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Context: Compared to Europeans, Māori and Pacific peoples living with dementia in the Counties Manukau District Health Board region are three times less likely to use Aged Residential Care (ARC). Objectives: The aim of this study was to investigate whether reduced ARC utilisation by Māori and Pacific peoples living with dementia is equitably compensated by an increase in Home Based Support Service (HBSS). Methods: Routinely collected sociodemographic and clinical data for people diagnosed with dementia at an NZ memory service (2013–2019) were linked with administrative ARC and HBSS invoicing data. Two-part models were used to estimate adjusted costs of HBSS utilisation or ARC placement. Findings: six hundred fifty-seven people of European, Māori and Pacific ethnicity were included in the analysis. Compared to Europeans, both unadjusted and adjusted ARC costs per person-year were significantly lower for both Māori (–NZD$3580, 95%CI: –$6890, –$140) and Pacific peoples (–NZD$3110, 95%CI: –$5590, –$540) but HBSS cost per person-year was only higher for Pacific peoples (+NZD$640, 95%CI: $100, $1180) and not Māori (+NZD$180, 95%CI: –$470, $840). There was no significant difference in the combined HBSS and ARC cost per person-year for Māori (–NZD3460, 95%CI –7200, 280) or Pacific peoples (–NZD2490 95%CI –5090, 110). Conclusions: Lower ARC utilisation amongst Māori and Pacific peoples living with dementia does not translate to an equitable increase in HBSS spend. The difference is likely to be compensated by care provided by unpaid family carers. Addressing the wider determinants of long-term care use in these populations and providing alternative culturally appropriate services must be prioritised to address this inequity in allocation of public sector resources.

Background: Aged residential care (ARC) is a significant cost of dementia care. However, little is known about the predictors of ARC placement in New Zealand (NZ), which is important for service planning and funding. The aim of this study was to investigate the sociodemographic and clinical characteristics that predict future ARC placement among people who received a new diagnosis of dementia at a NZ memory service. Methods: Routinely collected baseline sociodemographic and clinical data in a memory service from 14/06/13 and 14/12/19 were linked with administrative LTC admission data up to 24/1/2020. Survival analysis was carried out using multivariate Cox regression models to determine significant risk factors and their association with ARC placement. Results: A total of 657 NZ European, Māori and Pacific Islander patients were included in the analyses. There were significant differences by ethnicity including age, living situation, comorbidity and ARC placement. Adjusted analyses showed that risk of ARC placement was increased by older age (HR 1.02 per year, 95%CI:1.00–1.05), moderate dementia (HR 1.45, 95%CI:1.05–1.99), severe dementia (HR 2.25, 95%CI:1.33–3.81), and antipsychotics (HR 1.55, 95%CI:1.04–2.32); while risk was reduced in Māori (HR 0.35, 95%CI:0.18–0.68) and Pacific Islanders (HR 0.32, 95%CI:0.20–0.51). Conclusions: Despite having more severe dementia and higher comorbidity, Māori and Pacific Islanders had reduced risks of ARC placement. There is an urgent need to better understand dementia care issues and to ensure culturally safe and responsive dementia services are accessible by Māori and Pacific Islanders living in the community.