Aged Care Australia Voice of the aged care industry Autumn 2011
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48 50 51
59 61 66 68 70 73 74 77
contents 3 5 9
National Update CEO’s Report President’s Report State Reports
16 31
Feature Report Productivity Commission Draft Report: Comments from Industry Representatives Productivity Commission Draft Report Q&A
37 40 42
Profiles The Hon Mark Butler The Minister’s First 120 Days The Aged Care Soccer Tragic
Technology 45 ACIVA - Active Industry Engagement 46 Solution Leaders Unite
ACAA OFFICE HOLDERS PRESIDENT VICE PRESIDENT DIRECTORS EDITOR PRODUCTION
Bryan Dorman Francis Cook Tony Smith Mary Anne Edwards Viv Padman Geoff Taylor Kevin O’Sullivan Rod Young Jane Murray
Workforce Attracting Young Staff Give Your Employees Hundreds of Extra Dollars Every Year For The Effective Cost Of One Extra Cent Per Hour ! Good News Stories – Industry Feedback
Sponsor Articles 52 Energy Contract Discount Offer 53 The PC’s draft report – the devil is in the detail 56 57 58
Editorial ACAA Endorsed “National electronic Resident Agreement” (NeRA) Achieves Resounding Positive Response from Industry The Challenge of ‘Stealing’ Is More Choice Better and Will All Buildings Look the Same?
79 Calendar of Events 81 Product News
ACAA - NSW
ACAA - WA
PO Box 7, Strawberry Hills NSW 2012 T: (02) 9212 6922 F: (02) 9212 3488 E: admin@acaansw.com.au W: www.acaansw.com.au Contact: Charles Wurf
Suite 6, 11 Richardson Street South Perth WA 6151 T: (08) 9474 9200 F: (08) 9474 9300 E: info@acaawa.com.au W: www.acaawa.com.au Contact: Anne-Marie Archer
ACAA - SA Unit 5, 259 Glen Osmond Road Frewville SA 5063 T: (08) 8338 6500 F: (08) 8338 6511 E: enquiry@acaasa.com.au W: www.acaasa.com.au Contact: Paul Carberry
AGED & COMMUNITY CARE VICTORIA
FEDERAL
ACAA - TAS
AGED CARE QUEENSLAND
PO Box 335, Curtin ACT 2605 T: (02) 6285 2615 F: (02) 6281 5277 E: office@agedcareassociation.com.au W: www.agedcareassociation.com.au
PO Box 208, Claremont TAS 7011 T: (03 6249 7090 F: (03) 6249 7092 E: smithgardens@bigpond.com Contact: Tony Smith
PO Box 995, Indooroopilly QLD 4068 T: (07) 3725 5555 F: (07) 3715 8166 E: acqi@acqi.org.au W: www.acqi.org.au Contact: Nick Ryan
ACAA OFFICES
NAB Health survey of ACAA Congress 2010 Delegates Is That All There Is? Space and Place for Australians in Late Age 010 Delegates Designing for Lifestyle and Physical Therapies in Aged Care Top 5 Tips For Aged Care Daily reminders help Aged Care Facilities stay safe and secure Aged Care Industry Vendor awarded Medal of the Order of Australia Top Five Toe Tips For Seniors The Politics of Climate Change
Level 7, 71 Queens Road MELBOURNE VIC 3000 T: (03) 9805 9400 F: (03) 9805 9455 E: info@accv.com.au W: www.accv.com.au Contact: Gerard Mansour
Aged Care Australia is the official quarterly journal for the Aged Care Association Australia
Adbourne PUBLISHING
Adbourne Publishing PO Box 735 Belgrave, VIC 3160
Advertising Melbourne: Neil Muir (03) 9758 1433 Adelaide: Robert Spowart 0488 390 039 Production Claire Henry (03) 9758 1436 Administration Robyn Fantin (03) 9758 1431
DISCLAIMER Aged Care Australia is the regular publication of Aged Care Association Australia. Unsolicited contributions are welcome but ACAA reserves the right to edit, abridge, alter or reject any material. Opinions expressed in Aged Care
Australia are not necessarily those of ACAA and no responsibility is accepted by the Association for statements of fact or opinions expressed in signed contributions. Aged Care Australia may be copied in whole for distribution among an organisation’s staff. No part of Aged Care Australia may be reproduced in any form without written permission from the article’s author.
www.agedcareassociation.com.au
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Front Cover: The Hon Mark Butler, Federal Minister for Mental Health and Ageing
national update
CEO’s Report
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CAA sought industry partners to finance and guide the undertaking of the Cost of Care study.
Grant Thornton (WA) was commissioned to undertake the study which is now underway. The participating partners in the study are:
Rod Young CEO, ACAA
COST OF CARE STUDY AN IMPERITAVE The ACAA Federal Board approved the undertaking of a Cost of Care study for Australian residential aged care in 2010.
• • • • • •
CAA A ACSA Catholic Health Australia ACAA NSW ACCV Australian Unity
The project will be over sighted by a Steering Committee drawn from each of these participating organizations with Nick Mersiades from Catholic Health Australia undertaking the role of Chair of the Cost of Care Advisory Group. The CoC Advisory Group would be keen to receive offers of support from other interested aged care stakeholder organizations interested in supporting this project and/or assisting in the work of the Advisory Group. If your organization is interested then please contact Nick Mersiades, Pat Sparrow or Rod Young, to discuss.
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The undertaking of this piece of work is we believe, an important endeavor, as it is essential that the aged care industry creates an in-depth understanding of the true costs of services
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The undertaking of this piece of work is we believe, an important endeavor, as it is essential that the aged care industry creates an in-depth understanding of the true costs of services, and is in a position to negotiate with Government about appropriate price points, if adequate resources are to be made available in the future to achieve long term sustainability. In addition, the Productivity Commission in its recent support on aged care reform, has made a recommendation to Government that the Department of Health and Ageing’s Aged Care Division, be separated so that the Department continue to be responsible for policy and legislation and that a new Regulation Commission be formed with responsibility for just about everything else including the additional function of regularly reviewing the cost of aged care and
making recommendations to Government as to an appropriate annual index and the appropriate price to pay for the aged care services being provided. This aspect of the Productivity Commission report has been strongly endorsed by ACAA as a mechanism for the provision of adequate subsidies to maintain system viability. ACAA believes therefore, that the commissioning of the Cost of Care study will place the industry in a strong position to liaise with the new Regulation Commission and provide in-depth input into the Commission’s consideration of appropriate funding levels for the industry in the future. The Cost of Care study will be estimating the costs of operating a modern single room ensuite aged care facility built in the last five years. If you are an operator of such a facility, the chances are that you will shortly be contacted with a request that you participate in the Cost of Care study as it will be essential to obtain a reasonable cross section of facilities that meet the criteria of single room ensuite facilities, built in the last five years to achieve a statistically relevant sample size to undertake the study. It is expected that this study will be completed by mid 2011 and will then be published and distributed to all interested parties at that time. We look forward to working with Grant Thornton and the Advisory Group to ensure a useful piece of research is created that will have maximum future benefit to the industry. n Nick Mersiades: nickm@cha.org.au Pat Sparrow: psparrow@agedcare.org.au Rod Young: youngr@agedcareassociation.com.au
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national update
President’s Report A
CAA has been delighted by the broad level of consensus across the industry to the draft report.
and living expenses based upon their capacity to do so;
The major areas that the Productivity Commission has covered in their recommendations to government are:
(f)
Government should pay a basic level of care service and where individuals have capacity to contribute, they should be making a contribution towards their care services;
1. Create an all encompassing Australian Seniors Gateway which will be responsible for;
(g)
Charges for care services to be paid by individuals should be equalized in both the community and residential setting;
(h)
Specified health care such as palliation should be treated as a personal right with people in residential care being afforded the same right to access such services as if they were in the community;
(i)
That the government should create a net equity draw down facility which could be used by persons whose main asset is the family home to make a greater contribution towards their hotel, living expenses or care costs;
(j)
The government should create a pensioner bond fund into which pensioner clients could deposit monies that would be held on behalf of the individual for payment for care, living expenses or accommodation during the period the person is in receipt of care;
The chance of government agreeing to make major reform is enhanced if the main stakeholders of the industry broadly agree on the reform agenda.
Bryan Dorman, President, ACAA
Productivity Commission touches the major points With the release of the Productivity Commission’s draft report 21 January 2011, an exciting phase of potential reform for the aged care industry has commenced.
Common assessment across the care continuum; Development of nationally consistent assessment tools; Provide a one stop shop information source for persons looking to obtain care and services in the broader aged care environment; Provide care coordination services on a local and regional basis. 2. Financing Aged Care;
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The chance of government agreeing to make major reform is enhanced if the main stakeholders of the industry broadly agree on the reform agenda
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(a) (b) (c) (d)
(a) All aged care service recipients with the capacity to contribute towards their accommodation and care should do so; (b) A strong safety net should apply to all individuals who do not have the capacity to contribute towards their care or accommodation; (c) The Government should fund the accommodation and care services for individuals funded by the safety net; (d) There should be four categories of service domain, namely: • personal care services • health services • living expenses • accommodation (e) All persons should contribute towards their accommodation
(k) Those individuals entering residential care be afforded the opportunity to: • pay a periodic payment • lump sum contribution • a combination of both (l)
That aged care providers in setting their periodic payment/lump sum contribution would need to calculate the cost of supply to determine the level of periodic payment that can be levied and to equate that periodic payment with a lump sum that would generate the same income stream. >
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national update
President’s Report (continued)
3. Workforce The Commission has been relatively silent on workforce issues except to recognize that workforce over the next thirty years will be an issue of major difficulty for the industry. The PC also acknowledged the need to pay competitive wages and has recommended to government that the independent agency that they have recommended be created also be charged with setting the real cost of care which should include sufficient funding to enable providers to pay staff competitive wages. 4. The Australian Aged Care Regulation Commission (AACRC) The Productivity Commission has recommended to government a complete separation of responsibilities between the
existing DoHA and the new AACRC with DoHA maintaining responsibility for policy and legislation whilst the new AACRC would take over all of the operational aspects of over-sighting the Aged Care Act including: • pricing the cost of care; • compliance checking and the enforcing of regulations; • approving community and residential aged care providers; • administering prudential regulation; • monitoring costs and transparently recommending a scheduled set of prices, subsidies and a rate of indexation for subsidized aged care services to the government; • complaints management and reviews As you can see, there is a lot of material in the Productivity Commission’s report.
ACAA will certainly be responding to this draft report by the response deadline of 21 March 2011 and will be giving further evidence to the Commission in early April. We look forward to the final version of the report in June this year and the Government’s response by, we hope, September/October of this year and then the addressing of the major recommendations in the context of Budget 2012 with the commencement of a reform process starting in July 2012. This certainly is a substantial change and will have a significant impact on the future structure of Commonwealth funded aged care services. We recommend all members take considerable interest in this process and ensure that your thoughts and suggestions flow through to ACAA state offices for incorporation in our future dialogue with the Productivity Commission and Government. n
national update
ACAA – SA Paul Carberry, CEO ACAA - SA
T
here’s no doubt the main game for our industry in the first half of 2011 will be our responses to the various reports and reviews currently in progress at the federal level, with the Productivity Commission’s Report by far the most significant. The Commission’s Report, and what the government does with it, will have a more far-reaching influence on the future of aged care than anything which has happened since 1997. At the same time, however, we have a legislative review underway in South Australia, the outcome of which will also have a significant financial impact on aged care employers in this state, and which therefore will demand our time and attention. Despite changes to our Workers Rehabilitation and Compensation Act in 2008, SA’s workers compensation scheme still leads the nation in poor performance.
Overall, we have the highest average premiums, the worst return-towork rates, and the highest unfunded liability of any scheme in the country. For our aged care providers this all translates into workers compensation premiums which are two to three times those of their interstate counterparts. Currently their levies are 7.5% of wages, without the opportunity for a reduction from having a good claims history. The effect this has on our members’ profitability and their ability to pay higher wages is obvious. We hope, through our submissions, and those of other industry associations who share our concerns, to influence some fundamental changes. Some of the areas we will discuss in our submission are: •
Aspects of the claims management process which hinder rather than promote early and proactive injury management.
•
The wages step down points are too generous compared to other states, and reduce workers’ incentive for early return.
The saddest aspect to all of this is that, besides adding unnecessary costs to employers, studies have shown that extended periods on workers compensation have a detrimental effect on workers’ psychological heath. A system which fails to do all it can to get injured workers back to work as quickly as possible lets them down badly. n
national update
ACAA – NSW Charles Wurf, CEO ACAA-NSW
The 23rd ACAA-NSW Congress One of the major events that support the aims of the Aged Care Association Australia - NSW is the annual State Congress which, in 2011, will be held for the 23rd time.
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ollowing positive feedback from last year the 2011 Congress will again be held at the Sheraton on the Park, Sydney and is scheduled for Thursday 19th and Friday 20th May.
The Congress is renowned for its topical, thought provoking and fun-filled presentations and to hold with tradition the 2011 theme: Carving out the Future for Aged Care covers a range of topics. We are in the midst of a reform agenda by the Commonwealth Government and with the release of the draft Productivity Commission Report, messages from the Productivity Commission and the Minister for Mental Health and Ageing, will identify where that agenda is taking us. The keynote address from Kevin Sheedy will challenge us to a rethink of practices in the face of what might seem unworkable circumstances. The concurrent sessions on the Thursday will pose the difficult choice of which to attend; with a workshop from Greg Donlan on ‘showcasing your facility’, to hearing a range of topics on business development and staff support. The first day will climax with presentations on those areas that are in the forefront of care; supply of GPs, Oral Health and Palliative Care. Not to be outdone the second day of Congress will be kicked off with two great presentations from Khoa Do and Todd Coats; two men who have faced challenges and overcome them with significant success especially in a changing environment! Another quandary for delegates is to which concurrent session they should attend on the Friday. With a panel discussion on building organisational resilience, or three presentations on projects implemented in organisations to promote positive mental health and well being in aged care facilities, the choice will be difficult. The Congress will not be without the famous closing act and who better to do that than Father Bob Maguire! Father Bob was an advocate for the Grand Plan, the Campaign for the Care of Older Australians (CCOA) and has spoken on national television supporting the CCOA initiatives for aged care reform.
This Congress provides delegates with the chance to network with colleagues from around Australia and to be presented with the most innovative equipment, products and services to aged care facilities through the wonderful support provided by the Trade Exhibition. The ACAA-NSW invites members and guests to take the opportunity to hear the most-up-to-date information, learn from the experts and have fun along the way. The Congress Program and registration details are available on the ACAA-NSW website at www.acaansw.com.au. We hope to see you in Sydney in May! n
national update
Aged & Community Care Victoria Gerard Mansour, CEO Aged & Community Care Victoria
Aged & Community Care Victoria (ACCV) formed in 2006 as the single and united voice for aged and community care in Victoria. Since this formation, ACCV has conducted an annual member survey to understand ACCV’s member engagement position and ensure the association continues to improve upon the service it provides to its membership base.
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ndependent market researchers Alliance Strategic Research completed ACCV’s third annual online survey and second qualitative telephone interview assessment in October 2010. Approximately 28 per cent (94) of ACCV’s members completed the questionnaire, and a further 30 members and non-members participated in the telephone interviews. Participants were from a representative sample of all membership areas, including residential care, community care and independent or retirement living. The third survey represented a great success for ACCV in terms of the services the organisation provides. Members reported a 20 per cent increase in satisfaction levels overall, and this continues to increase. Members reported valuable feedback to ACCV, providing essential information about their reasons for being satisfied with ACCV. In essence, feedback highlighted ACCV’s role as an information provider as being key to their membership purpose, be this through face-to-face, telephone or email communications methods, or conferences and events. Members also noted that they valued ACCV’s industry representation to government, stakeholders and the broader public. Member satisfaction continues to grow, with 65 per cent of members either extremely or very satisfied with ACCV’s services and performance, and the remainder being quite satisfied. This represents positive growth from the 2009 result of 61 per cent and 53 per cent in 2008. Members expressed reasoning for their responses, stating ACCV’s information services are ‘useful, reliable, prompt and cover a range of topics’,
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highlighting that ACCV provides ‘good training and education’ services, and that ACCV is a ‘unified voice for the industry’ – a very strong aim of the organisation and therefore very positive feedback. The benefits of being an ACCV member were also expressed through the survey, stating comments such as that ACCV is ‘a safety net’, that ACCV conducts ‘effective lobbying to government’, that ACCV membership provides ‘direct access to information that is up-to-date and accurate’ and that ACCV represents ‘one unified voice’. Reasons for continuing to be a member of ACCV were also highlighted and included that membership allowed members to ‘be part of the bigger picture’, to ‘have availability to a larger network’, that ACCV ‘gives a political voice’ and allows members to ‘keep up to--date with policies and trends’. Where dissatisfied with ACCV’s services and performance, members highlighted a ‘limited regional presence’, that the organisation is ‘not as focused’, could be ‘expensive’ and provides ‘too much information’ – all concerns that ACCV will now consider in its future operations. Overall, members believe ACCV meets expectations across all areas, with particular focus on the area of information provision. Ninetyeight per cent of respondents positively commented on ACCV’s provision of up-to-date, relevant information – an increase from 82 per cent in the 2009 survey. Three key areas which were outlined as being important areas of activity for ACCV going forward included requests for a more aggressive advocacy approach, increased government lobbying for funding and an improved delivery and variety of services to regional Victorian services. n
national update
Aged Care Queensland Nick Ryan, CEO Aged Care Queensland
Queenslanders have experienced a very tumultuous start to the 2011 year with a number of natural disasters impacting on the state. We have suffered fatalities, many people lost their homes and even more have been displaced. Further, much of the state’s infrastructure has been damaged or destroyed by the floods and Cyclone Yasi.
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cross the broad spectrum of community care, residential care and retirement living, aged care staff and residents stepped up to the challenge presented and continued on with
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ACQ has heard numerous positive examples of how the industry responded and assisted one another during and after these crises
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business as usual – albeit under very challenging circumstances and/or in a different location. ACQ has heard numerous positive examples of how the industry responded and assisted one another during and after these crises. In many cases, management and staff who were personally affected placed the welfare of residents/clients and carers ahead of their own needs. Some residential aged care facility residents are still displaced whilst their homes are undergoing repairs following inundation, but are looking forward to their return over coming weeks. We are particularly grateful for the support of other providers, suppliers and private citizens across Australia who offered goods and monetary donations. This is a clear demonstration that the Aussie “community” spirit is at the forefront in difficult times. These events have also highlighted the importance of forward planning and the execution of effective disaster management plans. Many organisations are now fine-tuning their emergency response plans to incorporate some of the lessons learned. Since late January, like with all State Associations, much time has been taken up with the Productivity Commission Draft Report. We have been busy interpreting the recommendations, collaborating with associate professional members on likely scenarios arising from the adoption of the Commission’s recommendations, meeting with members, holding forums to determine member’s views, conducting surveys and planning events to capture the industry’s considered view on this important piece of work. ACQ’s member feedback will be provided to both the National Submission and to the Public Hearings. Generally, we are optimistic about the Productivity Commission’s recommendations. Certainly, more detail needs to be obtained on some of the recommendations, but hopefully (if adopted) they will form an integrated package designed around industry sustainability, consumer choice and a new approach to regulation. The Productivity Commission’s Assistant Commissioner – Paul Lindwell is speaking at the ACQ State Conference on the Gold Coast from 23 to 25 March 2011. It is expected this will still be a ‘hot topic’ from the perspective of members - especially those from the regional areas as they have the chance to interact with their metropolitan colleagues. Minister for Mental Health & Ageing, Mark Butler will also feature with a pre-recorded interview. Other keynote speakers include Ita Buttrose, Mark McCrindle, Chris Richardson and Dr Norman Swan. With much change on the horizon, the conference is a wonderful opportunity to hear first hand member feedback. We encourage ACQ members to be active citizens in the political sphere. n
ACAA - WA Anne-Marie Archer, CEO ACAA-WA
W
ith each Aged Care Approvals Round (ACAR) the Western Australian aged care development demise is becoming increasingly apparent. In the lead up to the next ACAR, interest in any residential applications will be largely determined by the Extra Service allocation conditions and limitations in each region. The 15% regional cap on Extra Service licences for the previous round has left current and future developments in much doubt, not only for future viability, but in regards to access to capital and borrowings.
