High-needs psychogeriatric dementia patients could end up in public hospital care due to a lack of anywhere else for them to go, aged residential care facility operators fear.
Otago and Southland face a looming crisis in the availability of D6 beds for dementia patients with functional or behavioural issues, after critical staff shortages forced Presbyterian Support Otago to announce its specialist Lindsay ward at Dunedin’s Ross Home would close.
Only three other facilities in the region, apart from Ross Home, offer D6 care, and only one of those had any available beds yesterday.
New Zealand Aged Care Association Board southern representative Malcolm Hendry said the lack of beds for people classified D6 was a long-standing issue in the South and the imminent closure of the 24 beds at Ross Home would make an already fraught situation even more difficult.
"We had a resident who was reassessed at the D6 level, there was nowhere else for the DHB to send him, so their instructions to us were that we needed to hang on to that patient until they could find somewhere," Mr Hendry, who is Birchleigh Residential Care Centre chief executive, said.
Most facilities could not comply with such a request because they were not contractually able to care for a D6 patient, or did not have the trained staff and appropriate resources to do so, he said.
"They (D6 patients) can be a danger to staff and they can be a danger to other residents as well because of their inappropriate behaviour ... They are beyond our capacity to care for," he said.
"It becomes a health and safety issue.
"If someone is being punched, not just once but on a regular basis, it is a risk and we would have other government agencies breathing down our necks if we exposed staff or residents to that sort of behaviour."
He feared patients who had nowhere to go could end up in public hospitals by default.
In May, Mr Hendry wrote an open letter to Prime Minister Jacinda Ardern and Finance Minister Grant Robertson which called on them to recognise and address "the crisis our vulnerable elderly are facing".
Mr Hendry said successive governments had known for years the percentage of the population classed as elderly would increase and demand for D6 facilities and trained staff would increase, but little or nothing had been done to address the problem.
"I feel sorry for Te Whatu Ora," Mr Hendry said.
"They are the meat in the sandwich trying to deal with the implications of the lack of funding and what that has been doing to the sector that has historically been the moat that protects the public health system from this sort of issue.
"With funding the way it is now, we are all struggling to make it work."
Te Whatu Ora Health New Zealand Southern planning, funding and population public health executive director Andrew Lesperance said Leslie Groves home in Dunedin was adding an additional four psychogeriatric beds, which were planned to open next year.
However, in the short term, managing demand for psychogeriatric beds would be challenging.
"Ideally, we will look to keep these people in the community, which may include some bespoke arrangements with aged residential care facilities and/or families.
"In parallel, we will look at the pathways and supports in the community for people with declining cognitive and behavioural issues."
There are 3217 aged residential care beds in the southern region, 98 of which are certified as D6.
However, a bed requires trained and available staff who can look after the person using it and Mr Lesperance acknowledged many facilities were choosing not to fill some of their certified beds due to staff shortages.
"Whether or not they choose to admit to an empty bed is the facility decision and can change from day to day.
"We have no visibility of the number of beds which might be closed, and for how long."
Mr Lesperance said it was not unusual for a newly classified D6 patient to have to wait some weeks if they needed to move homes.
"We explore all options with residents and families, both locally and further afield.
"We find the demand for psychogeriatric beds is quite variable, with waitlists of up to 15 residents at some times, and then many months with no waitlists and vacant beds."
