There are two lists. The first is what a lonely, older, or disabled person in New Zealand can get someone else to pay for: the doctor’s visit, the prescription, the physiotherapy, the needs assessment and the case manager who does it, the mobility aid. The first list is long and the money is almost automatic. The second list is one item: a person to knock on the door, help them into a coat, drive them to a lunch where they know some faces, and bring them home. And that item is not exactly unfunded, which took me a while to see. Fragments of it get funded. The outcome never does.
I find that gap genuinely strange, and the more I look at it the less it looks like an accident.
It looks like triage
The obvious reading is triage. Health budgets fund health. Medication treats a condition, physio restores a function, an assessment allocates scarce support to the greatest need. A ride to lunch is, by comparison, a nice-to-have, a social extra, pleasant but not medical, and you cannot fund every pleasant thing. So the clinical gets paid for and the social does not, and that is just responsible prioritising under a fixed budget.
It is a reasonable story. It also assumes the thing being refused does not work, and that assumption is where it falls down.
The social is the medicine
I accepted the split it hands you, clinical on one side as the real, fundable stuff, and social on the other as the optional extra. But isolation is not a nice-to-have problem. Chronic loneliness carries measurable effects on health and lifespan: a large 2010 review of 148 studies found the isolated die earlier at a rate researchers place alongside serious physical risk factors like smoking. (Julianne Holt-Lunstad 2010) For a lot of older people, the reliable ride to a room full of people they know would do more for their actual health than one more prescription on an already long list. The social is not adjacent to the medical. In these cases it may be the most effective medicine on offer.
So the question is not really whether company works. It is why, when it works, nobody will pay for it whole.
Funding follows a shape
Money in a care system flows toward things that fit a shape: a diagnosis, a treatment, a provider, a code. Each of those makes the spending accountable and auditable. A prescription has a name and a dose. An assessment has a form and an outcome. Company has none of this. There is no fundable diagnosis for being alone, no dose for a Tuesday lunch, no clean way to prove that this particular outing prevented that particular decline. So the single most useful intervention for an isolated person falls straight between the lines. It is too social to be health funding, too structured and ongoing to be charity, and too mundane for anyone to have built a budget around. It fails no test of effectiveness. It fails a test of legibility, which is a different thing that we keep mistaking for the same thing.
The clearest evidence is that the system already funds fragments of the exact outing it cannot fund whole. Total Mobility, the scheme for people whose impairments keep them off ordinary buses and trains, will subsidise the taxi to that lunch. A funded day programme can put a van on the road to collect its regulars, because the van run is a leg of a contracted service. Neither is the system going soft on the social. Both are the same test being passed. A fare is legible: a metered distance, a registered driver, a receipt at the end. A van run is legible: a route, a roster, an invoice. The thing the fare and the van deliver a person to is not. Being expected has no unit, no code, and no receipt, so the money travels exactly as far as the kerb and stops.
The same line cuts through a single afternoon. A support worker can be funded to sit in a person’s house and help them practise a daily task, because that is a service with a code attached. The same worker, driving the same person to a lunch where they will laugh for the first time in a week, is doing something no line item recognises, even though the drive may be the more therapeutic of the two hours. Same worker, same person, same afternoon, and the funding can see one half of it and is blind to the other.
This is a pattern well beyond eldercare. Systems fund what they can categorise and starve what they cannot, and the coordination of ordinary life, the getting-there and the being-expected, is almost always in the second group. It is nobody’s department precisely because it is everybody’s, and it does not look like the things we are used to paying for.
Making company fundable
So what would it take to actually fund the ride to lunch? There seem to be two doors, and I am not sure either is clean. One is to medicalise it, to give loneliness a code and social contact a prescription, so it fits the shape the money already flows to. That would unlock funding, and it would also turn friendship into a treatment and an outing into a billable unit, which may quietly ruin the thing it was meant to protect. The other door is harder and more honest: to stop pretending the social and the clinical are separate budgets, and to fund company as prevention, on the plain grounds that keeping someone connected is cheaper and kinder than treating what happens when they are not.
I do not know which door is right, and I am suspicious of how tidy the first one sounds. But I am fairly sure the current arrangement, where we pay thousands for the pills and nothing for the person who would get them out of the house, has the priorities upside down, and defends it with a distinction between medicine and favour that does not survive contact with what actually keeps people well.