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.

Chart of the day

Here's one OECD chart New Zealand is topping, Family Violence

 

Chart SF3.4.A Prevalence of partner physical or sexual assault, women and men, around 2005.

CPAG research inconclusive at best

New research from CPAG claims there is "no evidence of an association between benefit receipt and distinct substantiated rates of child abuse."  And later under Conclusion, "...benefit income does not appear to be related to rates of child abuse."

How did they arrive at this?

Here's a cut and paste of the entire relevant text and scan of their scatterplot:


3.5 Benefit uptake

Benefit data is held by the Ministry of Social Development. We have assumed WINZ offices cover broadly the same areas as CYF site offices as MSD appears to know what percent of the population is on a benefit (see for example Collins, 2013) so would use the same or similar population estimates they use for CYF purposes. Here, data for the four main income-tested benefits has been combined since not all the jobless go on an unemployment benefit nor is it only DPB recipients who care for children (similarly, not all DPB recipients care for children, although most do). Benefit figures are from June 2012 so are for a point in time only: the numbers can easily change if the dynamics of people moving on and off benefits changes. The percentage of beneficiaries in the population was plotted against the rate of substantiated distinct abuse cases in each site office. If there was a relationship we
would expect to see rates of substantiated abuse rise as the proportion of working-age beneficiaries rose. This relationship is statistically insignificant, with the R 2  value being 0.39. The values for each site office are in the Appendix at Table 6. 

Figure 5: Scatterplot showing rate of distinct substantiated cases of child abuse and proportion of income-tested beneficiaries in population for CYF site offices. R 2  = 0.39

 The site offices with rates above 2.5 include Taupo (2.76 but a below-average proportion of income-tested beneficiaries in the population); Clendon (2.96 and a slightly higher than average proportion of income-tested beneficiaries in the population); and Whakatane (3.5 and an above average 10.1% of the population being on an income-tested benefit) and Papakura (4.0 with the 10% of the population estimated to be on an income-tested benefit being slightly less than Whakatane). There are 8 site offices with a higher proportion of the population receiving an income-tested benefit that have below average rates of substantiated child abuse.

The weak relationship between benefit receipt and child abuse may be no more than a reflection of the impact of the low incomes of benefit recipients (Perry, 2007). The data here shows no evidence of an association between benefit receipt and distinct substantiated rates of child abuse.

I have one major problem with this chart. It uses benefit dependency rates across all benefits. Most people on a working age benefit are not caring for children (58% 2012). Most children dependent on a benefit rely on the DPB (78% 2012). What would the chart look like if the relevant population was plotted?

Remember that earlier Auckland University research found,

 "There are 10,300 children maltreated by age 5 and seen on a benefit by age 5, comprising 86% of all children with maltreatment findings by that age – suggesting that the majority of children  with maltreatment findings are on the benefit relatively early in their lives since we only lose 3% when we ignore children who arrive on the benefit after age 2."

This strongly suggests that most would be on the DPB. Consider this graph from the Children's Social Health Monitor:




Anyway CPAG took exception to the Auckland University in their first report saying,

"It suggests child maltreatment is a function of membership of particular social groups, something for which the evidence is very weak."

They footnote this claim with the following, "See Child Poverty Action Group technical paper (forthcoming)."

And here it is.

Whose research is more robust? The University of Auckland or the Child Poverty Action Group's?

CPAG report into child abuse disappoints

CPAG has been heralding the release of a new report into child abuse which analyses CYF data. It hasn't gone on-line yet but Stuff has a pre-report. There's nothing of great interest so far and their analysis about the types of abuse and why reports have risen are old hat.

Broken down into types of child abuse over the same time period, sexual abuse accounted for the smallest proportion, at 6.7% of cases.
Emotional abuse was the most common form, at 54.6% on average.
Sexual abuse and neglect was relatively constant during the period, but the number of emotional and physical abuse cases had risen.
CPAG said this could reflect an increase in the number of police and family violence referrals, or the impact of the Ministry of Social Development’s 'It’s not OK' campaign.

Anyone who takes an interest in this area is well acquainted with these 'findings'.

Update

Actually I have found something of interest but CPAG missed it.

According to their report, the following are the areas with the highest rates of child abuse. They don't surprise. None is south of Taupo:

TOP TEN HIGHEST RATES OF CHILD ABUSE
Papakura
Whakatane
Clendon
Taupo
Otahuhu
Manurewa
Rotorua
Westgate
Whangarei
Far North

Last week I blogged about children taken into state care and did express surprise that the numbers were so high in the Southern region.