There is no doubt that all those who work within the industry are respectful of the equity of access argument that we have heard in relation to this matter on countless occasions. However that argument does not stack up, as a restriction on Extra Service places will deny access to everyone who would have otherwise been able to enter a new facility; which includes the number of supported residents that would have been catered for in the resident mix. There is no doubt that WA provides a vast array of aged care services of a very high standard, but if there is no development to meet future demand, the competition for places will increase for the limited vacancies available, affording little choice and long waiting lists in the future. Although the Productivity Commission’s Draft recommendations have received
considerable support in principle and may alleviate this problem with the abolition of the Extra Services altogether – it does little to sustain viability and growth in the interim of reform. As you would be aware the last round was once again grossly undersubscribed in WA with only 314 residential care places allocated out of the 1564 available and the previous years from 2007 showing a steady decline in bed take up across the State. Without the immediate removal of the 15% regional target, WA will simply not be able to meet the demand for services until there is major reform and even then, it could take years before the building once again continues. Future access delays for all frail aged Western Australians will have an enormous impact on our already struggling State Hospital System. WA Health will need to support more and more people in the acute sector at the expense of the wider community, whist they wait for appropriate aged care services. n
feature report
Productivity Commission Draft Report: Comments from Industry Representatives The draft report from the Productivity Commission; if adopted by Government following the completion of the final report in June has the potential to fundamentally change how aged care is delivered over coming years. Over the following twelve pages, ACA has asked a number of industry experts to comment on the draft report and give some initial impressions about the directions the PC had signaled for the future.
Nick Ryan
CEO Aged Care Queensland
The Productivity Commission’s Draft Report into Caring for Older Australians is the news of the day – and it deserves to be. The document is much more than a report into aged care or a collection of fixes. It is a serious effort in providing a blueprint for the redesign of aged care in all its elements given the current challenges in the industry, which will be amplified in the future.
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t is valuable to recall the aim of the Productivity Commission. The Commission is the Federal Government’s own internal ‘think tank’. The Commission sees its role as helping governments make better policies in the long-term interests of the Australian community. It provides arm’s length advice to Government on key economic, social and environmental issues. This is valuable because much policy advice to Government comes from within
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departments within its inherent (risk of) conflicts of interest. The Draft Report is a group of government economists talking to government policy makers. Aged care providers are not the primary intended audience and to arrive at the implications for providers has required some analysis. Now that the draft report has been released and digested I am particularly interested in how we in the industry use this opportunity of the policy reform. Rod Young and the ACAA Board have met with the Commission and parliamentarians to advance a provider view on the Draft Report. One of the strengths of belonging to a national association is that the association can act on our behalf on national policy matters. There is, however, the risk that we assume the association does the entire interface with federal parliamentarians on our behalf. Although national coordination and representation are essential there is much that can be done on a local level with federal politicians. The best outcome is a coordinated approach where aged care associations work with ministers and parliamentarians in Canberra and associations and providers work with their local parliamentarians at home to expose them to the local impacts and potential of policy reform. I have found that parliamentarians when home welcome local interaction – it’s where they gain their mandate and legitimacy.
I find them more open minded in their electorates and more personal. The Canberra scene is very different; policy seems more abstract there, it’s funneled and coordinated by staffers and policy advisers. Meetings are frequently interrupted by division bells. The Draft Report is ‘big news’ in our industry. However for most federal politicians it is one of a dozen or more areas of policy reform. Put simply, many parliamentarians may have read the overview but very few would have read the report in full. This is not to criticize them either. In any month there are numerous major documents released of the length and complexity of the Draft Report. Many parliamentarians will be grateful to have a provider view explained to them. This is why Aged Care Queensland in mid February invited every Queensland federal parliamentarian to a breakfast to interact with aged care providers at home. The breakfast provided members and parliamentarians the opportunity to meet, understand issues, hear from different sides of parliament and renew and strengthen links. Local connections complement Canberra based political lobbying. It corresponds with our form of government and Constitution. It reminds us that active citizenship is essential in achieving better outcomes, or in the words of George Bernard Shaw… Democracy is a device that ensures we shall be governed no better than we deserve. n
Once-in-a-decade opportunity Paul Carberry
Chief Executive Officer ACAA-SA
The Productivity Commission’s draft report Caring for Older Australians released on 21st January, provides the reference point for some serious policy decisions which Australia has postponed for too long.
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he Minister for Ageing has promised to consult with unions, consumer groups and the industry in working through the proposals. He’s also made the point that the Government is not bound to adopt all of the Commission’s recommendations. On the surface, that’s fair enough, Government’s are paid to make decisions and to take responsibility. Perhaps the Government has some really good ideas they haven’t told us about yet, which the Commission didn’t think of.
Gerard Mansour
CEO Aged & Community Care Victoria
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here is no doubt that the Productivity Commission Inquiry into aged care is the ‘biggest game in town’ for our industry. It is critical for Government to remember that this is about both longer term reform and short term additional support in this year’s budget. While our immediate aim is to see refinement in the draft recommendations, the focus will quickly turn to the Government. There is no guarantee that any Government will act on a report from the Productivity Commission.
More likely though, the Minister’s remark was designed to avoid pre-committing the Government to any hard decisions it would rather not make, irrespective of the evidence and the merit. For example, the Commission wants people who can afford to, to be responsible for funding their own accommodation and living expenses, and pay a means-tested cocontribution for their care. The whole question of user contribution has been avoided like the plague by governments for the last thirteen years and, no doubt, there will be some negative reaction to this proposal. But it’s the Government’s job to explain to the community why this change is not only necessary, but also fair and reasonable. The Commission also proposed that an independent body would determine the cost of care and the annual indexation methodology, and that this process would be open and transparent. Further, the Commission has said the scheduled care prices, which result from this process, should take into account the need to pay competitive wages to nursing and other care staff. This is another tough one because, presumably, if the Government agrees to this independent process, they sign up to the levels of funding determined by it.
And so, while it is essential we provide united and clear feedback to the Productivity Commission for now, the much more significant task is to present a united position to Government. This is the time for our industry to be united around the need and direction of the reform agenda. This in my view is both the biggest opportunity and the biggest threat: United we stand – Divided we fall. Put simply, if we do not have an industry that is sustainable, we cannot provide consumers with the choice or access they need. Never before has our industry been better placed to see meaningful reform for the future of aged care. n
Otherwise, why do it? The Commission knows that government expenditure resulting from this process will increase, and by a big number. Their long-term projection is that by 2050 the cost to taxpayers of the Commission’s proposed new aged care arrangements will be 1.9%, of GDP, compared to 1.5% of GDP in the Intergenerational Report, which was based on the current funding system. To put that into today’s terms, an extra 0.4% of GDP is about $5.2 billion; I have no idea what the difference will be in 2050, but we can all get the general picture. It’s worth noting here that, if the Government has difficulty with the idea of greater user contributions, then the cost to taxpayers will be even higher. So, will the Government bite the fiscal bullet, and set aged care up to meet the heavy expectations and demands it will have to face? In looking at the various challenges which aged care is facing, the Commission concludes that “the system, as currently configured, cannot withstand these challenges”. All parties at the table know that to be true, and have known it for some time. This is a once-in-a-decade chance to fix it. n
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Never before has our industry been better placed to see meaningful reform for the future of aged care
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feature report
Productivity Commission Draft Report Comments Cam Ansell
National Head of Aged Care Services Grant Thornton Australia
The report On 21 January 2011, the Productivity Commission delivered its long awaited draft report on its comprehensive review of aged care in Australia: Caring for Older Australians. The findings in relation to the current state of the sector were relatively predictable and the Commission has made good use of over 500 public submissions to the review as well as their own industry examinations. Importantly, the Commission has recognised that the sector requires a complete overhaul, rather than simply fine tuning, if Australia is to have a sustainable aged care system in the future. As anticipated, recommended initiatives included the relaxation on price limits on services and accommodation, including the restrictions on accommodation bonds in ordinary high care facilities. Supply restrictions would also be phased out over time and the current managed bed policy would be abolished after five years. Funding for the investment in improved services would be facilitated through a “user pays” system and public subsidies that would be more closely aligned to the cost of delivering care and accommodation. Comprehensive costing information would be obtained to inform the proposed new regulator on service pricing. Existing discrete residential and community care services would be replaced with a single, integrated system of care provision and users of those services would have more choice around the setting in which they receive care (in a quasi “voucher” style model) and their preferred provider. The report put forward a number of innovative strategies that were not widely
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anticipated, including a Government managed Equity Release scheme which would enable consumers to make accommodation payments and care copayments without having to sell their homes. An alternative in the form of a new Australian Pensioner Bond scheme would provide pension protection by allowing older Australians to invest the surplus proceeds from the sale of their primary residence. Age pensioners could draw on their bond to fund living expenses and aged care costs. The report also calls for the creation of a new agency to assume many of the regulatory roles currently undertaken by the Department of Health and Ageing. Called the Australian Aged Care Regulation Commission (AACRC), it would also take on responsibility for complaints handling and the Aged Care Standards and Accreditation Agency would become a statutory authority within the AACRC. An Australian Seniors Gateway Agency would be introduced to provide information, assessment, care co-ordination and carer referral services. No doubt the devil will be in the detail, but the Commission’s report provides strong arguments to build its case for reform. The report carefully articulates the integrated nature of the reform initiatives to reduce the chance of recommendation cherry-picking as we saw with the Hogan Report in 2004 and more recently in the Henry Review into Australia’s Future Tax System. Some media have been quick to latch on to the “forced sale of the family home” tag line, without reading the provisions relating to the Equity Release Scheme – or recognising that the primary residence is usually unoccupied when someone moves into a residential aged care facility. Other groups have been disappointed that their own agendas were not sufficiently addressed, however, compromise is inevitable in achieving balanced stakeholder outcomes.
The implications Subject to some further refinement, we believe that the adoption of these recommendations will go a long way to ensuring that older Australians are able to access the care they need in their preferred setting. The recommended reforms unquestionably open the door for a more viable aged care sector, fuelled by innovation and responsiveness, and tempered by increased competition. Greater levels of consumer contribution will be the driver of greater choice whilst fostering a more sustainable and equitable industry.
Grant Thornton estimates that more than $21 billion of investment will be required in residential aged care infrastructure over the coming decade. This includes the re-development of dated facilities as well as sector expansion to accommodate an ageing population. Critically, the Commission’s recommendations address the major impediment to sector growth – access to capital – and provide for the establishment of suitable pricing mechanisms for accommodation payments for those unwilling or unable to commit a lump sum upon entry. However, the proposed changes will not be good for everyone. The report suggests that a more responsive and innovative market will test the management skills of some providers and not all are expected to survive. Those operators that have been solely focused on accessing high care bonds
and the de-regulation of pricing may not be ready for the competitive pressures that will accompany these changes. Others may find their infrastructure inappropriate in an environment of increased consumer choice and fail to adapt quickly. Nevertheless, the recommended changes are inevitable – consumers will make a greater contribution towards the cost of the same services they’ve been paying for their whole lives, and they will be subsidised for direct aged care services. In return, high quality services will be made accessible, based on their individual needs and personal preferences. Future generations of older Australians will not have to accept sub-optimal aged care services and accommodation because the Government will not let them invest in their own wellbeing.
The issues Grant Thornton has made a number of observations and identified some issues that should be considered for the Commission’s final report, due in June 2011. Restrictions on Accommodation Bond Levels (Recommendation 6.4) The Commission has recommended that the accommodation bond amount, or accommodation charge, should be closely linked to the underlying cost of the accommodation service provided. The intention is to avoid the charging of “superbonds” that do not reflect the true value of supply. For the provider, establishing the cost of accommodation supply is more complicated than just an analysis of original construction costs. The proposed approach assumes that equitable bond/charge prices would be achieved through an aggregation of input costs rather than valuing the operator’s accommodation quality and service outcomes. An operator’s investment in the physical infrastructure of the service is an ongoing requirement over the life of the facility and the cost of accommodation includes less tangible contributions that enhance the service quality and reputation of the facility. These elements would be difficult to apply and measure constantly across the sector to arrive at an “accommodation value”. It would
also be very difficult for the AACRC to police effectively. The Commission correctly points out that the incidence of very high bonds results from supply constraints, high/low care crosssubsidisation, information gaps and a desire by some residents to preserve their pension. As discussed above, the Commission has developed a reform framework that addresses these deficiencies through the relaxation of supply constraints, the introduction of bonds in ordinary high care and the option of pension protection through the Australian Pensioners Bond scheme. On this basis, market forces should ensure that accommodation bonds are kept at appropriate levels without the need for this form of additional regulation. Consumers should have recourse to the Commission where there are exceptions to this principle. To enhance competition and provide valuable information to consumers, consideration should be given to the introduction of a star rating system for aged care accommodation and non-care services. An independent rating system for residential aged care has been successfully implemented in the UK. People often do not have time to undertake research on alternate services before entering residential aged care. A star rating system would enable consumers and their families to compare alternate facility options and prices relative to their accommodation and service offerings. The information could be made available through the Seniors Gateway Agency, however, the standard rating process should be undertaken by an independent assessment entity. Accommodation for Supported Residents (Recommendation 6.7) The report highlights the importance of encouraging providers to accommodate supported residents through an appropriate level of Government payment. The Commission has recommended that public subsidies for supported/concessional residents should reflect the average cost of providing such accommodation based on a two-bed room/ward with a shared bathroom. While we agree that the principle of establishing baseline accommodation standards for proxy pricing is appropriate, we believe that the standards proposed in the draft report require further consideration.
The current regulatory arrangements already make provision for delivery of residential aged care services in a shared environment. However, the vast majority of facilities built over the last decade have been built with predominantly single ensuited rooms. Consumer preferences for privacy make it extremely challenging to achieve high occupancy in a shared room environment unless there is little competition in the catchment area. The relaxation of supply and price arrangements under the proposed reform agenda will unquestionably increase competition and service quality and providers are unlikely to increase accommodation density for supported residents. In the UK, the relaxing of regulatory restrictions resulted in an overall improvement in accommodation and a marked decline in shared rooms, even though the level of local government financial support has not always reflected building standards. Older Australians in residential aged care are presenting increasingly complex clinical needs and higher levels of functional dependence. The Commission has placed priority on the requirements of special needs, such as palliative support. In these cases, twobed wards meet neither the support needs nor the personal preferences of consumers and are not suitable for supported or unsupported residents. Because the cost of accommodating residents in single ensuited rooms is materially greater than in shared rooms, providers would either have to wear the loss (which is what is happening now under current funding arrangements) or minimise the number of supported residents in their facility. To ensure that the Commission’s equity and access objectives are achieved in the long term, accommodation subsidies for supported residents should reflect modern design and construction standards, and provide for pricing based on single ensuited rooms. Financial modeling based on specified design standards and location would facilitate the estimation of reasonable basic standard costs. Role of the Australian Aged Care Regulation Commission (Recommendation 12.1) The Commission has concluded that
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the Department of Health and Ageing’s policy functions need to be separated from its regulatory role. It is proposed that the responsibility for the regulation of aged care be transferred to AACRC, which would also incorporate the currently “independent” Aged Care Standards & Accreditation Agency. While the breadth of this role, and the inter-relationship with the Australian Seniors Gateway Agency will require detailed evaluation and planning (as discussed below), particular consideration needs to be given to AACRC’s responsibility for prudential regulation of accommodation bonds.
care services, or whether the scale and risks warrant oversight by an organisation with dedicated capacity and resources in this area.
Today, less than half of the people in residential aged care have paid an accommodation bond. This is largely due to restrictions relating to high care (and the level of supported residents). The aggregate bond balance in Australia has grown rapidly and stands now at around $10 billion. The combined effect of an ageing population and the removal of restrictions on bonds in high care will see this figure grow exponentially over a relatively short period of time.
AACRC and Australian Seniors Gateway The implementation plan proposes the establishment of the new key agencies during Stage 2. Given that these are the agencies to become responsible for the key roles of assessment, referral and regulation, we believe that the establishment of the entities and comprehensive governance and transition planning should take place as an expedited measure within two years of reform commencement (Stage 1).
To date, less than $25 million in bond default events have been managed under the Department of Health & Ageing’s prudential arm. However, as new sector entrants arrive and greater levels of service variety and innovation emerge in a less regulated environment, the risk of bond defaults will increase unless prudential oversight is highly effective.
This would require a gradual transfer of responsibilities from the Department of Health & Ageing and other agencies. However, it would signal the support for the reforms by our political leaders and enable the AACRC’s involvement in transition planning and the implementation of reform (rather than relying solely on those entities that will have their responsibilities diminished through the reforms they introduce).
In these circumstances, it will be appropriate for the Implementation Taskforce to consider the suitability of the AACRC to manage this prudential responsibility given the broad scope of its regulatory responsibilities for
Timing for Implementation of the Recommended Initiatives (Recommendation 14.1) The table below reflects the proposed timing of implementation of the major initiatives: There are a number of areas requiring further consultation in relation to the Commission’s proposed timeline. Some key areas for consideration include:
Abandonment of the Managed Bed Policy The timeline provides for the removal of supply restrictions in both residential
Draft Implementation Plan Stage 1: within 2 years
1
2
3
4
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Remove distinctions between low and high care , and between ordinary and extra -service status. Require residential aged care facilities to: Set accommodation charges consistent with the cost of supply ; Disclose the charges and an equivalent accommodation bond ; and Remove bond retention amounts .
Stage 2: within 2 – 5 years
1
Establish the Australian Seniors Gateway Agency.
1
Remove supply restrictions in residential and community care .
2
Introduce new model of care assessments.
2
Commission a public review which would analyse and recommend :
3
Establish AACRC to transfer regulatory responsibility .
Changes to aged care accreditation standards
4
Transfer Aged Care Standards and Accreditation Agency to AACRC.
Maintenance of fiscal sustainability
5
Introduce Australian Pensioners Bond . Conduct a public benchmarking study of aged care costs to: Initially set scheduled prices ; Enable the progressive increase of the accommodation charge paid by the Government ; Set regional quotas ; and Enable providers to trade quota obligations
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Stage 3: 5 years and beyond
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Introduce the new co-contribution and stop-loss funding arrangements and equity release scheme . Implement the Commission’s draft recommendations relating to age friendly housing and communities . Increase quantity of residential and community places by 10 – 20% above the baseline .
Access for special needs group Continuation or replacement of quota arrangements . Whether the consumer directed system had developed .
care and community care five years after the reform agenda is approved. As the Commonwealth effectively lost control of supply in 2007 when the Aged Care Approval Round first became undersubscribed, we have reservations about continuing with the current form of managed bed scheme in an environment that requires providers to be innovative and competitive. We anticipate that there will be significant interest in developing new facilities under the reform initiatives, and there is no doubt that an interim supply management strategy needs to be in place. However, in residential care, as occupancy levels have been steady or declining in recent years there is unlikely to be a significant change in demand for institutional care because of consumer preferences not to enter a facility where possible. It is more likely to be community care that will experience a material increase in demand in the short term. We recommend that consideration be given to the establishment of alternate supply control mechanisms in Stage 1 to enable the sector to adapt and expand in the short and medium terms and that consideration be given to removing supply constraints on residential aged care, at least, during Stage 2. Measuring Health Care and Personal Care (Recommendation 6.2) The funding principles recommended by the Commission are set out on the following page. In this context, what is ordinarily referred to as “care services” has been split between “health services” and “personal care”. This enables the application of a universal public subsidy to health services, while introducing a co-contribution element to the personal care services component. While the reasoning on these principles is sound, it is difficult to separate personal care and health services as these are often inter-related services that are provided by the same carers. Few operators capture information on personal and health services separately and it would be expensive and necessarily arbitrary to do so on an ongoing basis. It would also be unduly burdensome to continually change the co-contribution level for an individual as their functional dependence levels change over time.
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regulation. This will have important implications on the AACRC’s regulation of care services and accommodation bond prudential oversight. Whilst we agree that retirement living and aged care regulation should not be aligned at this point, we recommend that further planning and analysis be undertaken in Stage 1 to ensure that consumer choice and AACRC powers are not diminished because of regulatory misalignment.
