangements to check the standard of services provided by rest homes.

DHBs' forecasts indicate that they will collectively spend $232.2 million on home-based support services in 2010/11. It costs DHBs significantly less to provide home-based support services than it costs to support older people in rest homes, making it vital that home-based support services are effective and efficient.

I have formed the view that, generally, services appear to be delivered adequately. However, this is a qualified view because the Ministry and DHBs do not have reliable information to confirm an assessment. For example, spending on home-based support services increased by 70% during the four years to 2008/09. However, because of the lack of reliable performance information, it is not clear to us whether this means simply that more older people received services, or whether they received better services. The Ministry and DHBs need to address the current deficiencies in performance information about home-based support services.

There is no mandatory standard for home-support service providers and DHBs do not have a consistent and robust approach to managing quality. I am therefore unable to give positive assurance about the quality and consistency of services throughout the country, although the limited information that is available does not point to widespread problems, and the small number of older people interviewed by my staff expressed the view that services were responsive and met their needs.

The stories of some of the older people my staff talked to appear as case studies throughout this report. They felt that their support workers and the services they received were essential and helped them to live independent lives.

There were very few recorded complaints about home-based support services, but no-one knows whether that is because there are very few problems or whether it reflects the vulnerability of older people – they may not feel safe or able to complain or make suggestions.

Generally, older people have access to home-based support services, and their needs are assessed and services are delivered in a timely way. I note that there is evidence of some inconsistency and inequity in how home-based support services are assessed and allocated. The methods that DHBs use to assess the needs of older people are becoming more consistent through the introduction of an internationally accredited assessment tool, InterRAI. However, its effectiveness will need to be reviewed.

Risks to the quality of home-based support services

The combination of increased demand, more complex support needs, and financial pressures presents a significant risk to future delivery of home-based support services.

DHBs have recognised that one of the biggest risks they need to manage is the ability of their service providers to supply a suitably qualified and well-supervised workforce. To meet this challenge, DHBs will need to work collaboratively with providers to ensure that providers will continue to have the staff they need to deliver services. Stronger contract management by DHBs would also help ensure that quality standards are met.

I have made five recommendations to help the Ministry and DHBs manage and support the delivery of effective and efficient home-based support services.

I thank the staff of the Ministry, DHBs, and other organisations for their help and co-operation. I also extend special thanks to the recipients of home-based support services who kindly allowed my staff into their homes and shared their experiences with them.

Lyn Provost
Controller and Auditor-General

5 July 2011