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Health boards have becoming increasingly tougher on assessing residents for aged-care funding and have a preference to fund home-care services, Forsyth Barr broker Lyn Howe says.
Since 2006, there had been a 35,520 increase in the number of people more than 80 years old but there had only been an increase in aged-care beds and service apartments of 4102.
Many of those people would be in the 39,000 residents estimated to be in retirement villages, although a significant portion were staying at home longer.
More than 70% of people in residential care were over the age of 80, she said.
``We have picked up anecdotal comments of home-care businesses at capacity and margins being very thin. Improving the capacity of home-based care could be achieved by allowing integrated villages with a care centre to deliver a DHB-funded home-based service to residents.''
Intuitively, home-based care should work well in large retirement villages and could help drive further interest in retirement villages for those residents qualifying for a level or home care, rather than aged care, but wanting the community and security of a retirement village, Ms Howe said.
With more people staying at home for longer, there would be an impact on occupancy for rest-home level care.
In recent years, more new residents were going into care with a higher level acuity (level of severity of illness), shifting the demand more to hospital level beds.
The average length of stay was decreasing as a consequence, also putting pressure on occupancy and profitability for hospital level care, given the time taken to fill a vacant bed.
Rest-home level beds continued to reduce and had been offset by the building of ``swing beds'' that could handle both hospital and rest-home level care, she said.
Those beds provided operational flexibility and allowed the resident to stay in the same room for longer.
Beds only providing rest-home level care were likely to be older and the operator was less likely to be able to charge a room premium.
In many cases, it was expensive or impossible to convert those rooms to qualify for hospital-level care, Ms Howe said.
Rest-home-only beds were still above 30% of total beds, indicating many operators might have an increasingly marginal product.
Looking at the supply outlook for aged-care beds, Ms Howe said while there were almost 2500 retirement village units built in 2016, there was only a 232 net bed increase.
A considerable problem was the sub scale and obsolete nature of many older care facilities continuing to leave the market. In the past 10 years, a net 89 facilities had left the market.
Smaller care operators with older facilities faced challenges such as the squeezing out of rest-home beds due to DHBs focusing on ``ageing in place'' and the higher level of acuity of new residents into aged care.
They also faced increased land prices leading to alternative use opportunities and increased operating cost pressures and an inability to charge room premiums.
The vast majority of new beds continued to be delivered by integrated operators like Ryman and, more recently, Summerset and MetlifeCare.
The lift in land prices in Auckland was further reducing the feasibility of new stand-alone greenfield aged-care development.
In the past three years, the number of new beds had increased and had exceeded the number of beds leaving the market.
The bulk of the 1715 new beds in the past 10 years had been delivered in the past three years.
The number of people in the 80-plus age group started to rapidly increase in four years, Ms Howe said.
``At this point, we should start to see a considerable increase in demand for aged-care services and home-care services. We expect a shortage of quality age-care beds at this point.''