Where to from here? The Commission has invited responses to the draft report by 21 March 2011.
The Commission has recommended that a public benchmarking study should be conducted into aged care costs to establish scheduled prices and set regional quotas for supported residents. We recommend that this study be extended to enable case mix modeling of care services to determine proportional cost allocations between personal care and health services. The study should produce a schedule of allocations for a variety of consumer profiles in alternate care settings. Furthermore, we recommend that the application of these scheduled allocations be determined for individuals by the Australian Seniors Gateway Agency at the assessment stage, and that co-contribution levels should remain constant unless there is a major change to the person’s health condition. The Seniors Gateway assessors would be working with a new funding/assessment instrument that must apply to both residential care and community care. The detail in relation to this initiative was not appended to the Commission’s draft report and careful assessment will be required when the annexure is released. In particular, resource allocation for key elements of basic support, personal care and specialised care can vary significantly between institutional and non-institutional settings and comprehensive modeling and testing will be required to ensure that parity is achieved between cost of meeting individual consumer care needs and the available funding streams.
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Retirement Living Legislation (Recommendation 10.4) There was a universal sigh of relief from retirement village operators upon reading the Commission’s recommendation not to align the regulation of retirement living with aged care. The report correctly identified the potentially detrimental impact of increasing the regulatory burden on villages. However, the Commission’s deliberations on this topic were based largely on how the two sectors operates today, rather than giving more in-depth consideration to the impact of the major reforms presented elsewhere in the report. Our recent review of the New Zealand aged care sector revealed that, in a less regulated supply and pricing environment, the line between residential care, community care and retirement living becomes increasingly blurred. In modern integrated villages, residents can move around care settings based on their service needs and preferences, with their subsidy entitlement moving with them. The Grant Thornton/RVA Retirement Living Survey revealed a desire amongst Australian operators to replicate this model, and the implementation of the Commission’s recommendations would make this possible. Unlike New Zealand, Australia has a three tiered government system. Facilitating choice between service settings will necessarily mean navigating between Commonwealth and State/Territorial
While there has been some negative sentiment expressed toward specific areas of the report, most stakeholders appreciate that the proposed reform framework is urgently needed and that the implementation of the Commission’s recommendations will help to secure improved accessibility, choice and aged care service quality. As individual industry bodies and sector leaders continue their deliberations on the report, it will be vital that a collaborative approach is adopted to ensure that the core pillars of the reform platform are adopted by the Australian Government. It was a lack of consultation and collaboration that resulted in changes to the 1997 reform package – the implications of which remain with the industry today. The principle objective for this reform is the establishment of a sustainable aged care system that enables older Australians to access the care services that best meet their needs in an environment of their preference. The Commission’s draft report paves the way to achieving this and should be supported by those who share this vision for Australia. n About the Author Over the past 20 years, Cam Ansell has provided strategic advice to aged care providers and government agencies in Australia, New Zealand, the United States and South East Asia. He has personally managed residential aged care facilities, retirement villages and community care services. For more information about the report or Grant Thornton’s aged care services, please contact: Cam Ansell Industry Leader - Aged Care T +61 8 9480 2000 E cam.ansell@au.gt.com
Productivity Commission Draft Report: Implications For Consideration Libby Madden & James Underwood James Underwood & Associates
Many voices in the residential aged care sector have strongly welcomed the recommendations of the Productivity Commission (PC) Draft Report.
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A key recommendation in the Draft Report is the abolition of the ACAR process, but how will the number of residential aged care places and community packages be determined and allocated?
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n particular, the apparent proposed deregulation of bonds – to be able to be sought for High Care as well as Low Care persons – has given the sector hope that ‘capital’ income sources can now match capital expenditure in a market-driven “bond or equivalent daily charge” arrangement. However, in some cases, the words written in the body of the report can appear at variance with this advised flexibility and deregulation. In other areas, we see some significant challenges to implementation. Let’s look at three key recommendations: 1. Deregulated Bonds/Charges for New Residents The PC recommendation appears to be that accommodation payments (i.e. bonds or charges) be allowed at an amount reflecting “variations in building costs for residential care facilities in particular regions and reflect[ing] different quality/ features without requiring valuations of each and every facility” (p.172 of the Draft Report). However, building costs alone are not necessarily an accurate criterion for assessing quality of accommodation or bonds needed. One Australian provider has recently built a large new facility with high standards of features and fittings for just $120,000/ place with the second stage of the building completed at just $70,000/place. Other new services in the same region have cost $250,000/place to build. It would be difficult for these building costs to be used with a “regional” bond level. We have spoken with PC representatives and they have advised that it is not intended for bonds to be limited in any regional way or generally. This is very positive and we will hope to see a final report that makes clear recommendation for providers to have access to bonds (or equivalent charges) that:
(i) reflect the real cost of provision of accommodation of different types, sizes, locations and amenity, and
(ii) encourage investment in new residential care buildings 2. Supported Residents – A “Basic Standard of Accommodation”? A great positive of the Australian residential aged care system is the availability of access to good quality care and accommodation regardless of financial capacity. Whilst the PC’s recommendation to continue regional supported resident ratios is positive, the recommendation that the cost (and, thus, the funding) of providing supported resident accommodation be based on a two-bed room with shared bathroom, is considered far from positive. Equity of access to single room, ensuited accommodation should not be limited to those with the capacity to pay for such. In addition, single, privatelyensuited rooms are not only what most consumers want, but, importantly, are what providers have been predominantly building for many years. It would be very difficult to go backwards and limit access to single rooms for new supported persons because government assistance was based on the less costly shared rooms. 3. No More Aged Care Approvals Rounds (ACARs) – Lifting the Restrictions A key recommendation in the Draft Report is the abolition of the ACAR process, but how will the number of residential aged care places and community packages be determined and allocated? How will the effects on supply and demand be monitored if the numbers of places and packages to be given out are unlimited? Could there be very negative outcomes – at least in the shortterm – by changing to a “market-driven’ allocation process? There is a perception that there are too few residential aged care places being built and that this means there is a great shortage of places in Australia. This is not the case. The reality is that the number of places being built exceeds demand. As a result, national
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Productivity Commission Draft Report – Implications For Consideration
The average number of new residential care places being brought “on-line” since 2004 is around 4,700 places pa (as per annual DoHA Service Lists at 30 June). Building just 4,700 places each year appears to have been quite enough, as evidenced by these declining occupancy levels. Despite this, the numbers of places being offered and/or successfully applied for in ACAR are far above 4,700 pa., as below:
occupancy rates have been in decline for many years, as below:
There is believed to be a record high number of provisionally-allocated places that have
not yet been built. This is unsurprising with so many being allocated, particularly in nonmetropolitan areas. Having a reasonable level of places vacant facilitates exercise of choice on the part of consumers. Having too high a level of vacancies in an inadequately-planned process may give rise to viability concerns and other unexpected negative consequences for the sector. With over 7,000 additional community care places now coming “on-line” following the December 2010 announcement of the
results of the 2009/10 ACAR, it is most likely that residential aged care occupancy rates will decline even further. Of the 7,023 home care places allocated, a huge 4,555 places were Extended Aged Care at Home (EACH) or EACH (Dementia) places – this means potentially 4,555 more elderly persons will delay, defer or bypass residential High Care in 2011. By comparison, in the 12 months to 30 June 2010, we saw just 2,740 new residential High Care places open in Australia and only some 1,656 new EACH and EACHD packages commence (per DoHA Service Lists). The 4,555 newly-allocated EACH and EACHDs for 2009/10 could likely meet an entire normal year’s demand for additional residential care places – High and Low Care. These EACH and EACHD packages could be expected to all commence within six months, i.e. by June 2011. The likely negative impact on residential care occupancy rates could be very strong, particularly in the ACT, Qld and WA, where, proportionally, the highest numbers were
approved. Accordingly, with the existing regulation on the numbers of new places/ packages allocated each year, there could be major negative consequences for the residential sector when large numbers of home care places are approved. How would this be monitored if the current allocation process was abolished? Conclusion This draft PC report is very well researched and holds great promise for effective change. However, the arrangements for flexibility in bonds/charges are not clearly defined; the “base-line” for supported accommodation is recommended at a shared room level that could “lock in” funding at an inadequate rate; and deregulation of the approval process may need more consideration to prevent viability challenges. It is up to all of us in the sector to provide much additional input to the PC between now and June 2011 to ensure the final recommendations are the best possible for Australia’s aged persons. n
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It is up to all of us in the sector to provide much additional input to the PC between now and June 2011 to ensure the final recommendations are the best possible for Australia’s aged persons
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Productivity Commission Report Comments Rachel Lane
accommodation bond up to their total assessable assets minus $38,500, while in high care residents pay an accommodation charge that is capped at $28.72p.d. once assessable assets exceed $98,237.60.
disincentive for people to move from their own home to an aged care facility if the proceeds from the sale of the home are likely to have a negative impact on pension entitlement.
Proposed Reforms
The Productivity Commission recommend that the distinction is removed, and as such the accommodation charge would become uncapped and the retention amount (currently $307.50 per month for a maximum of 5 years) removed. In doing this all residents would be given the option to pay their accommodation payment by;
In light of this the Productivity Commission recommend that the government establish a pensioners bond scheme that would enable pensioners to use the proceeds from the sale of their home to buy a bond from the government.
Executive Manager Aged Care Solutions Colonial First State
There are a number of proposed reforms that would impact on the cost of care in the future and the way in which a resident can fund this cost. While some of the proposed changes will better enable the overarching objectives of Quality, Equity, Efficiency, Sustainability and Choice further detail is needed to determine the extent to which these objectives will be met.
• •
Lump sum (Accommodation bond) Periodical payment (periodic accommodation charge) Or a combination of the two
Unbundle the Costs
•
Currently the cost of care bundles the cost of everyday living expenses; meals, laundry, electricity, water etc with the cost of accommodation (what would otherwise be rent or mortgage repayments) and the cost of care services; the cost of nursing staff. The first two costs are those that people would normally need to meet for themselves while health care services are made available through the health care system and funded through Medicare.
Essentially these are the same as the arrangements that we currently have for low care residents.
The Productivity Commission are recommending that these costs are separated out and that individuals should be responsible for meeting their accommodation and living costs and should contribute to their cost of personal care based on their capacity to pay. The provision of care services would attract a universal subsidy in line with public health care policies.
With the price of accommodations being published and therefore subject to competition it is expected that a market price will be formed. It is expected that this would remove the payment of very large accommodation bonds to be more in line with costs associated with building the accommodation.
Remove the distinction between Low Care and High Care There is currently a big financial distinction between low care and high care. In low care residents can be asked to pay an
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Aged Care Facilities would need to ensure that the periodic accommodation charge and the accommodation bond where equivalent and these figures should be published.
Establish an Australian Pensioners Bond scheme
The Productivity Commission acknowledge that many pensioners currently benefit from paying bigger bonds as the monies held by approved providers are exempt from pension income and assets test and the capital is guaranteed by the government. The Productivity Commission also realise that there may be a financial
Features of the bond are; • • • •
The bond would be exempt from the age pension asset and income test The bond would be indexed in line with CPI to maintain real value The bond would be free of entry, exit and ongoing management fees The bond could be drawn on to fund living expenses and aged care costs.
While unbundling the costs and removing the distinction between high care and low care should go some way to meeting the objectives of Quality, Sustainability and Efficiency, if supported resident thresholds and funding levels remain the same the objectives of Equity and Choice are unlikely to be achieved. This issue is not created by the changes, we already see this with residents who are not supported and try to access low care with a less than market price bond. However, in the current system providers can use a resident who pays a bigger bond to crosssubsidise a resident with a bond that is lower. Under the proposed reforms, with bonds being capped at a market price, this cross-subsidisation would obviously be harder making equity of access and choice for these residents even harder. While it is imperative that the financially disadvantaged are given access to care, it is also important that we don’t shift the bracket of financial disadvantage to the middle class. n
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Response to Productivity Commission Report David Sinclair
Director Stewart Brown & Co
As somebody that provides business and financial advice to aged care operators I would like to confine my response to those aspects of the report that affect the financial performance and viability of operators and in particular the changes relating to accommodation payments in residential aged care.
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irstly, the Productivity Commission should be congratulated on this very comprehensive review. Over the past three to five years there have been countless reviews of various aspects of the aged care sector but nothing that took a ‘whole of sector’ approach. As a result this report and the recommendations contained therein are extremely important and deserve a thoughtful response by all participants in the sector including government, operators, carers and those receiving care. An opportunity such as this to seriously influence policy direction does not come along every day so we must all take advantage of it. There was one thing that everybody has agreed upon through review process and that is that something needs to be done. The report contains many positive aspects and while there will be some argument about specific recommendations the major players in the sector are likely to accept the general thrust of the report in that it recognises that the sector is currently underfunded, that the way it is funded is overly complex and the government cannot be responsible for same proportion of funding as it is now given the increasing numbers of people that will require care. One of the biggest changes with respect to funding is in the payment for accommodation services and this is also an area of concern. The report acknowledges the fact that the cost of accommodation needs to be funded to an adequate level and currently this is not the case. In summary residents would pay for their accommodation costs either by way of a periodic payment for the duration of their stay, a lump sum accommodation bond or a combination of the two. This sounds very familiar to the current situation however it is far from it. Firstly there will be no
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retentions from any bond. The only income earned from the bond will be interest if it is invested. Secondly these accommodation payments must “reflect the cost of supply” and the accommodation bond must be “equivalent to, but no more than, the relevant periodic accommodation charge”. In short, this provides a capping of the bond amount. The report does not elaborate on what the exact relationship between periodic payment and bond will be. Currently the monthly periodic payment is comprised of the retention amount and an interest charge on the unpaid bond amount. In the absence of a retention amount we can only surmise that the relationship will be that an appropriate accommodation bond is set and the periodic payment will be based on some sort of internal rate of return or equivalent interest rate factor. It is likely that a bond value will be based on various factors such as local competition and standard of accommodation and related services. This will be similar to setting an entry contribution for independent living units. Both the periodic payment and the equivalent accommodation bond must be published by the operator. The base line for the market price is likely to be the price that the new regulatory body sets for the accommodation payment that the government will make to providers for supported residents. The recommendations around accommodation payments are likely to do two things; reduce the amount of the bond and reduce the number of people paying a bond. The report itself states that “these reforms, including the setting of a charge for standard accommodation, will lead to a reduction in the average value of accommodation bonds”. The sector has for a long period relied on accommodation
bonds to fund the construction of facilities and any significant change in those bond holdings is going to increase the risk profile of the provider. In the longer term most operators should be able to adjust, however in the short term, many operators will have to borrow externally to fund the payout of existing bonds and this could put real pressure on their financial viability. This will be exacerbated by the fact that, as the Commission states, the proposed reforms “could affect some providers who rely on the asset value of bed licences as collateral for borrowings”. The reduction in the asset values of providers may have affect of providers breaching covenants on existing loans and making it more difficult to take out new borrowings. Just as the Commission recommends that an equity release scheme be set up to assist
care recipients pay for their care needs where their assets predominantly consist of their home, we would recommend that a similar fund be set up to assist providers through the transitional period of reliance on bonds to be able to rely on an equivalent periodic payment. This would allow the commercial lending market to gain some confidence in the sector being able to repay borrowings. This may mean expanding or modifying the current zero interest loan scheme so that it is available to a wider section of the industry as well as not just for new construction. This report offers a lot to talk about and still much more to analyse but on the whole it does provide viable a blueprint for the future and does provide options that are sustainable but, as acknowledged by the Commission, it is not yet complete. n
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This report offers a lot to talk about and still much more to analyse but on the whole it does provide viable a blueprint for the future
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Productivity Commission’s Draft Report: Caring For Older Australians Q & A The following questions and answers have been prepared by ACAA and ACSA in order to provide further clarity about how the ‘new’ system proposed in the Draft Report would operate in practice. The Productivity Commission (PC) was consulted on the answers.
QUESTION 1: In the key points of the Overview in the draft report it states that older Australians would “choose between paying a daily charge or an equivalent bond (lump sum) for the accommodation costs of residential care – with both aligned to the real cost of accommodation.” How does the PC consider the new system of accommodation daily charges and lump sum payments for both supported and nonsupported residents would operate under the proposed changes in the Draft Report?
Answer: All non-supported residents The PC is proposing that each provider set their own accommodation charge for all non-supported residents. As occurs in other markets, providers would generally set charges which generate a reasonable rate of return, taking into account their costs, the amenity of the accommodation and its positioning in the relevant market. Charges could also vary for different accommodation standards in a facility. It is proposed that all providers be required to offer a periodic accommodation charge, and for that charge to be published. Providers could also choose to offer a bond option,
but the value of the bond would need to be the equivalent, at the time, to the periodic accommodation charge. It would also need to be published. The PC recognises that a number of residents remain in a facility for more than 12 months. There would need to be a mechanism for a periodic review of the charge, and for the bond to reflect a risk premium. Views are sought on these issues. The PC is aiming to create a situation where the forms of accommodation payments are equally attractive to care recipients and providers, and that they reflect the value of the accommodation rather than a person’s capacity to pay. The proposed Australian Pensioners Bond Scheme attempts to neutralise the distortions arising from the Age Pension asset test treatment of equity released from the sale of the primary place of residence. With the proposed abolition of low and high care on entry, all new residents (on their entry into a facility) would be covered by the system described above. The PC would propose that the Australian Aged Care Regulatory Commission (AACRC) monitor all accommodation charges and bonds, and monitor any attempt to introduce undue complexity into the charging schedules. Re-regulation would remain an option. Supported residents The PC has retained, in the draft report, the current definition of a supported resident. Under the draft report proposal, based on an assessment of reasonable costs, the new AACRC, would make a transparent recommendation to the Commonwealth Government on the level of the supported resident payment payable to providers. The actual payment level would be set by the Government. The PC is seeking views on what would be included in (and excluded
from) the AACRC’s cost estimates, including the treatment of land. Rural and remote area costs, and significant cost distortions in other regions, would need to be taken into account. In the draft report the PC proposed that the supported resident accommodation payment be based on a room shared by two people with a shared ensuite. The standard must balance the desires of older people, the benefits to some of sharing a room and the cost to the community. Views are sought on the appropriate balance. In the first two years, the PC proposes that the accommodation payment for supported residents be progressively increased, as an interim step until the AACRC is established. However, the Commission does not see merit in the payment increasing for current lower standard accommodation, but seeks participants’ views on such an approach. Although not explicitly dealt with in the draft report, the PC proposes that fully and partially supported residents would be allowed to use the Government supported resident accommodation subsidy as a part payment toward more expensive accommodation. In such circumstances, the care recipient or their families would be responsible for funding the difference between the accommodation charge set by the provider and the supported resident accommodation subsidy payable on behalf of the care recipient. Fundamental difference between supported and non supported residents The PC is proposing the basis for setting accommodation charges for nonsupported residents is fundamentally different. For non-supported residents, the accommodation charge will be a market determined price, which each provider will set themselves. The “cost” of accommodation is simply one of the
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factors providers would consider in arriving independently at their charge. The phrase “aligned to the real cost of accommodation” is intended to convey the meaning that, in the more competitive environment proposed by the Commission, market forces are likely to drive these independently set accommodation charges towards the efficient cost of supply for that accommodation. However, while market prices are envisaged for accommodation of non-supported residents, the AACRC would monitor the public posted prices to ensure that price gouging did not occur (for example, in areas where effective competition might be lacking). In regard to supported residents, the accommodation charges will be proposed by the AACRC based on an assessment of average reasonable costs for each region, and the AACRC will recommend subsidies for supported residents based on this estimate of average cost. It is worth noting that these average costs would in the view of the Commission include an allowance for a reasonable rate of return on investment for the provider.
QUESTION 2: In that case, could the PC clarify the following statement that appears in Stage 1 of the Draft Implementation Plan: “require residential aged care facilities to set accommodation charges consistent with the cost of supply.” (p.460)
Answer: Providers would set their own accommodation charges for non-supported residents. The cost of supply would be one of the factors providers would consider in arriving independently at their price. Other factors, as set out in answer to Question 1, would also feature in each provider’s setting of accommodation charges. It is proposed that the AACRC would monitor accommodation charges and bonds to identify providers who were seeking to use their market power to the disadvantage of their clients.
