Care of elderly and the welfare state

The author of The Welfare State We're In is writing a new book. His latest post coincides with my earlier topic this week prompted by discussions on Radio Live about elder care:

What do you do about granny?

I have just finished the first draft of the chapter on care for the elderly for my new book. So here is a quiz question: what is the range -  among different European countries – of the percentage of women aged over 65 and without a partner/husband who are living with one of their adult children? When I have asked people this question, they have mostly been totally wrong about both ends of the range. The statistics are indeed extraordinary. Please have a guess. The answer is revealed later on.

The chapter was really difficult to write. First,  the subject is depressing. It is grim to come across figures showing how many people in residential care are clinically depressed and wish they were dead. It is sad to read of the loneliness. Second, it is tough or impossible to come up with a simple answer to fit all situations. There is so much variety in the condition and preferences of people over 65. But it does seem to me that many countries have been too eager to give up the family as a unit which can provide comfort and care to elderly parents. It is strange – but I think is true – that supposedly backward Greece, Portugal, Spain (and Italy) may have been right while  ‘advanced’ Denmark, the Netherlands and Sweden (and the EU which has encouraged institutional care) may have been wrong.

The answer: the range of percentages is from 3% in Denmark to 61% in Portugal (research report dated 2000). Quite an astonishing range, I think. It shows how the behaviour of people is strongly influenced by their welfare states. We should not assume that the cultures of these countries were always different with regard to the elderly. There is reason to believe that all cultures, including the Scandinavian,  used to look after their elderly parents. Now I am moving on to crime and civil behaviour. I would be grateful for any input or experience from any country about how these things are now or how they have changed in the past 30, 40 or more years.

For example: if you go to public buildings like a post office or hospital in your country, is there a sign warning you not to abuse the staff? But I would be delighted to hear about any other perceptions you may have about crime or behaviour or, indeed, how the concepts of virtue or duty are doing in your country.

And this country?

New Zealand "has previously reported high rates of residential aged care relative to other OECD countries."

(Actually it won't be about "Granny". It'll be about Mum or Dad. I don't know why it's so fraught. But I've yet to meet the harsh realities some face.)

Corporate welfare

I accept the government's tax subsidy to Rio Tinto is corporate welfare.

Corporate welfare is bad because it's privilege for some.

The only way to reduce corporate welfare is to reduce the size of government.

One effect of the subsidy is keeping Meridian Energy economically sound.

Selling off Meridian is just a small step towards downsizing government.

So I'm supporting this dose of corporate welfare as a means to a more important end....

I think....

I'm open to changing my mind.

Tamihere First?

New Zealand's small population makes politics particularly fertile ground for power-hungry egos. Combined with the incestuousness of MMP,  implications for the entire country may ride on past rejections,  and subsequent development of further destructive co-dependent relationships. That's kind of fitting. The story of many personal lives.

I don't know when the jungle drum started beating but its rhythm picked up tempo very quickly. Radio Live host, Sean Plunket must have kicked off the public conversation about JT (also Radio Live host) joining forces with Winston First this morning. Matthew Hooton continues in the NBR (based on the time and day attributed).

This coupling would be hugely significant. The votes they'd pull are NZ male - 'good blokes' -  who feel disenfranchised by feminism; homophobes; xenophobes; nationalists;  elder entitilitis addicts; women who swoon over handsome Maori men; AND plenty of good folk to boot.

Ex-politicians who want to return make me distrustful. In the current climate, the money isn't bad. Importantly, it's steady. Tamihere can argue his altruistic leanings, his vocation to improve the lives of Maori, but his return to parliament isn't necessary to further that cause.

Under National, a couple of really important developments should have progressed Tamihere's urban Maori authority endeavours - whanau ora and charter schools. These initiatives deliver power into Maori hands. Nothing Paula Bennett knows or says is any different to what Tamihere was saying as a Labour MP. However, she did cut off some Waipareira funding(? Not sure what the court resolution was in that battle.)

If the rumour that Tamihere is talking to Winston has substance, what is it that Tamihere wants that NZ First can give him?

Or is this whole episode about Radio Live making the news instead of reporting it?

The care of aged Maori

There are only 34,200 Maori aged 65 and older.

65+  34,200
75+  11,000
80+  5,000

In the total population  616,660 people are aged 65 plus.  160,000 are 80 plus.

So only 3 percent of 80 year-olds and older are Maori.

I was prompted to look up these figures - I knew they were low - on the back of a conversation Willie and JT had yesterday about Maori and care of the elderly. They were talking about how, in the past, their elderly were always cared for by the whanau whereas Pakeha put their old in rest homes (though this was changing).

A caller said she had seen research showing that by the 1980s this was no longer true. That rates of 'institutionalisation' were actually the same. In particular, elderly Maori were often committed to psychiatric units. I came across the following table in my hard copy of the 1994 NZ Yearbook. It shows high Maori rates of first admission in the younger population but not the 60+. These stats relate to first admissions though.

