A/HRC/45/14/Add.2 62. Since 2007, needs assessments have been undertaken using the standardized Home Care International Resident Assessment Instrument (interRAI HC). They were introduced across all district health boards for use in community-based populations for admission to old-age residential care or for those requiring long-term care support. The assessments are conducted by trained health professionals (mainly nurses and social workers) to ascertain a person’s level of need, develop a care plan and identify appropriate services and support options. 63. There are significant variations across the district health boards as to when persons are admitted to old-age residential care within 12 months of a Home Care Assessment, which puts some of them at high risk of needing care.45 64. District health boards are responsible for mandating standards, including for staffing levels. The national Government and district health boards are responsible for the licensing and quality assurance of long-term care services. Impromptu inspections are conducted annually.46 65. Residential facilities are mostly private, and all home care services are provided by non-governmental organizations. 47 Residential care falls into four levels: rest home care, long-term hospital care, dementia care and psychogeriatric care. Some homes are equipped to provide all four levels of care.48 Seventy per cent of care facilities belong to major groups consisting of four or more care facilities, and 30 per cent are individual or in small groups of two to three care facilities. 49 Older persons’ care services that are culturally and linguistically sensitive are not readily available. 66. In prisons, there are no specific policies for care of prisoners with age-related conditions such as Alzheimer’s disease or dementia, or the health management of prisoners who require palliative care, with the exception of the Health Care Pathway Policy, which includes an end-of-life policy. The Department of Corrections established a HighDependency Unit at Rimutaka Prison in 2012, which now accommodates 30 mostly older patients. A new wing opened in 2015, where health-care professionals assist with toileting, feeding and bathing. This remains insufficient, however, to meet the needs of an ageing prison population. In June 2016, there were 130 prisoners aged over 70, compared with 51 in 2011.50 On 28 February 2019, 313 older persons aged 65 years and above were among the prison population. Almost half the persons who live in prisons and penal institutions identify as Māori.51 67. Old-age care services, whether home-based or in rest homes and private hospitals, as well as social services, disability services, mental health services and respite care, remain insufficient and underfunded. Carers need to be better remunerated. There are about 33,000 caregivers currently employed in aged care in New Zealand. Between 12,000 and 20,000 more residents will need aged residential care by 2026. The demand for care professionals is therefore expected to increase dramatically by at least 50 per cent by 2026.52 68. Particularly for older persons in remote and rural areas, the health system is forecast to come under pressure owing to an increasing shortage of health-care professionals and carers, which could leave older persons isolated and vulnerable. Women living in rural 45 46 47 48 49 50 51 52 12 New Zealand Aged Care Association, “Caring for our older Kiwis: the right place, at the right time”, p. 9. Suzanne Dyer and others, Review of International Systems for Long-Term Care of Older People (Royal Commission into Aged Care Quality and Safety, 2020/Flinders University, Adelaide, Australia, 2019), p. 24 ff. Ibid. See www.ageconcern.org.nz/ACNZ_Public/Residential_Care_Common_Questions.aspx. New Zealand Aged Care Association, “Aged residential care: industry profile 2017–18”, p. 9. See www.corrections.govt.nz/resources/strategic_reports/annualreports/annual_report_201516/maintaining_the_health_and_wellbeing_of_offenders_in_custody. See http://archive.stats.govt.nz/Census/2013-census/profile-and-summary-reports/outsidenorm/prison.aspx. See www.newzealandnow.govt.nz/resources/working-in-aged-care.