QUESTION 3:
How will the amount of an accommodation lump sum (bond) be determined under the PC’s proposals?
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Answer:
QUESTION 4:
The PC has proposed that an accommodation lump sum (bond) should be provided as an optional alternative to the daily accommodation charge. It would need to be equivalent, at the time of entry, to the periodic charge.
How will the lifetime stop-loss limit operate?
In this way consumers will be able to exercise choice about whether to pay a daily charge, a lump sum or some combination. And, as noted above, all new residents would be covered by this proposed scheme, due to the abolition of low and high care entry definitions. In the draft report, the Commission does not specify how periodic payments are to be converted to a bond-equivalent, although the intention is that it would be based on the interest rate, with the interest earnings equating to the periodic charge. Views are sought on the appropriate rate of interest to be used (and whether it should be based on an independently published rate). Example 1 – Daily Charge of $45 – Index Rate of 5.0% $45 per day equals $16,425 per annum and to earn this amount at 5% per annum would require a bond of $328,500 Example 2 – Daily Charge of $60 – Index Rate of 6.5% $60 per day equals $21,900 per annum, and to earn this amount at 6.5% per annum would require a bond of $336,923 Note: The accommodation charges and interest rates in the above examples are purely illustrative. Charges will be determined by each provider as described in the answers to questions 1 and 2, and the method of determining the interest rate, and how it will be varied has not been decided. The Commission considers that for long term residents, there could be scope for the daily charge to increase at regular intervals, with sufficient notice being given to residents (similar to rental contracts for other forms of accommodation). For an accommodation bond, however, the amount would be set at entry and the resident would be protected from increases. The Commission is seeking views on how providers might set a risk premium as part of the bond.
Answer: The proposed stop-loss limit would apply to people’s co-contributions towards Government subsidised aged care services that relate to the care component only. It would not apply to accommodation and everyday living expenses. The PC is proposing in the draft report that the level of an individual’s cocontribution would be between 5 per cent and 25 per cent of the cost of their approved aged care services, depending upon their capacity to pay as assessed by the proposed comprehensive means test. However, to protect individuals exposed to high costs of care over an extended period, the Commission proposes an upper limit (a stop-loss limit) on their co-contribution to care costs. When the limit is reached the government would pay 100 per cent of the cost of their approved care needs from then on. The stop-loss limit would be transparently recommended by the proposed AACRC and set by the Government. Based on assumed co-contributions for care ranging from 5 per cent to 25 percent, a stop-loss that covers the top 10 percent of contributions would need to be set at around $60,000. As an example, older Australians requiring close to the highest level of care (in the order of $50,000 to $60,000) and who were paying the highest assumed co-contribution of 25 percent would take around five years to reach the stop-loss limit.
QUESTION 5: The increase in availability of care packages will enable more people to receive higher levels of care in their homes. Whilst this will support people’s ability to exercise choice over where their care is delivered, what approach does the PC envisage to balance the ability of people to remain in their home beyond any point where care needs may exceed the available level of support?
Answer: The PC has proposed that a Gateway Agency would provide a range of services
including information, assessment and care coordination. In addition, the PC has proposed that Australian governments should fund an expanded system of aged care consumer advocacy services to assist people to choose the most appropriate care and the setting in which that care is delivered.
QUESTION 6:
The proposed assessment process would be continuous, responding to the changes in a person’s care needs over time. Built into the system would be a recognition that, beyond a certain point, and particularly in the absence of a capable informal carer or other continuous care and support, a person could only be provided with safe, quality care in a residential aged care facility. A person may not accept the advice to move to residential care, but the PC proposes that the maximum subsidy available for community care would apply in these circumstances, with the person being responsible for privately providing the balance of costs for continuous care and support.
Answer:
How will the price be set for the standard level of accommodation which the Government will fund for people who do not have the means to fund their own accommodation?
As set out in the answer to Question 1, the AACRC would transparently recommend to Government an appropriately daily accommodation payment for supported residents based on the average cost of providing a particular basic standard of accommodation. The AACRC, when it recommends this payment, would be expected to take into account all costs involved in the provision of accommodation including a reasonable return on investment for the aged care providers and regional variations in costs. It will be the responsibility of the Government to set the daily accommodation
Productivity Commission’s Draft Report:
Caring For Older Australians Q & A
payment for supported residents, taking into account the recommendation from the AACRC.
QUESTION 7: How will funding for accommodation apply where aged care providers solely offer accommodation to supported residents?
Answer: Providers will be able to choose whether they offer accommodation solely to fully and partially supported residents or to some combination of supported and nonsupported residents (or even trade their supported resident quota).
feature report
Productivity Commission’s Draft Report:
Caring For Older Australians Q & A
The answers to Questions 1 and 8 provide further information.
QUESTION 8: The PC has proposed that providers would be obliged to make available a proportion of their accommodation for supported residents, with the proportion being set on a regional basis. However, the obligation would be tradeable between providers in the same region. How would this work in practice?
Answer: If, for example, a particular region had four facilities with a total of 248 beds,
and the supported resident target for that region was 25% of the total number of beds, then in total 62 supported resident places would need to be provided in that region across the four facilities. However, if one facility in the region wished to cater for a higher ratio of supported residents, while another catered for those with greater means to pay for their accommodation, the former facility could choose to take on the obligation of the latter, provided the overall target for the region was met. The two providers would negotiate a mutually acceptable arrangement. The transfer of the obligation would need to be registered with the AACRC. It is expected that the PC’s final report would spell out further details in relation to this process, including a possible agreement by the AACRC to the proposed transfer. A system of tracking and verification would also need to be in place to ensure the required number of supported places in each region was continuously being met. n
profile
Mark Butler
Federal Minister for Mental Health and Ageing By Mike Swinson Mention the name Mark Butler in aged care circles and almost without exception, people will respond with a quick ‘He’s the new Minister for Ageing isn’t he?’ interestingly, most of the time, their voices exude a degree of hope and expectation of positive change to come.
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hen ask the question, ‘what do you know about him?’ Almost without exception those same people will either shake their head and shrug their shoulders, or volunteer ‘he’s the bloke who wanted to be the Minister for Ageing isn’t he?’ When I first started to research this story I hit a brick wall. There was nothing about Mark Butler, nothing on the net, at his school or old union. I reached the conclusion that not many people in South Australia where he is based know much about him either. I had virtually finished writing the story when suddenly I managed to get interviews with an old union friend and Marks Mum. Now I think I know more about the Minister than almost anyone. So let me share with you a fascinating insight into the man who; if he stays as Minister for Mental Health and Ageing, will have the huge responsibility of transforming the provision of aged care in Australia. Let’s start with this quote about Mark Butler from the Adelaide based Advertiser in 2002.
“He may be the key player within his union and represent the Left in how the state ALP is run, but outside Trades Hall Mark Butler has become something of a man of mystery. He keeps his head down over personal publicity. In 1995 ... Mr Butler was regarded as one of Labor’s brightest young stars. Aged 25, he was preselected to stand in the 1997 state election.
He was one the youngest candidates in Labor history. Some saw him as a future premier. Certainly he had the background for the job.” Mark Butler pulled out of that political race, and now I know why. The article went on to reveal some of Mark Butler’s family connections and why he had the background for the job.
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“He is great-grandson of state Liberal premier Sir Richard Layton Butler, who held office in the 1920s. He is great-greatgrandson of Sir Richard Butler Sr, another earlier premier.” So this Mark Butler has a long and proud family association with politics even if his forbears came from ‘the other side,’ the Liberal side. Go back to the late sixties, early seventies. Mark and his younger brother were born when his parents were living in the ACT. His Dad, a conscript, had just come back from Vietnam; soon after he came home the boys arrived. Mark’s dad had also been born just after his father returned from the Second World War. Unfortunately Mark’s parent’s marriage collapsed when he was just five. By then the family had moved back to the city of their roots, Adelaide. His mother Lindsay Nicholson told me that she and Mark’s dad still get on really well. “I got married for the first time when I was eighteen, I was engaged at seventeen, and it’s too young, way too young.” Mark attended Unley High, so did the current Prime Minister Julia Gillard. When I enquired at the school, ‘are there any teachers left who taught Mark Butler?’ the answer was ‘no.’
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Initially, it was another dead end at his old union, the LHMU. Nobody wanted to talk about Mark, well not publicly. His biography, available on the federal parliamentary website says: “Mark was elected to the Federal Parliament in 2007 representing the Electorate of Port Adelaide. In 2009, he was appointed Parliamentary Secretary for Health. Before entering parliament he worked in the South Australian Branch of the Liquor, Hospitality and Miscellaneous Union (LHMU). During this period Mark led campaigns in industries including hospitals, cleaning, child care, aged care, the wine industry and hotels.” The biography goes on to say: “Mark served as the youngest ever President of the ALP in South Australia in 1997/1998 and has been a member of the ALP National Executive and Executive Committee since 2000. He holds a First Class Honours Law degree, an Arts degree from Adelaide University and a Masters Degree in International Relations.” So what do we glean from all this? Mark Butler is no mug, not with two degrees, a Masters and eleven years of scrapping in the cut and thrust of pay negotiations and
industrial tribunals as the state secretary of the LHMU. Mark did say in a rare moment of reflection during our interview, that it’s his Mum, Lindsay who more than anyone else is responsible for his decision to enter the union movement, then politics. For her part, Lindsay told me that Mark grew up in a home that was always full of people discussing politics, religion, fairness and how we treat indigenous Australians, just to mention a few topics of interest. “When Mark was three or four I can remember his Grandmother saying to people who asked how old he was ‘Oh three going on forty.’ Mark was a kid who could question what you had said in a way that wasn’t rude. He was a strong minded boy, but also a reasonable one,” said Lindsay. Mark’s mate and fellow SA unionist, David Gray said “I have known Mark since he was twenty and he is ‘a wise young man,’ he is wise beyond his years. He is well travelled, he has lived in Italy and London, and he is fluent in both French and Italian. He is smart, he is a good listener, and he is always good company!” There are hints that reveal a part of the character of Mark Butler, about what it is
that ‘maketh this man,’ but you have to work hard to find them. He is not one for trumpeting his own successes. I’m sure he will be known as a quiet achiever, particularly if he manages to successfully transform the aged care sector. Mark Butler is a man, who according to his mates and his mum, wants everyone to have ‘a fair go,’ that our society should care for those who can’t look after themselves. Take this quote from his maiden speech to federal parliament in 2007. “If there is one thing only that I could do in my time in this place it would be to get a better deal for low-paid workers in Australia.” In the same speech, Mark also referred to his decision not to enter state politics after he had just won the state secretaries job in the LHMU. “At 26 I withdrew my candidacy for a traditional Labor seat in the state parliament to take on the role of Secretary of the LHMU, a decision I have not once regretted. As well as the opportunity to continue to work daily with those workers, I was given the experience of managing a budget of $7 million to $8 million and 60 staff and dealing with employers that ranged from small community based childcare centres to some of the biggest companies operating in this country. To all those South Australians who have been a part of the LHMU in those years, and particularly to the delegates, staff and officials, I say my first thanks. They are noble and brave people. “ Mark went on to say that, “I got to work with some of the hardest working but most poorly rewarded members of our community: cleaners, hospital workers, childcare workers, workers in aged care and disabilities, hospitality and tourism workers and people working in a range of manufacturing sectors.” Everyone I have spoken to about this new Minister tells me he is a good listener. David Gray told me that when Mark won state Labor preselection , then also won the state secretaries job at the LHMU, “ he was advised by many of us that he should not pursue a political career at this stage of his life and should instead concentrate on his time with the LHMU. He listened to all our advice, and then made his own decision, that’s what he does, that’s the way he operates.” The last word on Mark Butler should go to his Mum, Lindsay. “He was never a child you could manipulate, you could discuss things with him and he would form his own opinions. He even said to me once, when we disagreed over a subject, ‘Mum you think what you want to think and I’ll think what I want to think’” By the way if you ever want to curry favour with the Minister and buy him a beer, you would do well to get a Peroni Leggera, a low carb, mid strength beer, that was launched in Australia back in 2009. When he is home, Mark Butler lives in the Adelaide suburb of Woodville Park with his wife and children, and is a keen supporter of what he describes as the best football team in Australia – Port Power. No one is ever right all the time are they? n
profile
The Minister’s First 120 Days By Mike Swinson When you read this article it will be well over 120 days since the new Minister for Mental Health and Ageing; Mark Butler, was appointed by Prime Minister Gillard and sworn into office. Our assessment of his performance only covers his first 120 days.
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o be precise his first 120 days began on 14th September when he was sworn in and ended on the 14th January 2011. Given that the Minister hasn’t made a major gaffe, or put his political foot into his political mouth, then the largely positive assessment of his performance by this small group of people I have talked to is still valid well after the first 120 days! We are of course talking about the Honourable Mark Butler MP, the Gillard appointed Minister for Mental Health and Ageing from South Australia. The small group who I have asked to assess his performance are: • • •
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I think the new minister is doing an excellent job in the ageing component of his portfolio. He has made himself accessible, he is clearly across the issues and continues to show his preparedness to listen and encourage people to work together towards an agreed reform agenda.
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Ian Yates, the Chief Executive of COTA Australia Bryan Dorman, Chairman of ACAA Chris Overland, President of COTA Seniors Voice Inc.
Ian Yates, the Chief Executive of COTA Australia I have known Mark Butler for about 10 years, our paths crossed in South Australia where we both live and work. Mark Butler was the state secretary of the LHMU and I dealt with him on policy matters at a state level in the aged care sector. I always found him to have a good ear, he is intelligent and across the issues that matter. Those characteristics, I’m glad to say, have continued into the job as Federal Minister for Ageing. I sense there is an air of support and encouragement fanning the winds of change emanating from the new Minister and his office. I also know Mark Butler has had an interest in aged care reform for a number of years.
When Mark became a back bencher, I regularly talked to him about the need for aged care reform and thankfully he would listen and was very interested himself. It was over lunch one day in Adelaide when he said to me, ‘any reform will have to be driven by a single industry voice and that vision should come from NACA.’ (National Aged Care Alliances) I think the new minister is doing an excellent job in the ageing component of his portfolio. He has made himself accessible, he is clearly across the issues and continues to show his preparedness to listen and encourage people to work together towards an agreed reform agenda. I think he has articulated that his vision will incorporate most, if not all the recommendations of the Productivity Commission. That’s what we need, an aged care system that provides consumers with more flexibility, more choice, that is sustainable and high quality. Yet I don’t think for one moment that Mark Butler is the sort of bloke who would want to impose his vision on the aged care sector, rather he understands what the role of the Minister is in the reform process that is currently in motion.
Bryan Dorman, Chairman of ACAA I find the new Minister intelligent, articulate, well educated and across the issues of aged care. I am impressed that he doesn’t seem to carry baggage with him from his union days. He is playing it pretty smart in insisting that he only deal with the National Aged Care Alliance that means the aged care sector has to sort out its differences before putting a position to him.
The previous minister had a different Chief of Staff and was into what I call ‘spin.’ This chap and his staff don’t get into that. That is a breath of fresh air in itself. He obviously has the imprimatur for change from his colleagues in cabinet. He plays with a straight bat and our members from South Australia who have dealt with him over the years in the industrial courts say that’s the way he operates. He could be the industries best bet for change for a long time, that’s if politics don’t overtake the agenda. That’s our great fear. I think the recommendations of the draft report from the Productivity Commission are far reaching, are on the right track in terms of a road map for the future. For years I have been pushing both sides of politics to change aged care funding, this report addresses all my areas of concern.
Chris Overland, President of COTA Seniors Voice Inc. SA I can only speak for COTA Seniors Voice in SA; I do not speak for COTA. I know that this minister in his time as LHMU state secretary represented most of the aged care workforce, apart from nurses. I also know that he is a prominent figure in the left wing of the Labor Party. I have had a number of meetings with the new minister now, the most significant of which was at a meeting in Canberra recently of the National Policy Council of COTA, of which I am a member. I have to say that I was impressed by this bloke; he is one smart cookie and is well across the significant issues in the aged care segment of his portfolio. He is unusual in that regard, in that as a new minister he already knows a great deal about it. The other thing
we liked about him was his acknowledgement of areas that he doesn’t know a great deal about and is willing to learn. That is a breath of fresh air. Our overall assessment of this new minister is very favorable and on top of that he seems like he is a nice bloke! He also knows there is a clear need for major reform, and that it’s long overdue. So we are looking forward to him being able to carry out the reform agenda that is on the table. By a strange quirk of fate my grandfather knew Mark Butlers great grandfather, the former Premier of SA. I don’t understand why, but the premier came to our house, even though my father was just a humble copper liner by trade and then premier was a conservative! n
profile
The Aged Care Soccer Tragic By Mike Swinson and Paul Wilkins, with thanks to The Age newspaper. He is a self confessed soccer tragic, he’s a journalist, he obviously loves his sport and he is a marketing and communications manager in a large not for profit aged care organisation.
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ecently The Age newspaper had this to say when Paul and his mate, Andrew Den Elzen decided to whip over to Doha for a weekend of soccer, to watch Australia; almost beat, should have beaten, lose to Japan. “A handful of ultra die-hard local soccer fans are making a mad dash to Doha to cheer Australia on in the Asian Cup final. Paul Wilkins and Andrew Den Elzen are spending more than $2500 each to be in the stadium from 2am on Sunday Melbourne time - when, they hope, the Socceroos rout nemesis Japan. The bulk of that money is the airfare: game tickets cost $10 each. ‘’Yeah, basically we’re mad football supporters,’’ Mr Wilkins said. ‘’It’s pretty out-there but it’ll be fun. I’d love to see the Socceroos win the Asian Cup. I don’t think I’ll ever see them win a World Cup, but this is the next best thing.’’
Meet Paul Wilkins.
Paul finished work on Friday, flew to Doha, got a bit of sleep, went to the game, had a short wake with other disappointed Aussies, then flew home ready for work on Monday. Paul has a degree in journalism with a Masters in marketing and has worked in the not for profit sector for a fair while.
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With Australia making the final and it being their first major tournament final I just felt it was something I couldn’t miss. I guess most Australians would find it crazy, but those who really love the game understand the reasons why
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He is a Communications and Marketing Co-ordinator for Southern Cross Care in Victoria. “It’s a great organisation to be a part of,” says Paul. “It’s much easier to communicate our services to prospective clients than it would be to try and flog muesli bars or corn flakes. I love it. It’s also great to know that what I do makes a difference in people’s lives.” It’s interesting when you ask people like Paul, why they do what they do, and discover that there are many people in this world who want to ‘make a difference.’ It’s not an old fashioned, out of date cliché, certainly not in Paul’s case.
Paul is a journalist, so it’s no surprise that he likes to write and what better topic than his favourite pastime soccer. So, over to you Paul. “I’m 28, single, and I still live with my parents. Most of my friends are either married, have kids, or have a mortgage. What do I have to show for my 20s? Well, I’ve been to two World Cups, have travelled to London to watch the Socceroos take on England and ventured to Japan to a World Cup qualifier. Ten years ago, the football bug bit me. I might not have a house, a wife, children nor even a girlfriend - but I have a lifetime of priceless memories. It is hard describing the experience of a World Cup to someone who hasn’t been there. But there is more to it than just a month-long party. At my first FIFA World Cup, (Germany, 2006) the locals absolutely loved Australian fans. Hosting the FIFA World Cup brings a sense of intense national pride. People can make friends with strangers. Travelling to South Africa provided yet more unforgettable experiences. The FIFA World Cup has tremendous healing powers for a nation; it can change a whole nation’s psyche. The most memorable part of a FIFA World Cup is the chance to interact with people from all over the globe. Australia would be no different. Paul confessed to me when I said I had a son-in-law who loves to follow the Tourde-France that he would like to do that too. More overseas travel coming! On ‘that’ game, said Paul, “we should have won; we had lots of opportunities, lots of scoring shots that just missed. Japan scored with the only opportunity they got all day. Well that’s life!”
