Alzheimer's Care in New Zealand

My last interview in Wellington was with a GP in a small family practice. He estimated 50% of his patients were older adults; so, he was keen to talk about dementia care. I think I have been here long enough to have some Kiwi expressions creep into my speech: keen to, go to hospital, and of course kia ora(Maori for hello or literally translated as “be well”, “be healthy” or “have life”).  I am so fortunate to have had the opportunity to speak to some many health care providers here and learn about the rewards and challenges of their practices.

My last day in New Zealand was spent in Auckland.  Google Maps was once again my savior as it pointed me toward the best way to get up to the North Shore Hospital for my last interview.  I chose an express bus from the airport and short walk to the hospital (50 minutes).  As usual, I had extra time and stopped for a date scone and my last flat white.   I was rewarded for my efforts by the time I spent with a very experienced clinician who has implemented exactly what I would like to do in Vermont.  What a way to finish up!

I’ve started to sort my interview data and get it ready for input into the HyperResearch program. This sabbatical has certainly accomplished the intent of “learning something new” and the learning is far from over.  Thank you for following this blog, my first, and I hope it gave a favor of this research project and the lovely country of Aotearoa.  Now my work clearly lies ahead… analyses and dissemination with the help of my colleagues Dr. Betty Rambur, Lori McKenna, Dr. William Pendlebury and Dr. Michael Lamontia.  

 E noho ra!  (Maori goodbye)

First on my list of things to finish up here was to gain better understanding of the role of a nurse practitioner in the care of elders with dementia.  So I was lucky enough to spend a morning with Lesley Maskery who is the nurse practitioner on the Mental Health for Older Persons interprofessional team.  Each week the team gets referrals from general practitioners and others for comprehensive mental health assessments.  The team includes: social worker, occupational therapist, geriatricians, geriatric psychologist, nurse, and nurse practitioner. This week they had 7 referrals and would divide up the tasks of completing the assessment. It’s so inspiring to see highly functioning interprofessional teams.

Lesley took me to a facility which had senior apartments, rest home care (assisted living), and a dementia unit all on the same campus.  In the dementia unit, the staff is able to call on the nurse practitioner for assistance with problem-solving behavioral issues and medications changes as needed. The facility had lots of outdoor space, gardens and even a nesting quail. A near-by kindergarten was visiting and sharing arts and crafts time with the residents. Our last stop was a 16 bed acute care gero-psych ward which is used for stabilization before placement elsewhere. That facility was equipped with all the physical features necessary, but clearly the most important component was the caring staff.   Now I have a better sense of dementia care in this part of the world thanks to a lovely colleague who shares a similar passion. 

My wellness activities for this week include: more swims in the 50 meter pool that is now right across the street from me, a spin on an Onzo bike since I have finally have borrowed a helmet, time on the Meridian Wind Sculpture Walkway, and one more yoga class in the beautiful Space studio high on Mount Victoria overlooking the Wellington harbor.  Lucky me!

With most of the interviews done (5 general practitioners, 2 nurse practitioners, 4 nurses, 2 social workers, 2 caregivers and a team from the ministry of health) Lori and I pushed on further into the South Island.  We took the TranzAlpine train from Christchurch to Greymouth through the Southern Alps.   This was a 4.5 hour ride through mountains, valleys, across the Alpine fault line, past old mining and logging towns and finally into the temperate rainforest of Greymouth.  Vegetation is THICK here with lots of palm trees and ferns. 

If you want to see an interesting depiction of life for 19^thcentury Scottish settlers here – rent The Piano (1993) from Amazon.  It’s a dark story of all the hardships that a “mail order bride” (Holly Hunter, Academy Award Winner) faced but the scenes of the Tasman Sea and the rainforest are spot on.  This movie gives a hint to the hardiness of the modern-day Kiwi’s. 

From Greymouth we travelled up the coast by bus to the Pancake Rock or Punakaiki.  A paved trail takes you to spectacular layers of stratified limestone that line the coast.  The attention paid to NZ’s natural treasures is impressive and well-maintained and signed trails make these special places very accessible. Another example of this is Abel Tasman National Park.  The Department of Conservation has created an impressive network of “tracks” with the Coastal track noted for some of NZ’s best scenery – golden beaches, clear blue water, and lovely vistas through thick bush.  With kayaking, birding, hiking, biking, horseback riding, and boating options, this park is inviting all ages and abilities.  I wish I could do further research regarding Kiwi’s love of the outdoors and being fit and active.  Now I’m on a 3 hours ferry boat ride back to the North Island looking forward to one more week of work before my return to Vermont. 

