Auckland District Health Board Healthy Ageing 2020: A comment from the Royal New Zealand Foundation of the Blind

The Royal New Zealand Foundation of the Blind (the Foundation) is a disability support service constituted under the Royal New Zealand Foundation of the Blind Act 2002. It is the primary provider of habilitation and rehabilitation services to over 11,500 blind, deafblind and vision-impaired New Zealanders. More than two-thirds of those members are over the age of 65.

The Foundation's vision is that blind, deafblind and vision-impaired people have the same opportunities and choices as other citizens to participate fully in society. Our mission is to remove the barriers faced by individuals and to promote their participation in all aspects of life. We work with a variety of partners to ensure the incidence of preventable blindness is minimised.

Services we provide include specialist assessments, orientation and mobility training for adults and children, communication and adaptive technology instruction, guide dog services, talking book and braille library services, instruction in the skills of adaptive daily living, and vocational services. We operate services specific to the needs of Māori and of Pacific Island communities. We provide advice and training on access and disability issues to a wide range of public and private organisations.

Within its business and strategic planning the Foundation is committed to continuous improvement in service delivery. This includes researching the needs of older members and further refining its service delivery to meet those needs.

Accountability to members

Members of the Foundation are blind, deafblind and vision-impaired people who choose to register with the Foundation to receive its services. Foundation members directly elect the Board of Directors and can participate in consultations around strategic and business planning. As an organisation which is accountable to its membership, the Foundation encourages member feedback, supports a network of Community Committees at the local level, and works in partnership with nine consumer organisations that undertake a range of advocacy activities.

Comments on the Consultation Document

Firstly, thank you for taking the time to consult with the community regarding ADHB’s Healthy Ageing Strategy.  The Foundation would like to continue to be involved with any future consultation you undertake. 

As you note in the Background section of your consultation document, Healthy Ageing is a concept that involves more than just health and requires an attitudinal shift regarding the value we place on our elders.  The same needs to be said regarding disability.  However, your concept of building “intergenerational capability” by “introducing school and rest home exchanges” without introducing positive models of care seems to perpetuate the notion of the elderly as marginalised or incapacitated.  The Foundation believes that agencies providing services to older people should develop programmes that equip older people to lead independent lives. That is certainly a key objective for the Foundation in its own delivery of services.  We recommend that ADHB should be encouraging a model that promotes the notion of independent elders; people who are supported in the community to maintain their independence.  Schools may better change societal attitudes by introducing school and independence-promoting agency exchanges.

Similarly, in section 3. Home Based Support, you promote the “recovery model”.  While recovery is one part of elder care, systems and services that promote or support independence in the community, and reduce the risk of events which require ‘recovery’ should also be a focus of population based services promoted and funded through ADHB.   Orientation and mobility training is one example of a rehabilitation and habilitation discipline that equips blind and vision-impaired people with the skills to move about and enter any familiar or unfamiliar environment and navigate it safely, effectively, and independently. Overseas experience suggests that elements within the orientation and mobility training provided by the Foundation to its members could assist other people with low vision or reduced mobility to move about with a lower incidence of falls and injury. The Foundation's Adaptive Daily Living instructors provide services such as educating people that a simple colour and texture contrast can help distinguish surfaces (i.e. a doorway from a wall or a step down from the floor level). Such interventions make a demonstrable difference in the day-to-day quality of life experienced by Foundation members, the vast majority of whom are elderly, and could be funded to meet the needs of the general population as it ages and experiences age-related vision impairment.

Your consultation document notes that a range of people and agencies are involved in the provision of care or support services for older people.  We would like you to note that not for profit organisations, like the Foundation, are not currently funded for the level of life skills and health-related preventative training they could undertake if they were better resourced. More research and the identification of unmet need are likely to require new rather than realigned funding.

