You are not permitted to download, save or email this image. Visit image gallery to purchase the image.
For many, a residential care facility is their final home - but as the number of elderly New Zealanders increases, will there be enough beds to meet demand?
The Otago Daily Times series on ageing continues, with a look at rest-homes. Mike Houlahan reports.
South Dunedin's Radius Fulton has 93 beds, 93 residents, and a decent-sized waiting list.
There are 66 aged residential care facilities in Otago and Southland, and they would all have a similar tale to tell.
Out of 20 district health board regions, Southern rates fourth highest in terms of occupancy rates for aged residential care beds, at 90.8%.
By 2050 a quarter of all New Zealanders will be 65-plus, and by 2068 it is projected 78.4% of people will die aged between 85 and 94 - today it is just over 30%.
"We used to have a lot more rest-home beds, but people are now staying in their homes for longer so we have seen an increase in hospital level beds," Radius Fulton facility manager Robyn Bowie said.
"Now we are seeing there are still rest-home level people needing beds, but there are also still a lot of people needing hospital level care and dementia care ... those numbers are only going to increase, and what is going to happen?"
While worrying about meeting the looming demand of potential residents, rest-homes still have to worry about looking after those who live there now.
In that respect, finding staff is what keeps Mrs Bowie awake at night.
"Registered nurses are especially hard to find, because what the DHB can offer them in terms of remuneration we can't even compare.
"It's such a shame, because you would think people would value nurses and value people who are in aged care more highly ... but unless we get the same level of funding, we can't offer the same level of remuneration."
Radius Fulton offers three levels of care: 21 rest-home beds, 19 dementia care at rest-home level, and 53 hospital care.
Its 80 staff care for residents who are frail, unwell, or have varying degrees of dementia.
It sounds dark, but there is plenty of brightness, light and happiness at Radius Fulton.
Special moments happen every day, such as when hospital-level care resident Marie Millar plays the piano set up in her room.
"People think it is sad here but it's not - it is exactly the opposite," Mrs Bowie said.
"It is not a place to come and die, it is a place where people come to live their life.
"They may have been at home by themselves and be isolated and lonely, but here they have social interaction, they are well cared for, their meals are cooked for them and they are warm - it is really positive."
Residents spoken to by the Otago Daily Times said while Radius Fulton is a home, it felt like their home.
Former Northeast Valley resident Jimmy Sprague (88) lives at Radius Fulton rest-home while wife Margaret is in the dementia care wing.
Last year Mr Sprague fell and badly injured himself, meaning the couple had to admit their Pinehill home was too much for them to cope with.
"One of my daughters had been trying to find somewhere for weeks, knowing we were getting to the stage where we should shift, and she fluked this wonderful home where they could find a place for both of us," Mr Sprague said.
"Every second night I endeavour to have a meal with her, I can come and go as I like."
"They go the extra mile and there's always something happening; it's a very active place, which is really great."
However, Mr and Mrs Sprague, like most rest-home residents, had to wait to get a place, and go through a rigorous needs assessment to make sure they needed care and what government subsidy might be available for that care.
"Sometimes they will be assessed in their home, sometimes they may have had a fall and be assessed in hospital," Mrs Bowie said.
"You need to have an assessment before you can even apply for a subsidy, and it is means-tested."
The historic main block screens a large complex comprising rest-home, hospital and psychogeriatric beds and is home for 126 people in addition to 10 cottages housing 10 people.
Ross Home has 186 staff, a host of volunteers, and with its respite and day events programme is always a hive of activity.
"Previous boards were quite forward-thinking, so between 2001 and 2005 there was a $10million rebuild, and what is behind the main building was totally redone," manager Margaret Pearce said.
The rest-home and dementia wings have also had more recent upgrades, as have the kitchens.
"We have also had earthquake strengthening so we are pretty confident the building has plenty of life in it yet, but you have always got to have a good 10-year plan in place."
Ross Home boasts spacious rooms, most of which look out on to a carefully planted and tended central courtyard.
Resident Rua Hotton has had a busy day - family visitors have just left, and there are more expected later in the day.
"I moved in June of last year, and I enjoy living here," she said.
"There's no cooking - I like that - and no lawn mowing, which is even better."
With 11 great grandchildren Mrs Hotton is very much the matriarch of the clan.
"We have a good crowd living here though, and we have a lot of fun.
"It's been good for me."
SETTING THE REST-HOME STANDARD
Every day is audit day, a rest-home manager says.
In reality, audit day comes either annually, or every two, three or four years depending on the certification a rest-home is awarded.
Every home in New Zealand has to be certified, and a range of providers are contracted by the Ministry of Health to make sure the 66 age related residential care facilities across the Southern District Health Board region pass muster.
It is not a simple task to meet code: a full audit report runs to more than 70 pages, and assesses the standard of buildings, facilities, training, meals, resident liaison, medical treatment, how they deal with adverse events, and many other categories besides.
Each certification audit involves two visits - a pre-scheduled inspection, and a random unannounced visit which can happen three months either side of the booked examination.
The auditors' criteria is set by the ministry but they are independent, and their report determines what certification is eventually granted by the ministry.
"It is a very complete review," Emma Prestidge, the ministry's quality assurance and safety group manager, said.
"You are expected to meet the standards every day of the year and every shift of the week ... but it is a very robust process to give surety that the certification process is well-managed."
In addition, changes of management or senior staff, reports of adverse events or "near misses" and other notable events are all required to be reported to the ministry - any of which can trigger a spot inspection or additional audit.
A four-year certification is the highest grading awarded, and almost half of the southern region's rest-homes hit that standard, meaning they achieve or are continuously improving in most criteria.
Of the remainder, most, 28, are on three-year certificates.
Five facilities are on two-year certificates while three are on a one-year provisional audit - a status automatically given when management or ownership changes so the ministry can be confident the correct standards are still being met.
"The standards are very important, and I don't think they are over-rigorous or over-weighted towards unnecessary compliance," Ms Prestidge said.
"They are all about ensuring all New Zealanders receive good and safe services, and I think everyone can see the merit in that."
Having said that, the standards are reviewed every four years to ensure they are fit for purpose, and consultation on that is under way now.
"They do need refreshing from time to time with changes to contemporary care practice, changes to models of care and other changing needs."
Audits, of course, reflect the moment in time when the inspection took place.
Likewise, no system is perfect, and both the Health and Disability Commissioner and the Ombudsman have oversight roles in the aged-care sector and can investigate complaints.
"Overall, I think the level of transparency and rigour that we do have in New Zealand holds us in very good stead to expose any matters and to get on top of things before we have systemic or undue surprises," Ms Prestidge said.
"It is about making sure that very vulnerable people are receiving the care they need in the right way and in the right place."