Table 7.21. RATES OF FIRST ADMISSION TO PSYCHIATRIC HOSPITALS*

Year	Ages							Total all ages
	0-9	10-19	20-29	30-39	40-49	50-59	60 and over
*Per 100 000 mean population. Year ended 31 December. Source: Health Information Service
1987—
Maori	15	170	393	253	117	103	51	180
Non-Maori	13	111	218	149	127	98	149	127
1988—
Maori	5	210	488	275	170	131	90	218
Non-Maori	10	108	222	159	127	103	151	129
1989—
Maori	12	179	444	260	153	91	92	197
Non-Maori	11	95	225	157	129	95	133	124
1990—
Maori	12	165	496	338	292	156	37	230
Non-Maori	7	88	240	213	165	140	136	142
1991—
Maori	4	168	470	318	197	91	93	208
Non-Maori	7	80	225	174	122	98	125	121

I've been trying to find historical data relating to residential care populations but drew a blank.

Relating to current numbers the Human Rights Commission produced this report:

 "During visits to aged care facilities the Commission was struck by the absence of Māori as residents. Conversations with providers suggest that residential care residents are predominantly female and Pakeha, although providers have noted increasing diversity in recent years. Data from the OPAL study (2008) based on Auckland figures, show that two percent of rest home residents were Māori, compared to 92.4 percent European and 4.5 percent Pacific Island. Of those in hospital level facilities, 2.6 percent were Māori, 89.1 percent European and 6.4 percent Pacific."

Those numbers are particularly low for Auckland and doubly interesting in light of the Pacific numbers.

So it would appear elderly Maori are disproportionately cared for in their own homes or their adult children's homes. That's a good disproportionality in my view.

More inconvenient truths CPAG overlook

Last week the Child Poverty Action Group released a report into the link between substantiated child abuse and socio-economic deprivation, ethnicity, benefit income and the youth population.

I've blogged about the shortcoming in their methodology to conclude there is "no correlation between benefit receipt and child maltreatment."

So let's move onto their next finding, p.2:

"...there is an association between ethnicity and child maltreatment, however given the strong association between ethnicity and socio-economic disadvantage in New Zealand this finding needs to be treated with caution."

On p.13 the following "discussion" appears:

Disproportionately high rates of child abuse among Māori need to be treated with caution: the ethnicity given is that of the child; New Zealand data shows a strong link between socio economic deprivation and ethnicity (Perry, 2009, 2012). Data from Perry (2012, p. 76) shows that between 2009 and 2001 the median income of Māori families fell 1.1% ($26,300 to $26,000), the median income of Pacific households fell an astonishing 5.3% ($28,300 to $26,800) while that of Europeans – starting from a much higher base – fell 0.8% ($35,500 to $35,200).

Here's the relevant table (note their typo - 2001 should be 2011):

The updated 2013 report shows that between 2011 and 2012 Maori income increased to $30,000 and Pacific income increased to $29,800 (Perry, 2013, p.80).

That in itself is inconvenient. Perry notes:

From a longer-term perspective, all groups showed a strong rise from the low point in the mid 1990s through to 2010.  In real terms, overall median household income rose 47% from 1994 to 2010: for Maori, the rise was even stronger at 68%, and for Pacific, 77%. 

But the issue I really want to focus on is this.

CPAG got ethnicity breakdowns on the substantiated findings of abuse across CYF site offices.

They provide a comparison in their appendix:

Note the bottom line which shows that, on average, substantiated abuse findings are exactly the same for Pacific when compared to the NZ European baseline.

CPAG describes this table thus (p.12):

Raw data for all substantiations (not distinct cases) shows nationally Maori children are more than twice as likely to suffer abuse as Europeans (abuse rates for each ethnic group by site office and country overall are listed in Table 7).

So if "a strong link between socio economic deprivation and ethnicity" is the reason Maori children are over-represented in abuse statistics, why isn't it operating amongst Pacific and other ethnicities?

This is a fly in the ointment for CPAG. For them poverty has to be associated with  child abuse because it provides support for their main campaign which is to increase benefits.

The report ends with this:

Rates of child abuse in a society are not pre-determined, nor do they remain static. New Zealanders’ rates of child abuse have increased over time: they can change for the better if we so choose. Reducing the risks associated with poverty would be a good place to start.

So "rates of child abuse have increased over time" yet Maori households, where a disproportionate amount of the abuse occurs, have incomes rising faster than the median.

Their position is implausible.

Smoking and sex

My subscription to e-mail notifications of new studies coming out of the Christchurch Health and Development Study delivered this finding today:

 Findings across 3 studies using a complement of genetically sensitive research designs suggest that smoking during pregnancy is a prenatal risk factor for offspring conduct problems when controlling for specific perinatal and postnatal confounding factors.

The problem is, according to the new version of the Christchurch study, Growing up in New Zealand, tracking  babies born in the late 2000s:

* More than one in 10 mothers continued to smoke through their pregnancies (with an over-representation of those identifying as Maori and living in the most deprived areas.)

At least teenagers are smoking less according to the Auckland University  Youth Health and Wellbeing survey released last week.

Which reminds me, I've been blogging for a while about the falling teenage birthrate (since 2007) and speculating on reasons why. One could simply be that teenagers are having less sex.

Well it seems that may well be the answer according to the same survey.

In 2001 31.3 percent had "ever had sex" down to 24.4 percent in 2012.