As the Baby Boom generation enter their 70s, younger generations of New Zealanders are putting plans in place to care for them in their old age. Health reporter Mike Houlahan asks how ready Otago is to give them a happy retirement.
It has literally been coming for decades - New Zealand's ageing population.
The offspring of the "Baby Boom" of the 1940s and 50s are entering their golden years, and subsequent generations are now trying to ensure they have a happy retirement.
But that comes at a cost.
Stretched health budgets will be further tested as GPs and hospitals deal with more age-related diseases and conditions.
New Zealand will need more aged care beds, more aged care workers, and more clinicians trained in geriatric medicine.
All this is well known - but it battles to be considered against short-term priorities.
There is no deadline event to prepare for, like the kick off in the first match of the Rugby World Cup - the ageing population is already here, and is steadily getting older.
The Southern DHB region has one of the oldest populations in New Zealand: 36.4% of people are 50 or older - nationally the figure is 33.9%.
There will be more people here aged 75 or older - by 2036 the number will rise by as much as 400% in some places.
GP consultations by people aged 65+ are expected to rise by 73% in the same period - but about 40% of New Zealand's GPs are expected to retire within the next decade.
The most important thing, SDHB chief medical officer Nigel Millar said, was for none of this to be seen as a problem.
"An ageing population is a success," Dr Millar said.
"We tend to paint this the other way around, that somehow this is an awful thing - it's a great thing."
Twenty-five years ago, when Dr Millar started practising in New Zealand as a geriatrician, he was predominantly seeing people in their 70s. Today, his patients are generally much older.
"Each generation of elderly is typically fitter and healthier than the previous generation ... there is probably a limit to that," he said.
"There had been a debate in health whether we are creating more years of life or more years of disability - for me we are creating more years of productive and enjoyable life, perhaps at the expense of a small rise in years of disability."
Catering for both longer lives and greater age-related disabilities is a major theme in the primary and community care plan now being finalised by the SDHB - geriatric care is one of eight areas highlighted as an early priority.
"It's a misnomer that there is nothing we can do about it ... but it is a very complex sector," Lisa Gestro, SDHB strategy, primary and community director, said.
"We have to support the growing population of older people, in a way which is meaningful for them."
Planning starts at first principles: where are these people going to live?
Ideally, at home for as long as possible - that is the message being pushed in the SDHB's plan, and it is one few would likely disagree with.
For it to happen, non-government organisations will play a vital role helping people to stay safe and comfortable.
"One step further is the volunteer work force, which is such a valuable resource, and then there is the role of family and neighbours," Mrs Gestro said.
"People don't just become elderly and their life disappears, we need to keep them connected."
Age Concern Otago is already ready to help care for Otago's older residents - it has done so for 70 years.
"People can age positively in their own homes," executive officer Debbie George said.
"We provided community support to 10,000 older Otago residents last year in a variety of ways to improve their health and wellbeing outcomes."
The health sector needed to work together in the area, Ms George said: "there's no way primary care and the DHB can do it alone.
"But it's not like it has happened overnight ... the main players are working towards positioning themselves to respond," she said.
Ms George was confident Age Concern was ready to play its part, with its existing pool of 1000 volunteers.
"I have never seen a volunteer effort like it anywhere I have seen here or abroad, here in Otago we are so blessed to have that."
Mrs Gestro said the SDHB was asking whether aged care was the right answer for everyone.
"Historically there has been this idea that someone becomes frail, unsteady, and the logical next step is aged care: we are trying to turn that on its head because there are so many more alternatives these days in terms of increased level of clinical input that we can provide.
"Ultimately, we need to support people's choices, and more and more elderly are saying they want to stay in their homes as long as they can - our obligation is to help that choice."
Nevertheless, demand for aged residential care will inevitably rise.
The 66 care homes in the SDHB area have almost 4000 beds available, at a 90.3% occupancy rate - about 4% higher than the national average.
Over the next decade residents are projected to rise by 30%.
The Government is now reviewing the funding model for aged residential care, for the first time in 20 years.
Contracts are in three categories - rest-home, dementia care and hospital care - but Aged Care Association chief executive Simon Wallace said carers faced many different demands these days, with more patients needing palliative or bariatric care, and a greater need for respite and short-stay care.
Commensurately, costs such as foods and medicines were on the rise. As one example, there has been a big rise in the cost of consumables like incontinence products," Mr Wallace said.
"Increases in funding have not kept track with what we call the aged care price index."
Someone has to care for those people: the ACA estimates nationally the sector will need to recruit 1000 extra staff a year to cope.
"If the current demographic trends continue as it is and projections are right, we're not going to have enough staff to look after the projected number of residents we have," Mr Wallace said.
Complicating this are the historic low pay rates in the sector - although the recent pay equity agreement has addressed this, to a degree - and the fact that upwards of 30% of care workers are migrant workers.
"Current immigration settings won't allow us to keep migrant workers for more than three years, and that's going to be a problem in terms of how we train people up," Mr Wallace said.
"They have a very good care ethos, the migrant caregivers, and if we can't keep those people for more than three years that is a business continuity issue for our members and for residents ... we just can't find enough Kiwis, or the right Kiwis, to do those roles."
While the health sector will be at the forefront of managing the ageing population, the key to doing so successfully would be recognition this was a challenge for society as a whole, Dr Millar said.
"Eighty percent of the informal care of older people is provided by friends, family, whanau and neighbours.
"We need to recognise that and say that it's normal, not abnormal ... we as a society, need to adapt to having a larger number of old people in our community.
"We are challenged, but I'm optimistic we have the willingness and capacity to adapt."