As memorials grew and grew in Christchurch, Lori (my Memory Center colleague) and I decided to get out into the country for the day.  New Zealanders love hiking so well-marked and maintained “tracks” are available almost everywhere.   We headed for the Banks Peninsula and the village Akaroa on a bus from Christchurch (about 2 hours).  The entire peninsula was created by a volcano and the winding journey over the highest peak down into the village is amazing. Once in Akaroa, we bought a map of the tracks that would take 3 hours or less and headed off.

Climbing out of town toward the Akaroa bush reserves via quiet back streets and dirt trails, we were quickly by ourselves despite the crush of people debarking a very large cruise ship at the town’s wharf.  As we walked past a beautiful home, we were greeted by a woman coming out of her driveway to take her dogs for a walk.  She asked if we were out for a walk and we answered with a compliment of her lovely village and an expression of sorrow for New Zealanders about the recent shooting. At that point, she invited us in to see her gardens.

Her house was previously the home of a French consulate who requested to retire to Akaroa after her service was done.  Jacqui and her husband were able to purchase this incredible place which had extensive gardens and an amazing view of the Akaroa Harbor.  It was definitely one of the most beautiful homes I have ever been in.  When we explained our research to Jacqui she was kind enough to share her recent caregiving experience and give us even more insight into dementia care in NZ.  What a lovely lady, we are so thankful for her invitation into her home and her life.  This chance encounter provided us with another unique voice of a New Zealand family carer. 

As circumstances would have it, Lori McKenna, my brother, Julian High and I were due to fly to Christchurch on Saturday, one day after 50 Muslims were murdered while they prayed in their mosque in that city.  On Friday, the news broke slowly: 4 shooters, then 1, school kids in locked in their schools until 6PM, and many businesses shuttered. Our first reaction to stay away was based on our previous experience of “lock down” and how it paralyzes normal life in a city. The next day, our 1:30 PM flight to Christchurch was cancelled; however, we were all automatically rebooked on an earlier flight leaving at noon.  Despite our uncertainly, sorrow and a little bit of fear we decided to go. 

Several things are strikingly different in a country naïve to gun violence. First, people are not numb to this news, they are hurt, angry and want to do something to express their sorrow. So many people have come to the street across from where we are staying to lay flowers and leave signs or other objects, pray and sing.  Now that display stretches is 3-4 blocks long and 6 feet deep. Hymns and Maori singing can be occasionally heard.  Media coverage from around the world is set up here.  The Prime Minister has assured her country that gun laws will be changed in 10 days’ time and there will be a day of national mourning.  We were told that when President Trump asked Prime Minister Jacinda Ardern what he could do, she replied “have sympathy and love for all Muslim communities”.  The sign pictured below captures the spirit of New Zealand – a unique and diverse land of many people.  A tragedy witnessed…

With our busiest week of interviews coming to an end, I’m going to reflect on some lessons learned on a couple of levels.

Regarding requesting an interview of busy healthcare professionals– persistence counts. One office was contacted six times and then came through with two interviews for us.  The snowball effect definitely pays off as each interviewee was asked to recommend others for us to contact. Lastly, finding a practice manager who has experienced Alzheimer’s Disease on a personal level can open many doors. 

Regarding money management –  Wire transfers of funds are a nightmare when in a different time zone and date – avoid at all costs.  Out of country debit cards are treated like credit cards here in New Zealand so there is no option to select debit or credit.  Finally, American Express is NOT preferred and many shopkeepers will tell you exactly why – too many fees and policy changes for them.  So don’t believe the ads, bring cash and a debit card and a back up credit care. 

Wellness activities are essential to keeping the team going– For example, riding up in the Cable Car and walking down to the city for 40 minutes through the lovely Wellington Botanical Gardens with my team and my brother. A lovely hike along the rugged coast also keeps our spirits high. 