”I almost missed my plane home because we got locked in the stadium after the game. They had a fireworks display organised and no-one was allowed out. It was a mad dash to the airport but we made it. I was back at work Monday morning,” said Paul. Paul told The Age that, ‘’With Australia making the final and it being their first major tournament final I just felt it was something I couldn’t miss. I guess most Australians would find it crazy, but those who really love the game understand the reasons why.’’ Just in case you think this might be a great idea, let me give you details of Paul’s itinerary. Left Melbourne at 11.00pm on Friday night, flying direct to Doha. Arrive 7.00am, and spend the day in Doha. Head to the game that night, and then as soon as they got out of the stadium it was back to the airport to catch a flight home at a little after midnight. Home by 10.00pm Sunday, get some sleep, then back to work beady eyed and bushy tailed on Monday! n
technology
ACIVA – Active Industry Engagement W • • •
ith a passionate interest in advancing the eHealth agenda ACIVA members spent their Christmas and New Year holiday period involved in:
discussions about context and challenges reviewing processes and identifying the risks associated with the national eHealth agenda.
With membership spanning all states and territories ACIVA, the sector based Association, is made up of Clinical (including medication management), Financial and Quality Management software vendors and Infrastructure vendors. ACIVA membership supplies both the Residential Aged Care, Community Care sectors and covers 90% by market share of the sectors’ Clinical Software Vendors. Chris Gray CEO iCare (ACIVA-Treasurer) said “It’s about an industry lead but vendor agnostic point of view to ensure better deliver and implementation of the eHealth agenda for the sector.” As such ACIVA’s reach and areas of involvement are significant. Therefore the active engagement of ACIVA members and collaboration on national eHealth, Compliance, Conformance and Accreditation initiatives is a key part to jointly advance common IT causes for the Aged Care industry. And active engagement it has been, recent activities ACIVA members have been involved in have included: • • • •
HI (Health Identifiers) Conformance, Schema requirements, assessment and test cases Support for Aged Care Industry Information Technology Council (ACIITC), electronic medical management initiative A series of briefings and workshops (medication management, eHealth general practice clinical desktop, NEHTA updates) Engagement in NEHTA’s test interest group for Compliance, Conformance and Accreditation (CCA) testing.
View
Aged Care Australia online!
• •
Provision of feedback on eHealth Authority CCA materials Working to ensure that issues such as sustainability, scalability, interoperability, open standards, reduction of barriers to entry and mitigation of risks are taken into account.
Caroline Lee – CEO LeeCare (ACIVA President) said “ACIVA members have committed significant voluntary time and resources to cooperatively work on multiple initiatives. Specifically we recognise the value of national deployment of E-Health in Aged Care. As such we (the group and it’s membership) will leverage and support other available national resources to bring the E-Health Agenda to a timely implementation.” ACIVA is the premier association for technology vendors to aged care, community care and acute hospital industries. For membership inquiries please email info@aciva.org.au, or president@aciva.org.au n
Visit www.adbourne.com and click on ‘Aged Care Australia’
technology
Solution Leaders in Aged and Community Care Unite In a joint initiative announced recently between Leecare Solutions and EOS Technologies (Silver Chain), Platinum 5.0 and ComCare will be integrated to provide a complete client and clinical management solution across both Residential and Community Care services for organisations across Australia and New Zealand.
“W
e are pleased to be working with Leecare, one of Australia’s great Aged Care technology companies, to deliver the best possible solution to organisations across Australia and New Zealand,” says Greg Russell, CEO of EOS Technologies (Silver Chain). “Leecare has seen great success in selling its Aged Care residential software, and we are excited to work with Leecare solutions as a key technology partner to provide an integrated solution across both aged residential and community care organisations.” EOS Technologies (Silver Chain), has developed their solution over 25 years of consultation with the Community Care Industry and will provide their awardwinning Community Care solution, ComCare, to all Aged and Community Care organisations across Australia, at an affordable price. Leecare Solutions, industry pioneers and winner of the 2010 Information Technology in Aged Care (ITAC) Best Implementation Of The Year Award, is providing the first and only aged care software specifically designed from the ground floor up to utilize advanced touch screen interface devices like the Apple iPad. Dr. Caroline Lee, CEO of Leecare solutions says, “With the integration of Platinum 5.0 and ComCare, we now have the best technologies in the industry conjoined to fully support mobile clinicians in their effort to support older persons along their journey of care, from home to residential aged care.” Leecare Solutions and EOS Technologies (Silver Chain) will commence development in early 2011 to provide an integrated solution that will capture healthcare information to ensure the provision of quality services to all residents and clients with the purpose of improving provider productivity, reducing costs and supporting a complete care management solution. n
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About Leecare Solutions Leecare Solutions are the pioneers and industry leader of affordable clinical care and lifestyle software for aged care. Leecare Solutions offers the most comprehensive and professional clinical care and management program in the industry which is the only system to address all 4 Aged Care Accreditation Standards. Leecare partners with best of breed suppliers to provide our clients with the most up to date and current choices in the marketplace, and we also work in partnership with our clients to provide specialised expert support at a personal level. For further information, see the Leecare Solutions website www.leecare.com.au or contact Greg Beasley, Sales & Marketing Manager, on 0421 942 778. About EOS Technologies (Silver Chain) EOS Technologies (Silver Chain) is a social enterprise, providing the Award winning Community Care solution, ComCare. As Silver Chain is one of the largest Community Care Organisations in the Australian and New Zealand marketplace, we partner with our customers to consult, design, build, operate and support business solutions. From strategic consulting to application solutions and services, we have earned a reputation as a best of breed supplier of Community Care solutions that work. For more information, please see: the EOS Technologies website www.esotech. com.au or contact Emma Pate, Sales & Marketing Manager on 0419 286 572. Who, What, Why, Why, Where), as well as “How”.
workforce
Attracting and Keeping Staff in Aged Care Facilities By Mike Swinson When you read stories in the papers that focus on attracting and keeping young staff in aged care facilities, the tone of the articles is almost without exception a negative one.
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ake this recent story from the Tasmanian based Murdoch owned newspaper, The Sunday Tasmanian.
The first line reads, “The aged care industry is battling to attract a sufficient number of nurses in Tasmania.” That’s true, but then the journalist goes straight to the Nursing Federation branch secretary Neroli Ellis for a partisan point of view. “The problem is we’re not attracting younger nurses into this sector because of the workload, and because of the huge responsibility of running whole nursing teams and also because the wages don’t stack up.’’ Buried in the middle of the article is a quote from Carolyn Wallace, the Director of Clinical Care at Southern Cross Care, the biggest aged care provider in the state Carolyn said “we are working hard to entice nurse graduates into the sector; we are trying to influence the decisions of students studying nursing. We have established a sponsorship with UTAS, we encourage active participation with students and we offer clinical placements in aged care.”
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Does the story explore this initiative, NO! It goes back to Neroli Ellis to paint a bleak picture of the sector and its employment prospects and an unnamed aged care nurse who backs the union point of view, “we are underpaid and overworked.” “The fact is that, across the state, nurses believe that they’re really in a crisis situation, often with one registered nurse after hours caring for 100 residents,” said Ms Ellis. How about that! Yet the story originated from Carolyn Wallace at Southern Cross Care who contacted the journalist about the possibility of doing a story on its connection with the University of Tasmania and how it might help in the search for new and younger staff. So much for that good idea! Lesson: Never think a media outlet of any shape or size, is going to print anything positive, when they can easily throw a negative slant on it. Conflict sells papers! So just what is Southern Cross Care doing about attracting more staff? I talk to Carolyn Wallace. How do small aged care providers attract staff? I talk to the CEO of Cedar Place in Kempsey, on the North Coast of NSW. Carolyn Wallace from Southern Cross Care in Tasmania Southern Cross Care (Tas.) Inc. is a not for profit organisation and is Tasmania’s leading Aged Care provider. It’s also one of the State’s largest employers with up to 850 full and part time employees. Facilities are scattered across the state and the organisation is proud of the fact that they have just achieved current three year Accreditation status. Our average workforce age is just over 40 and most are female and yet when I talk to other aged care people, I discover that we employ a lot more men than most. Our workforce is around 850, full and part time.
There are still some employers who haven’t moved with the times and changed the way their staff work. We no longer ‘deliver service’ to our clients, we work with them and for them and to us it doesn’t matter if the staff member is male or female and it doesn’t worry our clients either. We have had a relationship with UTAS for the past ten years, because that is where our nurses of the future will come from. The people who teach nursing don’t know a lot about our sector, so we see it as our responsibility to change that. So we have students who do placements with us, where I talk to them about the ‘art of nursing’, instead of the science of nursing. In aged care, nurses do not have doctors and allied health professionals giving them directions, they are far more independent. They need both the science of nursing and the art of nursing, to be able to communicate effectively. That’s how I try to make nursing in aged care more attractive. We do get a number of nurse undergraduates who do placements here and then a few will also work here as carer’s while they are finishing their degree. We are seeing a slight increase in the number of younger nurses we can employ, but we would like more. We are up against what seems like the glamour jobs for new nurses of working in acute care or accident and emergency. They soon find out that work can be really exhausting and draining, but by then they seem to stay in the hospital sector. During the nursing academic year we might have up to ten undergraduates spending time with us. At best we are keeping two or three a year. Some will come back after four years away. I think it’s critical that during their training years they do spend time in an aged care facility so they can relate and compare. We participate in every research project that the university runs where we can. One of our
new young nurses, Roseanne Mudge says she decided on a career in aged care nursing because of the relationships she has formed with elderly residents. She says she finds the work very satisfying. Mary Henry, CEO, Cedar Place, Kempsey We have been working very closely with local schools and TAFE. We are a small facility and almost all our people work part time. We work closely with school based training organisations and assist with those kids who want to do Certificate 3 in aged care as part of their year 11 studies. Last year we had three students who trained and are now capable of working on the floor, even though they are still working towards their certificate 3. This year I am starting two students doing Certificate 3 and two doing hospitality. I run a very flexible workforce program, I try and give time off to those who need it
and flexible work hours. I also support staff who want to do nursing degrees as remote students. I encourage those who I feel are capable, and interested enough in developing their career wherever I can. They apply for scholarships through the college of nursing in NSW. I have two doing their fourth year, both in their fifties and two starting year one this year. One of the first year students is a young man, not yet thirty, married, with kids who used to deliver water bottles to our facility. He used to talk to me about wanting to do better in life, so he started working here until he went full time, now he is enrolled as a first year nursing student. We have a very low turnover rate here, we do an annual staff survey and try to be a very employee friendly place to work. If we weren’t flexible we wouldn’t be able to keep or attract new staff. n
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There are still some employers who haven’t moved with the times and changed the way their staff work. We no longer ‘deliver service’ to our clients, we work with them and for them
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workforce
Give Your Employees Hundreds of Extra Dollars Every Year For The Effective Cost Of One Extra Cent Per Hour !
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here is a lot of discussion in the industry at the moment about pay equality with similar industries. As we all know, there is no money tree in the backyard… let’s face it…the pit is not bottomless. The ability to be able to give your employees more without a major ongoing financial outlay is definitely appealing. How about an option that effectively costs you the equivalent of a pay rise of only one cent per hour! The ACAA Employee Benefits Program is a cost-effective way of giving a valuable bonus to your employees for very little outlay…. only $24.90 per annum, per employee…and that includes GST! The Program is strongly branded, with your organisation’s logo on the Card & Website. We also provide full implementation support to reinforce the message that your organisation is a caring employer. So…how much can the average family of three save in a year by using the Program? Food & Fuel Insurance Entertainment
$ 910 $ 720 $ 300
Health Insurance Movie Tickets Clothing Holidays Household Items Car Servicing
$ $ $ $ $ $
280 270 200 140 100 77
$ 2,997
With over 11,000 retailers offering discounts and in excess of 30,000 household products online, there is something in the Program for everyone. To make it more valuable to your employees, and hence your organisation, we have also made the Card usable by family members. I often meet resistance from organisations to implement an organisational funded Program, with the perception that “We don’t think our employees would use the Card”. I don’t know any Aged Care employee that could afford to pass up hundreds of dollars in savings annually, let alone thousands. We also off a Hybrid Program, that allows you to fund the Program for full time and part time employees (for example), and offer the Program on an Opt-In basis for casual
employees, who contribute to the Program themselves. This option still allows us to offer full implementation support. From experience of this type of Program, we are finding that 85% of employees that attend information sessions do perceive the value and purchase a Card on the spot. At the equivalent cost of a 1 cent / hour pay rise, the ACAA Employee Benefits Program is a fantastic opportunity to offer a substantial benefit to your employees at a minimal cost. Whilst each website is co-branded with your organisation’s logo and welcome message, our generic website can be viewed using the following login details: www.presidentialcard.com.au/acaa LOGIN: ACAA00000 PASSWORD: ACAA For full details, please contact me personally. Brad King Manager Business Development Presidential Card 0413 839999 BKing@PresidentialCard.com.au
Industry Feedback Good News Stories ACAA’s exciting section allowing you, our readers, to share ‘Good News’ feedback letters from clients,
roads to country, the off street parking and well developed grounds. I called it a dress circle location in Adelaide as it is near to many of our most prestigious and highly regarded locales.
happy staff emails, anything to do
May Ridge Park continue and extend these find traditions into the future to the great benefit of South Australia.
with the business of caring for frail
With sincere gratitude and best regards from
and older Australians. Following are 2 more examples of
Nola McCallum (on behalf of the late Mr Eric Minge, Ridge Park Resident 2009)
the positive feedback received: To all the fabulous staff at Regis Shelton Manor, Dear Mr and Mrs Padman, Thank you for providing the wonderful Nursing Home Ridge Park at Myrtle Bank. Our loved one was indeed fortunate to move from the country into Ridge Park. Particular qualities that impressed were the private nature of the home and the greater freedom of choice that brings in care choices, the sensitive and competent manager Mille, the beautiful heritage and historical setting and ambiance of the building, the location of it near to city and to major
I wish to thank you so very much for the fantastic care you gave Keith before he passed away. Keith was so very happy at Regis, he was extremely well looked after and he was very aware of how much the staff care for him. Myself and my family just can’t thank you enough for all the wonderful attention you gave us each time we visited and especially on the day of Keith’s passing – you were all so fantastic with your offers of refreshments and of course support during this time. Our entire experience with the staff at Regis has been nothing short of excellent. You have all been more than
happy to help in any way you could. Information on any aspect of care was supplied without delay, attention to Keith’s needs was always a priority and the friendly conversations and interactions made visits to Regis a comfortable and pleasant experience. Special thanks go to: Ryan, Pat and Brenda for attending Keith’s funeral and for the lovely speech and poem, and also to Dette, Gurmit, Kerry, Louise, Carol, Anne, Tracey, Margaret, Suda and Sue for all their care, help and support. Please forgive me if I have forgotten anyone, but you were all so wonderful it was hard to remember everyone. People say that all the Angels are in heaven, but they obviously haven’t met the staff at Regis Shelton Manor… Once again a very big THANK YOU from the bottom of my heart! With love from Judy Granger And on behalf of Joan, Warren, Carol and families
ACAA encourages anyone who works in the industry to submit their positive feedback received from clients and their relatives for publication in future editions of Aged Care Australia. Submissions can be emailed to editor@agedcareassociation.com.au
sponsors
Energy Contract Discount Offer (ACAA Preferred Supplier) EnergyAction is the largest energy brokerage in Australia and have been chosen as the Preferred Supplier to all the ACAA members and affiliates for Energy
and potential refunds including analysing the Network Tariffs for $ savings. The good news is that our fee of 1.5% is paid to EnergyAction by the successful retailer and your application and administration fee has now been reduced to only $450.00.
lthough your electricity contract maybe a period away from expiration, we secure more attractive rates NOW than you could at a later date.
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Energy Action began trading in 2000 and since 2005, we have conducted more than 4000 online energy auctions, with a combined value in excess of $5 billion whilst during 09/10 we conducted over 1200 online energy auctions and presently negotiate over $35,000,000 of contracts per month.
We are also confident that there will be a substantial rate increase over the next few months (see Futures Forecast below).
We are receiving in February 2011, Victorian rates of 5.0c kWh for Peak and 2.5c kWh for Off peak, through our auction platform.
Energy Action is an Auction House that trades contracts “on-line” through a reverse auction platform. We invite all energy retailers (AGL, Origin, TRUenergy, Energy Australia, etc) to bid against each other over a 10 minute transparent window, viewed by the client, to win the lowest price for your current or future electricity contracts.
Our starting point is to determine if you are a large enough energy consumer to qualify as a “contestable” contract (ie: to auction) or either fall under the category of “General Supply” whereby we obtain you up to 15% discount with the published Government regulated retailer rates.
Contract procurement.
Simply put, Energy Retailers compete on the auction platform to win your business and it purely comes down to which Energy Retailer can provide the best price. Furthermore, it is an open and transparent system with no hidden agendas, designed to save you time, effort and money. EnergyAction also monitors daily meterage demands, consumption, errors, anomalies
Initially, all we require is a copy of a recent electricity bill from all sites (front and rear sides of 1st page) and if you qualify as a “contestable” customer, then we require you to complete an LOA and RA forms (I will advise if these forms are required).
Peter Naylor EnergyAction Pty Ltd 17-33 Milton Parade Malvern Victoria 3144 Ph: 03 9832 0855 Fax: 03 8677 9633 Mbl: 0415 103707 Email: peternaylor@energyaction.com.au Web: www.energyaction.com.au
Futures Forecast It is very hard to forecast the future of electricity pricing as it is a volatile commodity. There is now a change of government and the imminent re scheduling of Carbon emissions trading. However I have copied a graph below with forecasted pricing until Q2 2014. In summary it shows pricing getting steadily dearer with a few peaks in periods of peak demand, historically this is in summer. At the moment pricing is very low due to the inclusion of new Queensland generation, the postponement of the Carbon Trading Scheme and the mild weather on the Eastern seaboard. Average pricing in Peak and Off peak rates at the present time is: NSW VIC QLD SA
7.3 6.1 5.1 7.8
3.1 2.4 2.0 3.3
Please realise that all pricing is site specific and these rates are the average. n
Required documentation is to be faxed through to (03) 8677 9633 addressed to Peter Naylor or contact direct for further information.
Figure 1 d-CyphaTrade regional quarterly base futures prices The side axis shows electricity wholesale pricing per MWH… this can be divided by 10 to show rates in cents. The price is also an average between peak and o/peak, therefore peak of 6c and o/peak of 2c equates to 4 cents per KWH or $40 $/MWH
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The PC’s draft report – the devil is in the detail Julie McStay and Julie Hough
Hynes Lawyers
Aged Care Association Australia, Hynes Lawyers and PKF Chartered Accountants and Business Advisors have been working together to assist ACAA to develop a formal response on behalf of the aged care industry to the Productivity Commission’s (PC) draft recommendations. To develop this response ACAA, Hynes and PKF (together with ACQ, ACAA-NSW and ACCV) held a series of forums across the eastern seaboard to gather the industry’s views on the PC’s draft recommendations.
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early 300 providers and industry stakeholders attended the forums. Providers seem generally supportive of most of the concepts proposed, but there remains a level of uncertainty about a number of elements of the proposed reforms and how they will interact. In this article Julie McStay (Partner Hynes Lawyers) and Julie Hough (Partner PKF) have set out the principal concerns identified by attendees.
Funding At a global level the financial and funding recommendations of the PC seek to reengineer the aged care system in to a continuous supply of consumer directed
care. The underlying economic approach is to change the status quo from a supply restricted regime to a demand driven system dictated by the number of senior Australians who are eligible to receive care, whether in the community or in residential care. The draft recommendations provide that the entitlement to care would be granted in a voucher-style arrangement which accumulates in a building block approach to meet an individual’s increasing need and frailty. The reform package is intended to be delivered over the next 2-5 years. Summary of funding recommendations We have prepared a summary of the key funding recommendations proposed in the PC’s draft recommendations which include: • Funding of aged care should be in accordance with the following principles: > accommodation and everyday living expenses should be the responsibility of individuals, with a safety net for those of limited means; > health services should attract a universal subsidy, consistent with Australia’s public health care funding policies; > individuals should contribute to the cost of their personal care according to their capacity to pay, but should not be exposed to catastrophic costs of care. • Removing the regulatory restriction on the number of community care places and residential bed licences over a 5 year period. • Removing the distinction between high care and low care places. • Adopting separate policy settings for the following major cost components of aged care: > care (both personal and health); > everyday living expenses; and > accommodation.