Children in out of home placements, by region

Region	F2008	F2009	F2010	F2011	F2012	F2013 as at 31 Mar 2013
Northern Region	1,367	1,305	1,234	1,173	1,227	1,195
Midlands Region	816	869	876	744	749	792
Central Region	1,060	1,027	958	801	846	835
Southern Region	1,277	1,204	1,166	1,166	1,062	1,014
Adoptions / Others	2	3	4	1
National Total	4,522	4,408	4,238	3,885	3,884	3,836

Very broadly speaking, it looks like the highest rates of child abuse are in the north, but the highest rate of child removal into state care is in the south. Fascinating.

Perhaps the two things are connected. Where children are removed from risk, abuse rates are lower?

Welfare reform - the 1990s versus today

A column published in the NZCPD newsletter today speculates about the lack of public protest against National's current welfare reforms:

In the early 1990s the National government introduced welfare reforms that were met with enormous resistance and provoked a good deal of public sympathy for the plight of beneficiaries.  The reforms featured benefit cuts which reduced most incomes by around 10 percent, with some losing as much as 25 percent. These cuts affected hundreds of thousands of beneficiaries and their children directly, and others, like retailers and landlords, indirectly. While the government needed to both save money and increase the gap between benefit incomes and wages to incentivise greater productivity, unemployment was above ten percent.

More.

Extending the IWTC is not a cure for child poverty

In the interests of children the In Work Tax Credit should be retained as a work incentive. Even Labour believed that working parents offered the best way out of poverty for children, and that extends beyond just the monetary rewards of working. That's why they designed a tax credit system that made working pay more.

Ever since, the CPAG has tried to overturn it, arguing discrimination against children of beneficiaries.

Today the NZ Herald has revealed that 51 percent of people participating in an on-line poll agree with CPAG. At 750 it's not a large sample but nevertheless it is disappointing that so many people don't think through the issue.

New Zealand's 'child poverty' problem is largely a result of welfare dependency. More welfare won't fix it.

What has John Ansell got up his sleeve?

I don't know. But he's a clever, quirky man and I'll be watching tomorrow at 7.20am TV One.

At the protest today

Here's Lexie at parliament today. She appeared briefly on the TV3 news coverage. Good turn out I thought. Good on John Banks and Mojo Mathers who both spoke and promised to keep the pressure on. And especially well done Caroline Press for organising the event. Quite a daunting endeavour.

No-one responsible for drafting the bill or opposing the amendment appeared. Gutless. I noted a few Green flags flying despite their party actually enabling the passage of the bill. ACT was the only party that voted against the bill. For the life of me, I can't understand the regulation of synthetic cannabinoids while the natural version remains illegal.

Feminists trample on women's rights

Originally feminists fought for important rights, like universal franchise. Doubtless I'd have been amongst them. They fought for women's rights. But now, in some respects, they seem to fight against them. For instance the campaign against  sexualised images of women.


In the UK, the Co-op, "one of Britains' largest magazine retailers"  has agreed to only stock mags in bags. But it's not enough,

Sophie Bennet, spokeswoman for the Lose the Lad's Mags campaign by UK Feminista and Object said that the Co-op's move did not go far enough. "The more accurate term for these so-called "modesty bags" is "misogyny bags" because the issue for the thousands of people who have called on shops to lose the lads' mags is absolutely not about nudity. It's about sexism. And if a product is so degrading to women that it has to be covered up then the Co-operative should not be selling it.
"By stocking magazines like Nuts and Zoo, retailers like the Co-operative and Tesco are sending out the damaging message that it is normal and acceptable to treat women like dehumanised sex objects.

But if a female wants to act like a "sex object" and earn an income from it, what about her rights?

(Just discussing this with my 19 year-old son who says that these mags are, in fact  "empowering to women who use their natural assets to make shitloads of money and degrading to men who show how pathetic they are by buying them." Always nice to get a different perspective.)

Updating: "March against animal testing on party pills"

Reminder about tomorrow's protest in Wellington and other places. John Campbell just ran a good piece. It was sad to see John Banks speaking against this to an almost empty house. If you can make it, hope to see you there. For more details.

 

HUHA, Helping You Help Animals, is an organisation I admire and support for their work with homeless animals and philosophy of never euthanising simply because a home cannot immediately be found. I saw what they do first-hand when I got my Beagle from them.

They are organising a further protest against the testing of party pills on dogs on July 30, 12 noon. The Wellington protest will be at parliament but it looks like other protests will run elsewhere.

Nobody has to take a psychoactive drug. It's their choice and their risk.

Labour wants to tell us who we can and can't sell our property to

Labour has announced it will ban foreigners from buying houses.

What a racist, anti-global, anti-freedom joke. What a retrograde step for New Zealand's reputation as a desirable destination for immigrants.

And if I can't sell my property to the highest bidder, regardless of their skin colour or country of birth, that amounts to a confiscation of wealth.

