A major report by the Aged Care Commissioner – a new government watchdog – raises the alarm about dementia rates, short-staffed aged-care facilities and home care services, and calls for free hearing
aids. Nicholas Jones reports.

The Aged Care Commissioner has called for the Government to provide hearing aids to everyone who needs them – warning that untreated hearing loss is causing dementia.

Carolyn Cooper has today released her first major report on how older people are faring.

The Government subsidy for hearing aids of $1022 a pair isn’t enough, she concludes, and hasn’t been topped up for well over a decade.

“[The subsidy] should be increased to cover the cost of hearing aids, assessment and fitting,” Cooper recommends.

“The cost of providing hearing aids to those who need them is far outweighed by the benefits and cost savings from preventing, diagnosing and treating dementia.”

Even low levels of hearing loss are associated with increased dementia risk.

New Zealand’s population is ageing, and dementia numbers are forecast to boom: from about 70,000 currently to 170,000 by 2050.

That is a looming crisis given short-staffed services and facilities are already under strain, and not nearly enough are being built.

Cooper is a nurse who headed giant aged care company Bupa NZ before being appointed New Zealand’s first Aged Care Commissioner in 2022.

Her report follows a nationwide tour where Cooper met with hundreds of older New Zealanders. It contains new analysis of data obtained from services, and its findings include:

Research published in the Lancet last April estimated the attributable risk of dementia from hearing loss was 29 per cent, Cooper noted, and access to hearing tests and aids reduces the risk of developing the incurable disease by up to 8 per cent.

“Hearing loss is more prevalent in people with dementia than for their peers who do not experience cognitive decline. Hearing loss and declined cognition can diminish people’s quality of life and increase social isolation and dependency on others,” the report stated.

“The risk of dementia is likely to be higher for Māori and Pacific people, due in part to prevalence of untreated hearing loss.”

Hearing aid subsidies – what’s offered

The Government provides two types of funding for hearing aids.

A funding scheme covers the cost of hearing aids (but not associated costs with assessment and fitting) for a limited number of people (8636 in the year to June 30 2023), such as those with Community Services Cards and who still work nearly fulltime.

Otherwise, a subsidy of $511.11 (including GST) per hearing aid is provided to adults, every six years. This was last increased in 2010, up from $500 and to adjust for an increase in GST.

Hearing New Zealand president Dr Lisa Seerup backed the Aged Care Commissioner’s recommendation.

The current subsidy isn’t enough, she said, and people with untreated hearing loss suffer increasing social isolation. Many stop working, which creates flow-on welfare costs.

There are perfectly good cheaper hearing aids, but people were often convinced of the need for more expensive models, said Seerup, an audiologist. The average out-of-pocket cost for a pair of hearing aids was $8000-$10,000, she said.

“For people on the pension, when you’re looking at $10,000, what are you going to afford – housing and food, or hearing?”

Like many in his community, Hurimoana Dennis, chair of Te Puea Memorial Marae in Māngere, endured hearing loss because the price of help was too steep.

That changed when the charity Hearing Auckland teamed up with the University of Auckland on research that provided free hearing aids to Dennis and other kaumatua, some of whom were battling migraines because of their disability.

“Hearing loss is that invisible māuiui. And for some it’s quite embarrassing. Hearing Auckland has not only made it accessible, but acceptable, through positive and friendly end-to-end service delivery and follow-up,” said Dennis, 59, a former police officer.

“It has improved, instantly, the quality of life for a lot of people. Even to the point where it’s getting a bit annoying. Someone made the comment the other day ‘now they can hear everything, the meetings have gone from an hour to two’. But, hey, that’s quality.”

Aged Care Commissioner recommends funding, hospital discharge changes

The Aged Care Commissioner’s report made 20 recommendations, including a dedicated strategy for the health needs of our ageing population (the over 65 population is projected to reach 1.5 million by 2050).

Better discharge planning by hospitals is needed, the report recommended, and a current funding review by Health NZ/Te Whatu Ora must help a sector that’s short-staffed and struggling financially.

“The funding review must also address the significant gap in the provision of kaupapa Māori aged care services, particularly for people with dementia and psychogeriatric care needs,” the report stated.

The Aged Care Association – which represents most care homes – reported the average reported ebitda (earnings before interest, taxation, depreciation and amortisation) per occupied bed day had fallen from from $23.82 to $3.94 in five years.

Aged-care facilities are required to notify when they don’t have enough nurses rostered to care for residents. This happens about 400 times every month.

Those pressures caused 66 specialist dementia or psychogeriatric beds to close in the six months from January 2022.

“Significant patient and whānau harm is caused by the lack of access to appropriate care for people living with dementia and other cognitive and mental health conditions,” the commissioner warned.

“To the best of our knowledge, no provider in the private sector is currently including a psychogeriatric level of care when building new facilities. This is a concerning prospect for the growing and vulnerable ageing population, particularly as we will see an increased number of people living longer with dementia and other conditions over the next decade.”

The commissioner also raised the alarm about home care services, which are declining in rural areas and suffer from complex funding arrangements. Clients and their families reported “inconsistencies in availability of care and unexpected and unwarranted reductions in the level of care provided”.

The report contained examples of innovation and schemes that could be widened, including a charity supporting people to set up Enduring Powers of Attorney to protect against elder abuse, a fall prevention programme developed by physiotherapists, and transport services to reduce loneliness and isolation.

The Government responds

Casey Costello, the Seniors Minister and Associate Minister of Health, said the problems identified by the commissioner were long-standing and not easy to fix, but she saw a “unique opportunity” to make real progress.

“Having the right living and care options available for people as they get older is one of the key challenges I want to address as Minister,” the NZ First MP told the Herald.

“This isn’t just about making sure there are more aged-care facilities and dementia beds – though they are specific issues – but looking at how older people live and the full spectrum of services they need to live as independently and well as possible.”

That included, for example, enabling people to live in their own home through care support. On the ongoing aged-care funding review, Costello said she looked forward “to establishing a sustainable funding formula for new residential care beds.”

Costello did not comment on whether the recommendation to fund hearing aids would be considered.

Nicholas Jones is an investigative reporter at the Herald. He won the best individual investigation and best social issues reporter categories at the 2023 Voyager Media Awards.