This is our busy week for interviews.  Social Worker Lori McKenna has joined Betty Rambur and I and provides a wealth of understanding of carer’s needs.   Lori is also a very experienced traveler and we have appreciated her insight and love of a good walk.  All our interviews are being conducted in Wellington and the Lower Hutt.  Half of the “journey” is getting to the destination on the bus and observing daily life in this part of the world. We have been on the bus by ourselves OR squeezed in with commuters OR seated with beautiful school kids of many cultural backgrounds. We have struck up conversations with locals including elders, teens and retired healthcare professionals regarding their opinion of their health care system and not gotten a single negative reply.   By week’s end we will have done 10 interviews, logged many bus and foot miles, and conquered any technological snafus which came our way.  Signing off feeling like empowered international women, Mary Val, Lori and Betty   

I’m fortunate to have two wonderful colleagues to help me with this research project. The first to arrive was Betty Rambur PhD, RN, FAAN who is the Routhier Endowed Chair Practice and Professor at University of Rhode Island.  Betty has been my research mentor on workforce issues since 2001 and we work well together.  She hit the ground running in Auckland and met two engaging older women with personal and professional experience in dementia care. One in particular has authored the two books pictured below. She will explore health policy and financing of dementia care in New Zealand. 

Once in Wellington, Betty and I had an orientation day of busing around, New Zealand lawmaking (included a tour of the “Beehive”), and an Ethnic Food Fair at the local school with Indian, German, Hangi, Chinese, Mexican, Cambodian, African, Middle Eastern, Pacific Island, Somali and Greek dishes.  This gives you a good idea of the diversity in Wellington; I wish I could share the tasty treats!

Now that I have visited and contacted 16 primary care offices in Wellington NZ, I would like to offer this observation…. New Zealand really knows how to use nurses in primary care! In each office the Nurse Consulting Room is up front close to the waiting room.  I was lucky enough to snaps some photos to give you an idea of this space. The nurses’ role in chronic disease management allows the GP to focus on the medical care and adds to the holistic health of the patient and family in their home setting.   I wish I could bottle up this model and bring it to Vermont. 

My wellness activity for today… a nice swim in one of the many pools in Wellington.  Did you know that all children are required to learn how to swim in grade school here?  A smart idea for this beautiful island nation; the investment in their swimming pools is evident everywhere.  Happy me!

Today I went farther that I have to date guided by my trusty Google Maps ap. The destination was Johnsonville which is on the northwest side of Wellington, past Khandallah and my favorite name: Kaiwharawhara. Being a little phonics challenged, I’m appreciative when the syllables repeat themselves.

Here are a couple of things that I have noticed from my time in waiting rooms: No one wears white coats, the GPs “room” there own patients and the nurse consultation rooms are usually right off the waiting room.

The best thing about my bus ride today was the second practice that I visited was on the other end of the #1 bus route. A 51 minute straight shot to a lovely little beach neighborhood. Bonus – it was a double decker bus. Of course I had a picnic lunch and then my snack treat – a flat white and Anzac biscuit. During my snack break, I watched a procession of school kids heading for the beach with their hats and towels and teachers. It seems a bit chilly to me but there they go. I’m starting to love my routine here.

Wellington New Zealand is an interesting collection of neighborhoods nestled into a hilly topography connected by bays and tunnels in some places.  The weather has been great for walking but I’m considering getting a new haircut that will look good no matter which way the wind blows.  “Windy Welly” has been appropriately named.  A sturdy hat or the perfect haircut is necessary to avoid looking like my dog with his head out the car window when I introduce myself at a each new practice.

Nevertheless, I have made my introduction at 13 primary care offices.  Some were follow ups to letters, emails and postcards that I had sent. Most visits involve a brief introduction, handing over the research information sheet, and a request for the GPs or nurses to be interviewed about dementia care.  Most practices have Practice Managers that can be very helpful saying for example “my dad and grandfather have dementia”; or can be strict gatekeepers of access to the providers.  I love when I get invited into a nurse’s consultation room.  These are usually a well set-up exam rooms with a computer and telephone included in this work space.  I promise I will take some pictures.  The nurses I have met have a big help in securing an interview with a GP, often recommending the best one in their practice. I have done 2 interviews so far which have confirmed that I came to the right place to study different models of Alzheimer’s care.   I have 2 more interviews on my schedule and at least 5 more new practices to visit before circling back to the ones that I have already contacted.  It’s exciting work for me and each new waiting room helps me understand New Zealand’s health care system a little better.