It's a nasty small-minded policy that makes Labour look desperate. Shearer is under siege from his own party and consequently we're getting siege-mentality policies.

Local government taxing the bejesus out of us

Here's a number that doesn't get publicised often.

In the financial year ending June 2012 the total local government took in taxes was,

$4.653 billion

With a population of 4.471 that's  $1,041 per man, woman and child.

The bulk of the taxation is recurrent taxes on immovable property - rates.

A direct comparison is impossible due to record keeping differences and fifty years ago local government got a lot more revenue from rents on buildings, licences and public utilities but in rates alone, in 1952 it collected 14.5 million pounds on a population over just over 2 million. A ratio of around 7:1  compared to today's 1,000:1

Wow. WOW.

Who is this?

That was weird. I'd glanced at this morning's paper while making a cup of tea, and was fleetingly trying to figure out who the woman on the right is. She looked vaguely familiar and the person who sprung to mind was media trainer and TV producer, Janet Wilson. So I found a picture of Janet from a few years ago. By comparison, the woman on the right is similarly gingery, same nose, same eyebrow line, same complexion tone, the eyes starting to go downwards at the sides without a very broad smile, and overly made-up to compensate for age?

Perhaps not, but who does she look like?

On being a case manager

Unusually, I was reading the comments thread after a piece on Stuff about 35 WINZ roles going. Resentment against case managers led to some taking a celebratory position (even though the roles aren't case managers - most readers don't actually READ).

Anyway the following comment caught my eye:

The ignorance of some of these comments is astounding. I used to be a DPB case manager in Porirua with a caseload of 136 clients. Most were lovely people who were victims of circumstance, but some were nasty pieces of work. Threats of violence, nothing you did was enough for them because of their sense of entitlement. The fraudsters, those that chose benefits as a lifestyle. Yet you still bust a gut to help them within the bounds of legislation. Hard not to be pissed that some were making more than you on the benefit ($26,250 was my salary. Ludicrous).

Until you've been on the other side of the desk, don't make assumptions about the lack of empathy of your average case manager. They feel overworked, stressed, carry great responsibility and are bound by lots of red tape. Most are in the job to genuinely help people, but when you get crapped on repeatedly, it's hard not to become cynical. Best of luck to them. And some of you need to develop empathy of your own.

The comment appears genuine. The caseload ratio  and salary look credible. And contrary to what people believe about me, I'm sure that most people on the DPB are perfectly nice people. Most I've come across are. I still  hold fast to the idea nevertheless, that the DPB hasn't improved their lives. The benefit itself probably created the "circumstance" that resulted in their dependency.

Yet again I wonder at the size of the second group she (more likely than 'he') describes. I once put the question to a close relative who spent some years working for social welfare on the front-line. That was back in the late70s/early 80s and times have changed. But he estimated around one third to a half were people exploiting the system. A handful were downright dangerous to deal with.

But see the real problem revealed within the comment above. The very people who know that someone is 'misusing' welfare have to play along. They are bound.

Whereas, in the non-government sector, a volunteer agency, services can be withdrawn when the 'client' isn't 'coming to the party'. The managers of an agency I volunteered with eventually made that call on a couple of my cases, to my relief.

To a degree, the new welfare reforms are an attempt to give case managers that facility. To sort the wheat from the chaff and act accordingly. The threat of a benefit cut when people won't take a job or meet an obligation is not entirely new. Under Labour, sanctions were routinely used. But the range of obligations and persons they apply to is now much wider.

As in any organisation, some will abuse power. Let's hope the majority of case managers reflect the one quoted here who sounds like a reasonable, compassionate individual.

Babies put into state care

The headline on Stuff reads: Babies taken at birth from risky mothers.

Guaranteed to pique my interest.

Nearly 800 newborn babies were taken from their mothers and put into government care in the past five years, with one Waikato baby taken within hours of its birth. The 773 babies - all less than a month old - were taken due to "serious concerns" about their parents' ability to care for them.

773 babies over a 5 year period. Sounds a lot but it's only 3 a week. Out of 1,176 per week (2012).

The reporting doesn't say so but I am thinking some of these births will be to incarcerated females. While imprisoned mothers have the facility to keep and care for their newborns, some will still not be in a position to. Apparently, "The mothers and babies units are only available to women who meet security requirements."

Some of these newborns could be to mothers on methadone whose babies are removed to de-tox.

Some births will be to women with known serious mental health problems. 3 a week is not surprising.

Then, I'm looking to see if the reporter has broken down the figures annually to show any trend. No. Because if she had, more than likely the numbers are decreasing (if they reflect the below graph) - not good copy. Decreasing numbers may simply be a facet of decreasing births over the past six years.

I am left speculating on the difference between regions. The number for the Southern region seems high. Perhaps it reflects practice rather than the incidence of at-risk births.