• Removing the regulatory restrictions on accommodation payments, uncapping the accommodation charge, and abolishing retentions on accommodation bonds. • Introducing a system which provides care recipients with flexibility for payment of their accommodation payments. The draft recommendations provide for the establishment of two financial products to support care recipients: > An Australian Pensioners Bond scheme to allow aged pensioners to contribute proceeds from the sale of their primary residence. The bond is exempt from the assets test and income deeming rate, and can be drawn on to fund living expenses and care costs. > A Home Equity release scheme to assist older Australians meet their aged care costs, whilst retaining their primary residence. This scheme allows withdrawals of funds to an agreed limit with repayment when the underlying property is sold. • Removing the restrictions on additional services and discontinuance of extra service bed licences so that each care recipient may access additional services according to their ability to pay. • Introducing a prescribed scale of cocontributions for care which would be consistently applied across all settings anticipated to be between 5% and 25% of the cost of care. • Providing that accommodation payments will be determined by a comprehensive means test based on income and assets, including the family home. • Introducing the following protections for care recipients: > quotas for concessional residents to be maintained at current levels, but subject to being tradable within regions for up to 2 years and to a tender process at the 5 year timeframe;
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sponsors
The PC’s draft report – the devil is in the detail (continued)
Providers also indicated that clarification is needed from the PC on the following topics:
• a community ACFI with supplements and supports for specific needs; and
• a better definition of the expected cost of supply models underpinning the accommodation, daily living and care policy settings;
• the existing residential ACFI with its supplements.
> introducing a level of accommodation support for concessional residents that will be equivalent to a shared room with shared facilities; and
• a rationale for setting the suggested benchmark for supported residential care at a 2 share room with shared facilities; and
> introducing a lifetime stop loss limit for care recipients who incur catastrophic costs of care.
• the intended structure of the new funding instrument needed to underpin the concept of continuous care delivered across all settings.
Provider Reaction While providers welcomed the potential for increased user pays recurrent funding, there was far less certainty surrounding the capital funding recommendations. In all of the 3 forums held along the eastern seaboard, providers raised concerns regarding the perceived disincentives for consumers to pay lump sum accommodation bonds in favour of periodic payments for their accommodation. This effect is brought about by the operation of the proposed Pensioner Bond scheme, which is intended to exclude the proceeds of sale of the family home in calculating pension entitlements, yet be flexibly structured towards periodic draw downs, indexed to the CPI and government guaranteed. Providers saw little scope for the Pensioner Bond scheme to be limited to the deposit of only excess funds after the payment of an accommodation bond, particularly as consumers have the choice of lump sum or periodic payment, or a combination of both. This implication, coupled with downward pressure on the average size of accommodation bonds raised significant doubt amongst providers that the PC’s recommendations would deliver the large scale capital funding boost needed by the sector. Providers perceived that bank borrowing arrangements for construction debt is likely to be considered a higher risk by lenders, notwithstanding lump sum bonds would be available on all residential aged care places. Indeed some providers acknowledged that in striving to reach a balance between bank debt repayments and sufficient lump sum resident funding, there may be a need to discount bonds in a deregulated market place.
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Regulatory scheme The PC proposes that within 2 – 5 years the Australian Seniors Gateway Agency (Gateway Agency) will be established as a statutory authority independent of the Department of Health and Ageing (DoHA). The Gateway Agency will operate as a “one stop aged care shop” to provide information, assessments, care coordination and care referral services. The Gateway Agency is proposed to be administered by a system of regional hubs. These hubs would be operated by the Gateway Agency or could be operated on a contract basis by government or non government agencies. Summary of regulatory scheme recommendations The PC has recommended that a “building block approach” be used to determine entitlement levels across community and residential care. A new assessment instrument, the “Aged Care Needs Assessment Instrument”, is proposed to identify care and support needs and will be linked to the Government’s set of schedule fees. This assessment is intended to replace: • assessments for low level care currently undertaken by providers funded under HACC; • ACAT assessments; and
To separate the policy arm of Government from the regulation and supervision of aged care, the PC has also recommended the establishment of the Australian Aged Care Regulation Commission (AACRC). The AACRC will be independent of DoHA. Its key functions will include: • a compliance and enforcement arm to regulate quality and investigate noncompliance across all types of aged care to be administered by the Aged Care Standards and Accreditation Agency (ACSAA); • a pricing arm to monitor prices charged to consumers, the costs of care and advise Government on prices, subsidies and the rate of indexation; • a complaints handling and review arm which will assume the role currently undertaken by the CIS; and • a data collection and dissemination arm. Provider Reaction While providers acknowledge the efficiency and consistency issues within the current system, they expressed a general reluctance to endorse the concepts proposed without clarification of a number of issues. In relation to the Gateway Agency further clarity will be sought in relation to: • the proposed interaction with the existing GP network; • the proposed operators of the regional hubs and the multi disciplinary teams and if those services are to be contracted out how potential conflict issues will be addressed; • the extent to which any new assessment introduced will adopt current ACFI processes;
• initial ACFI assessments undertaken by providers for people entering residential care.
• whether assessments conducted by the Gateway Agency will be as comprehensive as initial ACFI assessments currently undertaken by providers;
The PC has considered a number of models for the new funding instrument but appears to favor a combination of:
• the mechanisms that will be available to providers to challenge assessments undertaken by Gateway Agency;
• how consistency will be achieved in the quality of assessments conducted across the regional hubs; • the proposed role of the regional hubs in case management services; and • the proposed accountability measures for the Gateway Agency and regional hubs including prescribed time lines to undertake assessments. In relation to the AACRC, further clarity will be sought in relation to: • the methods proposed to be adopted to address issues of quality and transparency that currently exist within the ACSAA; • whether it is proposed that a risk based approach to compliance and enforcement be adopted within the AACRC; • the proposed enforcement tools; and • the proposed policy in relation to audits, support contacts and unannounced visits.
Moving forward Written submissions are due in response to the PC’s draft report by 21 March 2011. While the concepts seem very promising, the devil will be in the detail. n
editorial
ACAA Endorsed “National electronic Resident Agreement” (NeRA) Achieves Resounding Positive Response from Industry The National electronic Resident Agreement (NeRA) application is a joint ACAA/ ACSA initiative supporting the first national approach to resident agreements. Since the launch of the software at the ACAA Congress in Adelaide late last year, the developer e-Tools Software Solutions and both the Associations are pleased to report an overwhelmingly positive response from the industry.
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NeRA automatically updates government data and the latest legal templates in relation to resident admission. This reduces the burden on providers to maintain accurate agreements and minimizes errors made in generating agreements.
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he National electronic Resident Agreement (NeRA) application represents a significant step towards a shared vision and collaborative outcome to address compliance and viability in the aged care industry. NeRA aims to assist providers with a mandatory function of accountability – currency of agreements. The Associations recognize the advantages of having a nationwide industry standard for resident agreements, rather than individually maintained documentation. The Associations have taken on the responsibility of monitoring legislative changes and maintaining the agreements via NeRA. NeRA automatically updates government data and the latest legal templates in relation to resident admission. This reduces the burden on providers to maintain accurate agreements and minimizes errors made in generating agreements. It has been great to see so many Association members taking an interest in industry initiatives and supporting a positive national approach to resident agreements. The uptake of the program has been significant, with over 700 sites nationwide now using the software. Many providers have commented on the ease of creating and managing agreements, and the additional security of knowing that the agreements are current and accurate. Furthermore, the national standard embodied in the NeRA program is constantly being reviewed and revised based on feedback from providers. As part of a dynamic approach to both the content of the agreements and the development of the program, aged care software developer e-Tools is pleased to support the Associations by taking on board provider feedback and working with the Associations to ensure a current national approach that reflects the industry’s interests.
This initiative is a first in collaborative information-sharing nationally and across sectors. The result is beneficial to providers as they contribute to the development of industry standards, and sets a pathway for more common areas of interest to be developed. Save costs, focus your attention on other issues and let your Association cover your back on the compliance matters they can orchestrate nationally. e-Tools is your Associations’ partner and supports the Associations’ initiative to be responsive to members’ needs. Visit www.e-tools.com.au or phone e-Tools on 03 9571 8611 for further information about this cost effective compliance solution. n
The Challenge of ‘Stealing’ By Jane Verity When a person with dementia ‘takes’ other people’s belongings they may firmly believe the items are their own. If you encounter this situation, it is important to remember that the person with dementia is not stealing. Accusing them of stealing is likely to result in an irritated, angry, or even aggressive reaction.
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hen the social inhibitions that normally regulate responses lift in people with dementia, learned rules and beliefs about what is socially acceptable disappear. When the person with dementia is attracted to an object they will instantly pick it up, put it on or keep it believing it is theirs. When a person with dementia experiences that their identity and role in life is lost, they compensate for those losses by looking to the external world. They may be attracted to jewellery, shiny, glittering objects, or clothes that are either colourful, familiar or have a special smell. The possibilities are endless because each person will have their own unique, individual preference. Their ‘treasures’ help them feel complete. Spark of Life Solutions Go with the Flow! Ensure that everyone has a relaxed and respectful attitude towards the person acquiring objects from other people. When you accept this behaviour, you are likely to go with the flow of the experience rather than judge and reprimand or try to take the item away from the person. This kind of response will only result in creating anger and challenging behaviour. Remember, you cannot change the behaviour of a person with dementia; you can only change your own attitude towards that behaviour.
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When a person with dementia experiences that their identity and role in life is lost, they compensate for those losses by looking to the external world
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Forewarned is Forearmed. When a resident moves into their new home in a facility, encourage family members to label every single item of the resident’s belongings. Even the smallest trinket needs identification as these are at the top of the list of attractive items. Gently explain that people with dementia may become attracted to the belongings
of other residents and often bring these items into their own room. Explain that their relative may one day also display this behaviour. Labelling every item will enable the return of each object to its rightful owner. Treasure Troves Set aside a special area – it might be a corner of a room, table, chair, or a large basket – and fill it with objects and items that will appeal to the person with dementia. You can go to the opportunity shop and set up a tremendously abundant treasure trove with very little money. People with dementia can then freely choose any object that is attractive to them. You can amplify the experience in a positive way and comment on their find. ‘Wow, what a magnificent item. Was that a present from someone?’ This interaction will allow the person to express their free flowing creativity. Remember that whatever they say is right! Every interaction with the person who has dementia is an opportunity to make that person feel special, to boost their self-esteem and lift their spirit. Each carer holds the power to success or failure in dealing with challenging behaviour and is responsible for making every situation a positive experience. Exceptional attitude is the secret to successfully engaging with people who have dementia. For more information on the Spark of Life Approach, visit our website www.dementiacareaustralia.com n
Jane Verity Founder of Spark of Life Dementia Care Australia © 2011 www.dementiacareaustralia.com
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editorial
Is More Choice Better and Will All Buildings Look the Same? Dwayne Nielsen
CEO & Director, Merrin and Cranston P/L
One thing that hasn’t changed over the last 30 years in caring for the ageing, is that everybody wants choice.
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o one likes to admit that they are getting older or can’t look after themselves, so when it comes to choosing where we want to live in our “retiring lifestyle”, certainly not in our “old age”, we want choices. Choices empower us when, in general, we are slowly losing control in many areas of our lives. Can I stay in my own home? Can we have independent living but in a more secure environment? Can we have communal facilities? Can I get more care if I need it? Can you look after me no matter what?
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So, thinking that there is one solution that fits all is probably a bit utopian. We need to be careful that what worked for us in one particular location is translatable to another.
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But how do we as providers and designers respond to this? Is there a one shoe fits all? Is there a simple formula that easily allows us to calculate the best outcome? In short, no… Whilst we can run different staffing models and operational parameters and different accommodation types, at the end of the day there are 2 major influences. One is legislation, and at this point in time, it tends to deliver very similar building types, because our funding streams are not flexible enough to cope with where the market is headed, which if we go full circle, is choice. So our second but really important driver is individual choice. So that makes it easy, we pull out some generational norms, make some assumptions about what the mass market will want and start planting building stock on the ground and we can’t lose? Right? Ah…no. When was the last time you put more than one person in a room and got them to agree on everything? Never…correct. This is especially the case when dealing with someone’s personal living environment. We as individuals, don’t necessarily agree on too much at all, that is the great part about being individuals, but this does make life complicated for providers and designers. We as individuals are influenced by so many factors. Where we grew up, what part of society we were in, what our friends liked or didn’t, how successful have we become and on and on and on… So, thinking that there is one solution that fits all is probably a bit utopian. We need to be careful that what worked for us in one particular location is translatable to another. What works in inner Sydney, probably won’t work in outer Sydney and may not work in Brisbane. What works in Brisbane, may not be acceptable in a less urban environment. So where does that leave us designers and providers? Be careful, plan specifically for each project. Study the market and the competition for sure, but understand what has been done and why and don’t just assume that because it has been done before it will work again. Then again, it might, that is the really tricky thing about individual choice… n
NAB Health survey of ACAA Congress 2010 Delegates Matina Karvounaris
NAB Health general manager
At the recent Aged Care Association Australia Congress, National Australia Bank’s specialised banking division, NAB Health, took the opportunity to survey over 100 CEOs, CFOs and senior managers.
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he survey results showed that in the next three years, around half (56 per cent) of operators plan to grow sales organically, whereas 15 per cent will look to merge or acquire and 12 per cent will seek a partnership or joint venture to drive growth. Interestingly, none expect business activity to contract which is an optimistic endorsement
on the growth and investment opportunities of the aged care sector – a view supported by NAB Health. Results also showed that by bed size, operators with 500 plus beds are almost twice (22%) as likely to merge with or acquire another organisation compared to sub-500 bed operators (13%) who will look for growth through organic sales. Age care facilities play an important role in the community. As an investment class, they enjoy lower-risk cashflow with government sourced income streams and the potential for strong capital appreciation.
While this forecast population growth will pose significant implications for government in terms of budgets and health costs, it presents an attractive opportunity for healthcare businesses such as aged care and businesses delivering primary care. Regarding key concerns over the next 12 months, 65 per cent of respondents feel that government regulation tops this list. With much of the industry subject to government influence, especially through the Aged Care Funding Instrument, it’s understandable that this issue was top of mind.
The economic and demographic fundamentals, in particular, Australia’s growing and ageing population, make aged care an attractive sector to invest in.
Like others in the industry, NAB Health is eagerly awaiting the draft of the Productivity Commission Report, Caring for Older Australians, and will be working closely with organisations looking to take up any opportunities that may arise.
The Federal Treasury’s Intergenerational Report projected that Australia’s population would grow from 22 million to 36 million over the next 40 years, and those aged over 65 years would increase from 13.5 per cent to 23 per cent of the population by 2050.
It was pleasing to see such strong attendance from such a varied group of industry specialists including aged care operators and suppliers. The industry certainly appears to be in a strong position and well positioned for future growth. n
About NAB Health NAB Health is part of National Australia Bank’s Business Banking division. With over 300 specialist healthcare bankers, it services public and private hospitals, aged care providers, pharmacies, GPs, specialist medical service providers, dentists, pathologists, optometrists, physiotherapists, chiropractors, community health services, veterinarians and medical researchers. It offers a full suite of products and financial services specifically tailored for the healthcare sector and its sub-segments, covering deposits, lending, wealth management, equipment leasing and EFTPOS transactions for medical businesses. NAB Health incorporates NAB’s specialist healthcare brands Medfin and HICAPS. For further information on NAB Health visit www.nab.com.au/health.
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Is That All There Is? Space and Place for Australians in Late Age Space and place Most of us would accept that, regardless of whether the need for treatment and specialised care is present, people have opinions as to where and how they would like to spend their time. Sometimes these preferences can override decisions about seeking care and treatment if it means having to visit or stay in an environment that they dislike.
Professor Tracey Mr Bill Turner, Professor McDonald , RN, PhD. RSL LifeCare McDonaldTracey , RN, PhD. DFC, B.Arch (USyd)
ChairLifeCare of Ageing, Australian Catholic University (ACU) RSL Chair of 1954 (Retired) Ageing, Mr BillAustralian Turner, DFC, B.Arch (USyd) 1954 (Retired) Catholic University (ACU)
W
ith the release of the Productivity Commission Draft Report on Caring for Older Australians in February 2011 the opportunity emerged for us all to consider taking a new direction in aged care service provision. Among the recommendations, 6.7 stated: The Australian government’s contribution for the approved basic standard of residential care accommodation for supported residents should reflect the average cost of providing such accommodation and should be set: • On the basis of a two-bed room with shared bathroom ... Considering the decade of work that has occurred across the residential aged care industry to meet consumer expectations of single room accommodation with en suite – a standard reflected in building certification requirements1 this recommendation by the Productivity Commission is indeed a change in direction. Under the Aged Care Act 1997 the objective is to promote a high quality of care and accommodation for the recipients of aged care services that meets the needs of individuals and part of the government agreement with the aged care sector was to address privacy and space requirements by 2008 – a target now met by over 95% of service providers. Response to the two-bed room recommendation has been swift with consumer and other stakeholder groups rejecting the proposal on the basis of it becoming the de facto standard for accommodation as well as government subsidy support. Some have even described the idea as ‘enforced co-tenancy’ of people who are in no position to press their rights to privacy and dignity.
In the 1970s, 80s and 90s an abundance of research was produced to advise on what is important to older people into the design of public and private places in which they can participate socially as well as accessing services. In 2011 many of these places are designed in ways that deter older people from using them and design seems to have given way to maximising the use of space rather than preserving the quality of the experience one might have while being there. Through the organisation of space, be it public or private, we shape how it will be used, by whom, and even when. Public spaces can affect interactions, power politics, and communal activities. It can even shape what is meant by difference, deviance and criminal activity. In all spaces people find identity, build memories and create histories … yet today, few ask who designed the spaces they inhabit and for what purpose. In specialised environments such as hospitals or aged care facilities, access to and use of the space is negotiated between service users, carers and families and professionals as well as managers2 with the outcome reflecting power-inscribed relationships between these stakeholders. Older people are central to the business of acute hospital services making it important that we understand the effect on people of the way hospitals organise social space and social relations as well as physical locations for receiving therapy. The interface between older people and the health care system needs to change according to Cheek (2004)3 who recommends a shift in emphasis from ‘acute care for older people’ to a focus on ‘care in this setting for people who are older’. ‘Place’ on the other hand is a process rather than a location, and when considered in this way the role of place in the exertion and negotiation of power can be revealed (Wiles, 2005)4 If the process of converting space to a place is shaped by politics and expediency then questions raised over many decades about the quality of living environments may remain unanswered. For instance, how do people feel about certain locations and surroundings? And how does this shape their involvement with those spaces and the services located there? Martin et al (2005)5 believes that different meanings of ‘place’ and the social processes arising from stakeholder encounters over its use
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can produce environments that are more or less therapeutic. Place, according to Tuan (1975)6 is a ‘centre of meaning’ constructed out of experience of all types. He found that a fully developed sense of place depends on augmenting passive experiences with active perception and awareness of different aspects of the place. Such a level of engagement may be difficult if Reed’s (1998)7 conclusion is accurate. He blames an increasingly mobile society for lapses in appreciation of the importance of ‘place’ when decisions are being made about family members and where they should live and receive care. In framing problems associated with place, power differences between stakeholders need to be considered as each will view them differently. A study in Scotland8 found that a group of people aged 86-90, all in poor health or with some disability, placed high value on meeting together as a way to develop confidence in expressing their views. Mostly they found that the social contact and opportunities for learning and development boosted their self-esteem. Through this process they were enabled to participate in policy development concerning community services’ sensitivity towards older people. Conflicts over place that persist over time can become normalised, leading to the marginalisation of some participants, along with their issues of concern. Midgley et al (1998)9 suggests the use of ‘boundary critique theory’ as a way to preserve the contributions of marginalised people in such situations by promoting and revaluing their input. One of the less obvious aspects of ‘place’ is ‘place identity’ which implies that one’s identity can be linked to a certain place because of various social and environmental factors that lead to the development of group characteristics, and affiliations built between people who live there. Even in complex living conditions, displaced people can get intergenerational support and build longterm, intimate friendships10 as well as coping with the politics of difference and having to rework their own identities (Becker, 2003). Cuba and Hummon (1993)11 found that ‘dwelling identity’ depends on the people and their interactions and interpretations; ‘community identity’ is built through social participation in local community activities; and ‘regional identity’ depends on patterns of intercommunity spatial activity. McDonald (1994)12 found that the
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potency of community identity depends on whether people living there believe the group possesses certain identifiable characteristics as well as an ability to deal effectively with internal issues and to effectively transact with external groups and communities.