It should also be noted that socio-economic factors limit the lifestyle choices available to disabled people. Inequities in access to education, long-term unemployment, and the additional costs of disability (direct costs, opportunity costs, societal costs) continue to have a significant impact on the lives of blind, deafblind, and vision-impaired New Zealanders.  These effects obviously compound in older age and anecdotally result in reduced life expectancy of blind, deafblind and vision-impaired people.  Consideration should therefore be given to issues associated with barriers to service access including age.  

As you note, it is difficult for those aged 50 – 64 years of age to access some services. The threshold of 65 years of age is in fact an arbitrary construct linked only to the age at which the country is prepared to pay a pension.  This decision was determined by other factors, such as affordability, as opposed to the potential to benefit or absolute need for health care.  This is inequitable due to a range of systemic differences in life expectancy.  As you will be aware, the life expectancy of Māori (especially Māori men) is considerably less than that of other population groups.  Surely, need and the ability to benefit from services should shape access criteria and this should be reflected in structural alignment including funding streams.  However, we would caution that altering current funding splits between the Ministry and District Health Boards should not be taken lightly.  The situation for an organisation like the Foundation, which is a national organisation with regional offices, is that contracting severally with 21 DHBs creates an unsustainable compliance cost.  We do not deliver our services based on the age of the member but based on their need and what we can offer and we would not wish to see that change but nor can we afford the costs of contracting with 21 DHBs or, even worse, with over 80 PHOs.

Access to information is often also a significant barrier faced by blind, deafblind and vision-impaired people.  We would support the concept of a “one stop” information site but note that of our membership only a small proportion (approximately 5 percent) have internet access.  Any website developed should also take account of website accessibility standards.  We assume that this website would be service user focused rather than professionally oriented to accord with the notion of promoting independence. The majority of our members do have telephones.  In addition, the Foundation provides a specific telephone information service (TIS).  We would appreciate being involved in and potentially ‘tapping’ into any phone information service you develop.

Also in the comments under section 7. Funding Issues, you note the potential for the development of an effective IT system.  Consideration needs to be given to who could access this information.  Agencies, such as the Foundation, should also be included in the list of community services, along with GPs and Pharmacies, subject to appropriate privacy protections being set up.  Furthermore, there is a huge potential to increase independence in the community with associated telecommunications technology. Information technology can deliver health services to New Zealanders. With the right technological infrastructure in place, it will be possible to develop services that support a range of people in a variety of situations, e.g. older people with or without disabilities who choose to remain in their own homes. Already many New Zealanders use a personal alarm system consisting of a wireless transmitter worn around the neck or wrist which can relay a signal to a remote location via the unit plugged into the telephone line. It is not difficult to see the value of extending the functionality of such monitoring technology to assist people who need some level of support to cope and avoid injury in their own homes.

Whoever provides support to people who are blind or vision impaired must be trained to be confident and competent communicators with people who cannot follow visually presented information or see their environment clearly. Deafblind people have unique communication needs, all too frequently overlooked in mainstream settings.  This factor needs to be considered under section 5. Quality Concerns.  The Foundation would be interested in being included in the Combined Quality Committee and in consultation regarding the development of the audit tool. 

With regard to section 2. Looking after carers, the document should consider being more assertive regarding the value of carers.  Like others in the voluntary sector, carers play a huge role in New Zealand’s ‘workforce’ and, as you note, receiving home-based ‘loved-one’ care is often a preferred option to residential care and may contribute significantly to the quality of life experienced by our elders.  What is important perhaps is balancing the quality of life of the cared and the carer.  This is not simply about ‘valuing’ the carer, who may also get a benefit from caring for a loved one at home, but absolutely about supporting the carer, not only to provide care but, to provide care in such a way that quality of life and other benefits accrue to the cared and the carer.  This is achieved by providing good support services to both the carer and the cared for.   Support services for the carer may include education on vision loss.

The Foundation requests that its comments and recommendations are considered and that the Foundation’s views continue to be obtained in future consultation processes.

Paula Daye

Chief Executive