Prevalence of key care indicators of pressure injuries, incontinence, malnutrition, and falls among older adults living in nursing homes in New Zealand

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Between 2010 and 2050, the proportion of the New Zealand population ages 65 and over is expected to double, from 13% to 26%, and the number aged 80+ will almost quadruple, from 3% to 11% of the population over this same period (Organisation for Economic Co‐operation and Development [OECD], 2015). Such rapid population aging is not unique to New Zealand (NZ), but it poses significant issues for the sustainability of nursing home industries in New Zealand.
New Zealand spends more on funding its universal healthcare system than any other country in the OECD (OECD, 2015). Furthermore, NZ has a higher than average proportion of long‐term care recipients, most of whom are age 80 or older (OECD, 2015). According to Statistics NZ (2013), more than 30,000 older people are reported to be living in nursing home care, which is a 14.1% increase since 2006. Maintaining access to, and the sustainability of, nursing home care in NZ over the coming years is now an issue of significant importance (Thornton, 2010).
Although NZ theoretically has a free universal health service, there are two anomalies. One is partial co‐payment for community‐based medical care (from a general practice team), and the other is private ownership of residential aged care services. Prospective residents are asset‐tested, and only if found eligible do they receive a government subsidy to pay their costs once their assets fall below a certain level. This private business model with shareholder responsibility risks constraining the quality of care provided.
Indicators of poor basic health care quality (e.g., pressure injuries, incontinence, malnutrition, and falls) feature prominently in complaints from nursing homes in NZ (The Health and Disability Commissioner, 2016). As people age, they become frail, which is associated with higher rates of these problems, conditions that often co‐occur (Ernsth Bravell et al., 2011). Quantifying the prevalence of basic health problems among aged care residents is essential to ensure continuing quality in nursing homes in a context of increasing demand and decreasing health. Monitoring such prevalence helps identify critical trends, can be used to identify the workforce capacity required to contend with such problems, and can signal potential skills or workforce enhancement needs should trends continue. Despite the increased demand for nursing home care in New Zealand and the need for monitoring problem trends and potential resolutions, no such system exists at the national level. Lack of data for government review increases the risk that critical problems in nursing home care will remain unmonitored and unresolved, in a private care environment characterized by profit seeking.
Having identified an international paucity of prevalence assessment of nursing home care problems, Halfens et al. (2013) reported on the prevalence of some of the basic problems in aged care (e.g., pressure ulcers, incontinence, malnutrition, and falls) and related preventive approaches across healthcare settings in the Netherlands, Austria, and Switzerland. This constituted the first international comparison of data stemming from the National Prevalence Measurement of Care Problems (In Dutch: Landelijke Prevalentiemeting Zorgproblemen: LPZ). These data offer other countries benchmarks against which to assess their own relative problem burden and interventions undertaken. The LPZ program was designed by the Department of Health Services Research, University of Maastricht, the Netherlands, introduced to the Dutch healthcare system in 1998, and has been repeated annually since then. It now is done in the Netherlands, Germany, Austria, Switzerland, and New Zealand, and other countries are currently piloting it (Romania, Indonesia, Brazil, Suriname).
The New Zealand arm of the international comparison project is the National Care Indicators Programme—New Zealand (NCIP‐NZ).
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