Provision for ‘place’ in late age Most people aged 65+ years are living independently within Australian society and the vast majority are healthy and active within the normal limits of their physical capacity and many continue in paid employment. Increases in longevity are a success story associated with better nutrition and education, better sanitation and infection control, and living in a country with stable government and civil society. We anticipate that over the next few decades the older cohorts will continue to increase in number but not necessarily increase demand on remedial medical services. For those who succumb to ill health and frailty there is a very real risk that they will be pressured to give up their home and go into spaces designed around clinical services or efficient use of space geared to management outcomes. Whether they will be able to enjoy living there and feel some ownership and control will depend on the design and operation of that space. In any event, space can have the effect of disempowering those who enter. Older people report high levels of satisfaction with their homes even where the area or physical aspects of the house may not be particularly salubrious (O’Bryant, 1982)13. It follows that many of the drivers of satisfaction among older people about their homes also transfer to their preferences of care settings. A 2006 British study by Sarah Barnes14 found that residents in aged care homes providing more gradation of space foster well-being and environmental control; and those spending the day located in their own rooms have higher observed activity behaviour and environmental control. She noted that residents with high dependency are more likely to be gathered in communal lounge areas despite the evidence that they may be happier not to do so. The issue of variety of space having a positive effect on quality of life is something to be considered in planning for residential care, however limitations placed on older people through routines and workload management
strategies will negate even the best designed areas if people have limited daytime access or control over the location and timing of their daytime activities. Moos (1980)15 called for the design of specialised living environments and community settings to be responsive to the needs of older people. He suggested that such environments need to be evaluated in terms of the person-environment selection and allocation; and the provision of opportunities for resident choice and control. One of the more obvious areas of control is that of being surrounded by meaningful objects. Objects accumulated across a long life have particular significance to older people. Sometimes these objects are quite small but others, such as a dwarf radial-arm circular saw, may be less so. Objects evoke memories and emotions and in a 1987 study, Rubinstein16 found that responses could be categorised as: (i) (ii) (iii) (iv) (v) (vi)
objects symbolising relationships with others past and present objects as symbols of the self those serving as a defence against loss and unwanted change objects of care representations of the past; and objects that focus mature sensuousness.
Personal objects can assist the maintenance of identity in old age and may be used to express one’s personality to others who are privileged to be shown them. These social aspects of place combine with the objects and their placement within the space to create a sense of identity borne of control and ownership.
Optimum space and place requirements Planning for spaces within residential aged care that could become places for living, need to be of adequate size for the modern older person. We estimate that the minimum space required would be 5 metres by 5.5 metres with further free space of 6 metres by 5 metres to allow for a sitting, working and entertainment area, plus an en suite and perhaps a kitchenette. The layout of the living space as well as surrounding areas is also important to the feeling that the place is one in which a person
can live for some time. For instance, lighting needs to be adequate and not too dim. Steps rather than ramps are easier to navigate in orthopaedic shoes provided the riser is not too high, the step is wide enough to allow for equipment, and there are handrails both sides and landings every 4-5 steps. A riser of 15 cm rather than the usual 25.5cm which, while more efficient, does require greater strength and energy to use. The usual 18cm width for steps is also too narrow and feels unsafe for those needing to use a walking stick or similar. We recommend a step width of no less than 30 cm. Quality of life flows from individual and joint efforts to be healthy into late age and this includes exerting some influence over one’s environments. In 2007, Newton’s17 review of the literature on green space as it relates to health and wellbeing, concludes that the natural environment provides wellbeing benefits and is a key constituent and determinant of objective wellbeing and mental health. The prospect of living in a
space with little or no access to a garden or natural environment is quite depressing for people who have enjoyed interacting with nature for most of their lives. Sugiyama et al (2009)18 notes that open space within a neighbourhood is important to quality of life. Their research found that ‘pleasantness’ and ‘safety’ as well as the accessibility or closeness of these spaces are crucial to life satisfaction while quality of pathways is associated with walking behaviour. Perceptions of safety are related to self-confidence as well as trust that the environment is not dangerous. Older Australians in the general community tend to avoid public spaces that attract crowds and people in a hurry because of the risks of being pushed off balance and falling. Public spaces are set up for the physically robust with no need of handrails and who can navigate misaligned steps such as are used in the Sydney Opera House and precinct.
Systematic efforts to disconnect older people from their communities occurs when the media sensationalises occasional criminal activity that occurs in public places, creating fear and caution among older people who doubt they would be able to fend off an attack. The difference between actual and perceived crime needs to be included by media writers in their reports to avoid promoting unnecessary fear and encouraging nonparticipation of some groups in community activities.
Conclusion Australia’s population is maturing and the normal changes that accompany healthy ageing need to be acknowledged by planners and designers of spaces in which many of these people will want to congregate and use. Design for younger users of the space will be redundant within a very short time span and will need to be retrofitted for different users if the services and spaces are to be fully utilized into the future.
Is That All There Is?
Space and Place for Australians in Late Age (continued) These caveats apply also to existing environments which were designed on the basis of understandings drawn from the needs of previous generations who, at a younger age, were sicker and more frail and who may have been more willing to relinquish control over the places in which they live. Modern older people, even those with treatment and care needs, may not be as malleable as their parents or grandparents when it comes to quality of life and their living spaces. It is time for the current cohort of middle-aged people to consider how we redirect and reshape the care, support and living environments that we will all have to share in the not too distant future. n
References 1.
Department of health and Ageing Building Certification of Residential Aged CareHomes The Auditor-General Audit Report No 35. 2007-1008 Performance Audit.
2. Martin,G., Nancarrow, S., Parker, H., Phelps, K. and Regen, E. (2005) Place, policy and practitioners: On rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the UK. Social Science & Medicine, Volume 61, Issue 9, Pages 1893-1904 3. Cheek, J. (2004) Older people and acute care: A matter of place? J. Illness Crisis and Loss. Vol 12. No. 1. pp. 52-62. University of South Australia. 4.
Wiles, J. (2005) Conceptualizing place in the care of older people: the contributions of geographical gerontology. Journal of Clinical Nursing Vol.4. Issue Supplement s2. p. 100-108. September.
5. Martin et al (2005) op cit. 6. Tuan, Yi-Fu (1975) Place: an experiential perspective. Geographical Review. Vol 65, No 3 April. Pp. 151-165. 7. Reed, J. (1998) The importance of place for older people moving into care homes. Social Science & Medicine, Volume 46, Issue 7, Pages 859-867 8. Barnes, M. and Bennett, G. (1998) Frail bodies, courageous voices: older people influencing community care. J. Health and Social Care in the Community. Vol 6, Issue 2, pp. 102-111. March 9. Midgley G., Munlo I. and Brown M. (1998) The theory and practice of boundary critique: developing housing services for older people Journal of the Operational Research Society, Volume 49, Number 5, 1 May, pp. 467-478. 10. Becker, G. (2003) Meanings of place and displacement in three groups of older immigrants J. Aging Studies. Vol17, Issue 2. May. Pp. 129-149. 11. Cuba, L. and Hummon, D.M. (1993) A place to call home: Identification With Dwelling, Community, and Region. Sociological Quarterly Volume 34, Issue 1 pages 111–131, March. 12. McDonald, T. (1994) Theoretical and Technical Considerations when Measuring the Health of a Community. Master of Science (Hons) thesis. University of Wollongong. Faculty of Health and Behavioural Sciences. 13. O’Bryant, S. (1982) The Value of Home to Older Persons: Relationship to Housing Satisfaction. Ohio State University Press. 14. Barnes, S. (2006) Space, Choice and Control, and Quality of Life in Care Settings for Older People. J. Environment and Behavior September 2006 vol. 38 no. 5 589-604 15. Moos, R.H. (1980) Specialised living environments for older people: A conceptual framework for evaluation. Journal of Social Issues, Vol. 36, Issue 2. Spring. Pp. 7594. 16. Rubinstein, R. L. (1987) The significance of personal objects to older people. Journal of Aging Studies, Vol 1. Issue 3. Autumn. Pp. 225-238. 17. Newton J. (2007) Wellbeing and the natural environment: a brief overview of the evidence (Dept of Environment, Food and Rural Affairs (Defra) Internal discussion paper. http://www.defra.gov.uk/sustainable/government/ documents/Wellbeing_and_the_Natural_Environment_Report.doc 18. Sugiyama, T., Ward Thompson, C. and Alves, S. (2009) Associations Between Neighborhood Open Space Attributes and Quality of Life for Older People in Britain. J. Environment and Behavior. January, vol. 41 no. 1 3-21
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Designing for Lifestyle and Physical Therapies in Aged Care By Alexandra Davies
Memory Care
L
A number of facilities visited in China have memory care units for residents with dementia. Many of the memory care units were on the second or third floor of the building. Innovative design of outdoor spaces on these upper levels provided residents with an area to wander around landscaped gardens. The spaces were designed with raised garden beds with scented, textured or edible flowers and plants. Security of the space was achieved with unobtrusive structures that allowed distant views, however prevented the residents from climbing over. The outside flooring is non slip and provides good drainage to prevent water pooling.
ifestyle and physical therapy spaces in residential aged care are central to a resident’s wellbeing. In July 2010 Paynter Dixon Constructions sponsored me to attend the Sage Tour as part of a delegation from Australia to visit a number of elder homes and aged care facilities in Hong Kong and Beijing. This case study describes some of the innovative approaches to lifestyle and physical therapies practised in China. The population in China over 60 years is 167 million with 1% residing in aged care facilities. Due to shortage of land many developments are multi-level. Similarly in Australia many organisations considering designing and constructing new aged care facilities are finding suitable land is at a premium, both in cost and availability, therefore multi-level developments are becoming more common. The experience in China demonstrated that effective lifestyle and physical therapy programmes can be achieved in smaller spaces and in multi-level buildings.
Small, intimate living spaces were provided in the memory care unit to allow residents to interact in small groups. On a larger scale, in one centre memory care day therapy was provided for up to approximately fifty elders with dementia. These spaces were designed to have clear delineation between dining and activity areas. It was clear from this experience that day therapy can successfully be provided to larger numbers of elders without compromising the individualised care. In the indoor spaces, rooms with visual, auditory and sensory stimuli provide the resident with interactive activities. These stimuli can be adjusted according to the need of the resident for calming or exercise. One facility incorporated an interactive computer generated image onto the floor of the room where the resident could play soccer either from a sitting or standing position. It also generated an interactive fish pond with swimming fish which would move when touched. The image was projected from a data projector on the ceiling onto the floor, and required specific computer software and motion sensor.
Physical Therapies Physical therapies were a key focus in all Residential Aged Care Facilities. Indoor
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and outdoor spaces encouraged residents to participate in activities that improved their physical wellbeing. Equipment in the outdoor spaces mimicked the movements of Tai Chi, and could be used by the elders and their families. Children were observed interacting with their grandparents on the equipment which served as a physical activity for the elders and play time for the children. Landscaped gardens and ramps allowed residents and their families to socialise, while the resident practiced mobilisation skills. The emphasis of the facilities is on happy, healthy ageing and all the activities for the centres are organised by the staff. Many facilities include clinics with traditional Chinese Medicine, dentists, medical centre, massage and foot therapy. Other physical therapies are provided in rooms where equipment such as treadmills, stationary bikes and elliptical trainers are utilised to improve the mobility of the elders. Computer programs with chopsticks attached to the computer are used to improve dexterity of elders.
Activities The Chinese were all very involved in activities. One facility had a choir where the residents gathered regularly to sing. Another had a fashion parade with families and staff watching in the audience. Other activities included playing marjong, pottery, games nights, shopping trips, a quiet room for reading papers, a full size library, Chinese silk painting, and making wire stocking flowers. All residents regardless of their level of frailty were encouraged to attend. Visiting China provided a great insight into how we can learn from others in designing spaces for lifestyle and physical therapies for the elderly. It demonstrated that size is not everything! I would encourage everyone to design for flexibility of space, be innovative and design to include all age groups. n
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Top Six Tips for Aged Care Rachel Lane
Executive Manager Aged Care Solutions Colonial First State
Moving a friend, relative or partner into aged care can be an incredibly emotional and complicated experience. Many people are unsure of the steps to take, their options in meeting the cost of care and their choices can impact on pension entitlement and the cost of care itself. Here are the Top 5 Tips for people faced with this situation:
1. Get an ACAT Assessment Prior to being able to access an aged care facility your care needs need to be assessed by the government. The team of people responsible for this are known as the ACAT (Aged Care Assessment Team) and in some cases you can be waiting weeks or a few months to get an appointment for the assessment to be carried out so it’s a good idea to call them as soon as the need arises.
2. Understand the Asset Assessment Understanding the outcome of the “Request for Assets Assessment Booklet” prior to completing it is crucial. Your assessable assets for aged care are often different to your assessable assets for pension purposes. The key difference is that unless your spouse, child or in some circumstances other relatives or a carer lives in your home with you then your home is part of your assessable
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assets for aged care purposes. The aged care asset assessment will determine the maximum amount of accommodation bond or accommodation charge you can be asked to pay. The formula for this is fairly simple, your total assessable assets minus $38,500. If you are a couple the assets are considered on a 50/50 basis and $38,500 is minused from each share. Understanding the outcome of this assessment can help you decide whether or not you should submit one. The only time that the asset assessment is compulsory is if you are claiming to be a supported resident (those with assessable assets below $98,237.60). When you are a member of a couple and both of you are going to enter aged care the timing of the assets assessment can be critical. If you both move into an aged care facility on the same day and submit your asset assessment after you move in half the home will be assessed against each of you. Whereas if one of you enters care on one day and the other enters care a few days later the former will be exempted from the first to enter care because the other is still living there. In some cases this can mean that one of you will be eligible to be a supported resident and pay a reduced amount (or no) accommodation bond or charge. Of course you should first ensure that the facility is willing to accept a supported resident.
3. Keep and Rent the former home – know the exemptions The assumption is too often made that to fund the move to aged care you will be forced to sell your home. While for many people this is the decision that will be made, it is important to be aware that there are special rules that can apply to enable you to keep and rent your former home with both an asset and income exemption applying. The criteria that need to be met for these exemptions to apply are, you must be; Paying an accommodation charge OR Paying an accommodation bond by periodical payment AND Renting the former home
Where the criteria is met the former home and any rent received is exempt from the calculation of pension entitlement and Daily Income Tested Fees. While social security exemptions are applied to the asset and income, the rent needs to be declared for income tax purposes and capital gains tax may be applied to the eventual sale of the asset.
4. Pay the right amount of accommodation bond Aged care facility managers will generally take one of two approaches in determining the bond for a resident; they will request that you complete the asset assessment and then negotiate an amount of accommodation bond up to the amount stated in the resulting letter or a market price approach where they will determine the amount of bond for the facility as a whole or have a bond amount for different rooms based on size, views etc. It is important to know that often the bond amount quoted is simply a base amount and you can negotiate with the facility to pay more. While it defies most people’s logic to pay more than you need to as an accommodation bond, for some people this can be a very simple but effective strategy. Many facilities will offer discounts on the ongoing fees to people who choose to pay a bigger bond upfront. For some people this strategy can achieve a triple benefit; an increase in pension entitlement, a discount on ongoing fees and a reduction in the daily income tested fee. Like many financial strategies this benefit will not be received by everyone or even for the same person beyond a certain point. The discount that you agree to with the facility should be reflected in your Residential Care Agreement.
5. Consider using a Family Trust The sale of the former home means that you move from being a homeowner to a nonhomeowner for social security purposes. This means that the level of assets you can have
before your pension reduces under the asset test increases significantly, for the single age pension the asset threshold increases from $181,750 to $313,250. However, the income test is not affected and remains at $3,796 p.a for a single pensioner with a reduction of pension at 50c for each dollar of income above the threshold. Many people sell the house to fund the accommodation bond with little understanding of the consequences on pension and cost of care. The proceeds of the sale of the home which are invested or simply deposited into a bank account are deemed to earn income and often leads to pension entitlement being reduced under the income test and an income tested being added to the cost of care. The use of a family trust with non income producing investments can assist in bridging the gap between the income test and the asset test. Unlike investments held in your own name, investments held through a family trust are assessed based on the actual income being earned. Where the investments
grow in value but are not considered to earn income the asset value is assessed under the asset test but no income is assessed under the income test. In looking at aged care facilities it is not uncommon to find more than one type of care under the same roof. As such, it is not uncommon for facilities to offer residents choices in terms of the type of care they would like, for example you may be given a choice of a standard high care bed or a high care extra service bed. A different financial arrangement applies to each so it is important to be aware of this and whether one financial arrangement may be better suited to you/your family than the other.
6. The most important tip of all:
you have choices in the way that you meet the cost of aged care. The options that you choose to explore should be those that meet your financial needs and objectives while
“
In looking at aged care facilities it is not uncommon to find more than one type of care under the same roof. As such, it is not uncommon for facilities to offer residents choices in terms of the type of care they would like
”
ensuring access to the care that’s needed. An aged care facility doesn’t have to accept a resident or any given financial arrangement so you should always confirm with the facility what they will accept. n
editorial
Daily reminders help Aged Care Facilities stay safe and secure
In an effort to ensure the best care and safety measures are being taken in Aged Care facilities across Australia, Pro-Visual Publishing is urging industry staff to take necessary precautions with the National Guide for Aged Care 2011.
T
he Guide makes recommendations on physical activity levels for older people and how this activity can be achieved. According to the Guide, older people should accumulate at least 30 minutes of moderate intensity activity on most if not all days.
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Risk management features in the Guide as a crucial element of working in Aged Care facilities. Risk management, simply put, is the possibility of events or activities causing harm to a resident, visitor, volunteer, employee of the organisation itself. In Aged Care, risk management extends from staff health and safety and corporate liability and reputation into clinical risks such as influenza outbreaks and residents falling and causing themselves serious injury. This year’s Guide also contains a useful checklist for identifying hazards relating to resident aggression. When displayed in a convenient location in the workplace, the Guide acts as a daily reminder to all staff of routine care practices that should be adhered to by all staff. “The National Guide for Aged Care 2010/11 is an easily accessible resource for all members of the industry. This edition
of the Guide provides valuable, up-to-date information regarding aggression safety and security, recommendations on physical activity and risk management,” said John Hutchings, CEO, Pro-Visual Publishing. The Guide will be distributed nationally through industry associations. Additional copies are available and all Guides are produced and distributed without cost thanks to sponsorship. “I would like to thank all of the sponsors for their support of the National Guide for Aged Care 2010/11 who have made it possible for the Guide to be distributed free of charge to the industry,” concluded Hutchings. For further information, or to obtain additional copies of the Guide please call ProVisual Publishing on (02) 8272 2611, email enquiries@provisual.com.au or see www.provisual.com.au n
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Aged Care Industry Vendor awarded Medal of the Order of Australia Australian technology identity Sonja Bernhardt has been honoured for her outstanding contribution to the information technology industry with a Medal of the Order of Australia, on Australia Day 26 January 2011.
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onja, Chief Executive Officer of software development house ThoughtWare Australia, the designers of the award winning aged care specific i.on my Care software, is well known in the industry for her energy, passion, commitment and efforts to make a difference. She has spent the past 15 years serving on multiple executive boards and committes providing advice and guidance to Governments, Business and Community bodies on various aspects of information technology, as well as supporting and encouraging other women into science, engineering and technology studies and careers, and serving as long running resident ‘Geek Girl’ on ABC Radio (Coast FM), a regular radio spot on current technology and science topics. In 2007 she turned her passion and energy towards aged care, community care and acute hospital beds industries. She is a founding member of ACIVA (www.aciva.org.au) Aged Care IT Vendors Association, and in 2010 at the Aged Care Industry IT Awards her Governance, Risk Management, Compliance software solution i.on my Care (www.ionmy.com.au) won the best implementation of the year (under 150 beds). ThoughtWare was a finalist in the Aged Care ICT Company of the Year category (2010 and 2009). Across the 36 years of the honours program, she is the 30th IT person in all of Australia (and 5th female) to be recognised with on Order of Australia for services to IT, and the 1st Queensland female. Sonja stands out from the crowd as a visionary, a leader and a doer. A person who is not afraid to stand proud in the face of controversy to achieve her values and to passionately spread the word about IT. Her achievements are many and mostly voluntarily undertaken. With key ones listed at http://en.wikipedia.org/wiki/Sonja_Bernhardt Sonja is a mother of 3 - a 29 year old daughter (Naomi), and 26 year old son (Tom) from her first marriage and a 7 year old daughter (Kira) from her extremely happy second marriage to scientist Dr Robin Craig. Her third grandchild is due to be born shortly. n
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Top Five Toe Tips for Seniors Katrina Taylor
Director/Senior Podiatrist Senior Foot Care
It’s estimated that in a lifetime you would have walked three
1. Wash the Feet
5. Exercise
Washing the feet on a daily basis will help remove any irritants or debris that might have been picked up on the soles of the feet. Wash with tepid water, not hot. Hot water will dry the skin further, as will vigorous rubbing.
Poor circulation can impair healing, increase the risk of ulcers and infection and in worst cases result in gangrene and amputations. It can also be one of the causes of thickening of the toenails and fungal nail infections.
times around the earth. No
2. Dry in Between the Toes
wonder our feet start to ache
The whole foot should be dried thoroughly particularly in between the toes. The crevices of the skin between the toes can become waterlogged resulting in soggy/ macerated tissue which can lead to the skin breaking down and ultimately infection.
and show signs of wear and tear as we age. Here are five toe tips that should be a part of every aged care facility’s daily regime to help improve the foot health, mobility of their residents and reduce that wear and tear.
3. Moisturise the Feet As you age the oil secreting glands in the skin become less active resulting in dry skin. It is therefore necessary to keep our skin supple and resilient to damage by applying an emollient. Many commercial creams are water-based and our ineffective at keeping the skin moisturised. Check the label of any foot lotion you purchase. If the basic ingredient is water, pass that one up and go for an emollient instead. Look for emollients that contain lanolin, coconut oil, or shea butter as these ingredients bind to water trapping moisture in the skin. Apply emollient to the whole foot and remove any excess from in between the toes to prevent maceration.
4. Inspect the Feet Daily for any Signs of Trauma Inspecting the feet on a daily basis will help detect any trouble spots before they turn serious. The best time to do this would be during or after showering. Check the feet for any signs of trauma such as redness, blisters, bruises, cuts, swelling or colour changes. Also look for sharp toenails, ingrown toes nails, corns, calluses or anything that does not look normal or wasn’t there yesterday. All concerns should be reported to the podiatrist.
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Daily walking can help improve circulation and reduce the risks mentioned above. However, if a resident is unable to ambulate the alphabet workout is an alternative exercise that can be completed in a bed or chair. Have the resident draw each letter of the alphabet in capital letters beginning at the letter “A” by moving the ankle and using the big toe as the “tip of the pencil”. Make a note of the letter they reached and have them swap feet. Make it a daily activity, always start on the letter “A” and encourage the resident to pass the letter they previously reached. This exercise also helps strengthen the calves, ankles and the arches of the feet. If these tips are used on a daily basis they will help reduce ulceration, infections, foot deformity and hospitalisations of your residents and will ultimately improve their health and mobility. n
editorial
The Politics of Climate Change In relation to Australian electricity prices, carbon seems to be a dirty word. The government states it is investigating a cost-effective and economically responsible way to reduce Australia’s carbon pollution; however the reality is that future prices soar when politicians speak of carbon. The graph below of Q3 2012 baseload electricity futures illustrates how news of a carbon price being introduced from July 2012 affects the market.
The graphs below illustrate the effect of a carbon price on the cost of producing electricity assuming: • a carbon price of $20 per tonne CO2 • black coal-fired generation producing 1 tonne CO2 per MW (1 x $20 = $20 per MW) • combined cycle gas-fired generation producing 0.4 tonne CO2 per MW (0.4 x $20 = $8 per MW) • wind-powered generation produces no CO2 per MW
Impact on electricity futures on announcements of carbon pricing Source: d-cypha Trade
So how will a carbon price reduce CO2 emissions? The introduction of a carbon price will increase the cost of production for electricity generators who burn fossil fuels. The majority of Australia’s baseload electricity comes from coal-fired power stations so the price that these generators can sell their ‘carbon inclusive’ electricity will rise as a direct result of the carbon price. The theory is that additional carbon costs levied on ‘dirty’ generation methods will decrease their competitiveness and should result in new investment in ‘cleaner’ technologies because they will become more economically viable.
The cost of generating electricity from black coal, combined cycle gas or wind-power with or without a carbon price
The theoretical outcome of pricing carbon improves the competitiveness of combined cycle gas-fired & wind-powered generation leading to greater investment in the technologies, which in turn would increase sales and market share. A greater proportion of the National Electricity Market demand being met by gas & wind versus coal should lead to lower level emissions and therefore reduce Australia’s carbon pollution.
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editorial
The Politics of Climate Change (continued)
When would the carbon price start? The mechanism could commence as early as 1 July 2012, subject to the Government’s ability to negotiate agreement with a majority in both houses of Parliament and pass legislation this year.
How long would the carbon price remain fixed? How was the debate on climate change reintroduced into the Australian political agenda? 27th September 2010: The Prime Minister Julia Gillard announced the formation of the Multi-Party Climate Change Committee (MPCCC) to explore options for the introduction of a carbon price. The MPCCC was formed with 3 Labour, 2 Liberal, 2 Green and 2 Independent federal politicians working in conjunction with 4 recognised industry experts. The committee was directed to start from the position that a carbon price is an economic reform that is required to reduce carbon pollution, to encourage investment in low emissions technologies and complement other measures including renewable energy and energy efficiency.
Why does the government think climate change is bad for Australia? 21st December 2010: The MPCCC acknowledged that Australia needs to reduce its carbon pollution, as part of global efforts to combat climate change. Cuts in global pollution are necessary to reduce the risks posed by unmitigated climate change. For Australia, these risks are large, threatening our economy, our natural heritage (including icons such as the World Heritage listed Great Barrier Reef), and our way of life. The Committee considers that a carbon pricing mechanism is the most cost-effective and economically responsible way of reducing Australia’s carbon pollution, and that its introduction would enable Australia to play its part in global efforts to reduce the risks posed by climate change. A carbon price will also provide opportunities for innovation and investment in lower carbon technologies, and opportunities and rewards for improved land use management.
What is the government proposing to do in relation to climate change? 24th February 2011: The MPCCC announces that the Government and Greens members of the committee have agreed on a proposed carbon price mechanism. The Independent members of the committee (Mr Oakeshott & Mr Windsor) agree that the proposed carbon price mechanism be released to enable consideration by the community and to demonstrate the progress that has been made.
What does the proposed carbon price mechanism look like? The carbon price mechanism would commence with a fixed price on carbon emmissions (through the issuance of fixed price units within an emissions trading scheme) before converting to a cap-and-trade emissions trading scheme.
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The proposal is for a fixed price phase of between three and five years, with the price increasing annually at a pre-determined rate. The initial fixed price could begin to drive economic transformation and investment in low emission technologies, and ensure greenhouse gas emission reductions.
How would the carbon price transition from being fixed to flexible? At the end of the fixed price period, the intent is to convert to a flexible price cap-and-trade emissions trading scheme. It would be important to design the changeover in a way that provides business certainty and a smooth transition from the fixed to flexible price.
Who will the carbon price mechanism affect? A carbon price mechanism could cover all six greenhouse gases counted under the Kyoto Protocol and have broad coverage of other emissions sources encompassing: • The stationary energy sector • Transport sector • Industrial processes sector • Fugitive emissions (other than from decommissioned coal mines) • Emissions from non-legacy waste.
Will Australia’s carbon price be linked to the world? It is likely during the fixed price phase that liable parties won’t be entitled to use international emissions units for compliance. It might be possible once the flexible price scheme comes into effect for international emissions units (offsets meeting appropriate criteria concerning their quality) to be used for compliance. Before the introduction of emissions trading, these criteria around the quality of international emission units would need to be decided.
What is the government going to do to help those directly affected by carbon pricing? Assistance and other matters are still to be determined... n This document references & interprets information published by the Australian Government’s department of Climate Change. http://www.climatechange.gov.au
Article provided by
events
2011 Calendar of Events 17 – 20 May
19 & 20 May
20 – 22 July
Alzheimer’s Australia 14th National Conference
ACAA-NSW Congress
Nurses in Management Aged Care (NIMAC) Conference
Brisbane Convention & Exhibition Centre Contact: Secretariat T: 07-3255 1002 E: info@alzheimers2011.com www.alzheimers2011.com
Sheraton on the Park, Sydney Sydney Contact: Cynthia O’Young T: 02-9212 6922 E: admin@acaansw.com.au www.acaansw.com.au
22 - 23 September
October
6 – 8 November
5th Annual National Dementia Research Forum
SAGE - USA (Including IAHSA)
ACAA 30th Annual Congress
T: (02) 9689 2088 E: j.okeefe@thomsonadsett.com www.sagetours.com.au
Magical Mystery Tour - The Long and Winding Road
Wesley Conference Centre Sydney dementiacrc@unsw.edu.au www.dementia.unsw.edu.au
Jupiters, Gold Coast Contact: ACQ Conference + Event Management T: 07-3725 5588 E: events@acqi.org.au www.acqi.org.au
Contact: ACQ Conference + Event Management T: 07-3725 5555 E: acaa2011@acqi.org.au or enquiry@acaacongress2011.com.au www.acaacongress2011.com.au
LETTERS TO THE EDITOR Aged Care Association Australia is interested to hear from you. Maybe you’d like to
respond to an article you’ve read or you have an article you’d like to submit. ACAA welcomes letters to the editor of no more than 300 words. All letters must have the writer’s name, address, telephone number and job title clearly written. ACAA reserve the right to edit for reasons of space and clarity. Send to: editor@acaa.com.au or PO Box 335 Curtin ACT 2605.
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product news
HYGIENE CERTIFIED –
Coated Tablecloths That Save You Money
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ince 1997 The Coated Tablecloth Company has been producing specialised hand painted cotton table linen for the hospitality industry. They supply over 1000 restaurants, hospitals and aged care facilities in Australia, the UK, USA and South Africa. The unique coating known as TEXTILE SHIELD™ allows
spills to simply be wiped away with a domestic antibacterial spray, removing the need for laundering, saving you money and improving your decor at a fraction of the cost of a renovation. “We offer a customised product in any colour and design with a 12 month low cost rental and service plan that saves our clients up to 35% on current laundry costs or linen hire,” says Kevin Fine, Australian director of The Coated tablecloth Company. These cloths have been recognised as being the hygienically safer option for eateries, having achieved the official TOXPROOF certification from renowned German laboratory TÜV Rheinland. TEXTILE SHIELD™ prevents germ particles from penetrating the fibre of the cloth. “Our tablecloths showed up less than five units of all
bacteria tested for. The European regulations state the legal limit of these bacteria is 30 units,” says Kevin, “It proves that bacteria on our wiped clean, coated tablecloths barely exist, meaning they are a more sanitary option than keeping tables bare or using regular cotton coverings.” “Bare tables allow germs to get trapped in the cracks and grain of the wood which is when bacteria can reach dangerous levels.” By going Eco-Friendly an average sized facility comprising of 20 dining tables will save even more money by reducing their water consumption and saving the Australian environment 13,000 litres of water each year by eliminating washing. For more information: www.handpaintedbycarmel.com.au kevin@handpaintedbycarmel.com.au Tel: 1300 9600 37 or 0416 161 440.
Vision Food Solutions AGED CARE CATERING
Mixermate turns your old hard-to-use taps into an easy-to-use lever tap!
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he Mixer-Mate allows you to convert yourexisting hot & cold shower taps to a mixer tap. With this new system, there is no needto open the shower wall and there is nodamage to your tiles.
WATER SAVING Having a mixer in your shower can help you to save water as the shower temperature can be preset and precious water not wasted on attaining the right temperature.
EASY RENOVATION A Mixer-Mate in your shower is a cost-effective wayof renovating, giving you a lever shower mixer to control your hot and cold water for a fraction of the cost of an in-wall mixer.
A
s industry leaders in Aged Care Food Services, our gourmet aged care menu options and comprehensive aged care catering services are designed to boost meal time efficiency and improve the bottom line of your aged care facility. Our operational services cover the entire spectrum of aged care catering, and a customised approach can be created to suit the specific needs of your organisation. Core offerings include: Staffing & Payroll, Cleaning & Maintenance Schedules, Purchasing & Supply Services, Stock & Revenue Controls, and Menu Planning. When you work with Vision Food Solutions, you get access to world-class aged care catering services, including: • • • • • • • •
Fixed menu costs for 12 months Professional staffing with qualified chefs and trained food service assistants Home style cooking, with a focus on comfort Market fresh produce & locally sourced meats A commitment to ‘continuous improvement’ Dietician accredited & nutritionally balanced menus for elderly residents Complete or partial delivery options All staff are fully trained in food hygiene procedures
AGED/DISABILITY AIDE
Contact us today to talk about how we can improve the catering service offered to your residents
Our system enables the elderly, disabled and those with arthritic conditions to control water with ease.
www.visionfoodsolutions.com.au
ADAPTABILITY The Mixer-Mate System can be adapted to fit kitchen, laundry and bathtub 3-in-line combinations.
www.mixermate.com.au Phone: (03) 9583 3049 Email: brucegbrand@gmail.com
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product news
S911 Mobile Duress Device
response times in a multitude of industries and applications. Operating via the GSM mobile network and utilizing GPRS technology the device is designed to assist in providing enhanced user safety. There are a number of benefits that this product has to offer including:
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he S911 Personal Mobile Duress Device, distributed by Multitone is a unique state of the art 2 way communications and duress system. Its award winning design can help improve safety and
• Adjustable G force sensor for impact and man down alerting • One touch dialing • 99 phone book memory capacity • 2 way communications via mobile phone network • Geo fencing capability to set up defined areas of operation for the device • IP54 rated for protection against the elements.
Sudocrem® Product Information Sudocrem® Healing Cream is a soothing emollient cream which aids and assists in the management of incontinence dermatitis, pressure sores, Stomal therapy, wound care, eczema, minor skin irritations….not to mention nappy rash. Now available in a convenient and hygienic 30 gram tube it is a perfect size for a patient’s personal use. Sudocrem® has a triple action, which helps soothe, heal and protect the skin. Eczema, Wounds and Abrasions The healing properties of Sudocrem® make it an effective treatment for minor skin disorders such as eczema, wounds, scratches, dermatitis, cuts and abrasions. When applied in a small circular motion Sudocrem® leaves a translucent film, allowing skin to remain supple whilst you are able to see the wound healing. Incontinence Dermatitis Sudocrem® helps to provide barrier protection to the skin from stools and urine, promotes healing and soothes irritated skin. Use Sudocrem® after cleaning and drying the affected area, as often as required. Applying a thin, even layer directly on to the skin will not interfere with the absorbency of incontinence pads. Pressure Sores Sudocrem® helps to provide barrier protection against moisture which aids and assists in the management of pressure sores. The emollient effect of Sudocrem® Healing Cream can help to maintain the condition of the skin, leaving it soft and supple.
When the bracelet goes into alert it sends a text message and also makes a mobile phone call to pre programmed numbers. These can be either a fixed line or mobile phone number. Most importantly the bracelet sends an accurate positional location via its sophisticated mapping software and reporting program. This is able to be viewed from anywhere that you have internet access. Single or multiple devices are able to be monitored simultaneously and there is also an assortment of status and performance reports which can be generated from the device. The S911 can help put your mind at ease for the safety and security of your staff and loved ones.
For more information contact Multitone Australasia on 03 9888 1244
TECO The Comfortable Choice
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ECO has been manufacturing Televisions for over 20 years and now has available the latest technology in LED/LCD flat screen models in sizes from 15 inch to 42 inch. Some models in the range also come with an inbuilt DVD player. All models have inputs allowing them to be used as computer monitors and some models also have USB play back and record functions allowing residents to enjoy personal photo or video memories. The size range covers usage suitable for personal areas as well as larger common areas. The latest LED technology ensures these models consume far less energy than older style CRT models. TECO has also supplied a range of Wall Split system and Window Wall Air conditioning units in Australia for over 25 years. The current ranges feature either Fixed Speed compressors or Inverter controlled compressors, all with fully featured wireless remote controls. The smaller capacity systems can be used in individual rooms with capacities also available for larger common areas.
Nappy Rash
TECO Australia has distributors in all states and our staff will assist you with product details and can put you in contact with your closest TECO supplier, who will be able to assist with any enquiries.
Sudocrem® helps protect baby’s skin from coming into contact with irritants, which is the best prevention. Sudocrem® helps to soothe the burning and itching sensation of nappy rash, heal the skin and provides a protective barrier to assist in the management of nappy rash.
Both Air conditioning and LCD/LED television are major technologies providing the comfort conditions residents in Retirement and Aged Care facilities should expect.
For further information, samples & educational in-servicing please contact Nice Pak Healthcare Department on 03 9553 4100 or via healthcare@nicepak.com.au.
TECO is “The Comfortable Choice” for Retirement and Aged Care Residents.
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Moving the Business Beyond Spreadsheets with Corporate Performance Management Software
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orest Grove Technology is a dedicated supplier of Corporate Performance Management software. We specialise in helping companies move beyond a complex array of error-prone, complex, integrated spreadsheets for the business critical processes of budgeting, forecasting, business analytics, financial consolidation and reporting. While standard accounting packages provide strong solutions to the transaction processing requirements of aged care providers, the critical functionality required for corporate performance management is often forgotten, leaving finance departments with a heavy reliance on time-consuming spreadsheets. A PROPHIX technology solution www.prophix. com.au, delivered and implemented by our Australian based consulting team, can make an enormous difference to corporate financial management in aged care.
• • •
Financial consolidation; Dashboard and scorecard reporting; and, Key performance indicators calculation and reporting
• •
ENA Online Learning delivers highly interactive, user friendly and engaging online continence courses. The courses are offered to all TENA customers in Aged Care Facilities, as part of TENA’s total offer of continence management.
Refer to our ad on page 49 of this issue.
A leading innovator in Aged Care eBusiness, TENA has now developed the Gap Analysis feature. Gap Analysis assesses any deficits in knowledge 12 months after the initial course is completed via a quiz, then allocates for review course sections that have not been retained. In this way, facilities can be assured that that knowledge gained is maintained.
Forest Grove Technology Ground Floor, Kingsgate, 171 St Georges Terrace, Perth WA 6000 PROPHIX.com.au Phone: +61 (8) 9481 2400 Fax: +61 (8) 9481 6044 www.forestgrovetechnology.com.au
Budget and forecast functionality; Financial analysis and “what if ” scenario modeling; Financial reporting both adhoc and monthly reporting; Rolling reforecast capability;
EASY EFFECTIVE TAX-FREE EMPLOYEE BENEFITS
W
ith the Westpac PBI Employee Benefits Card (EBC™), your employees can spend $16,050 of their remuneration free from any tax, year after year. These tax savings typically result in an increase in net pay by over 10%, at no cost to your organisation. Your employees simply use the Westpac EBC™ to pay for everyday purchases with the untaxed pay that is deposited on their EBC™ each pay day.
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If you would like to know more about how a PROPHIX Corporate Performance Management System could help your business, go ahead and take the online tour at forecast.com.au, and don’t forget to look for us at the ACSA 2009 Aged Care Conference in WA in September.Alternatively, review recent client case studies at agedcare.fgtechnology.com.au, or speak to our team directly about how the software has helped other Australian aged care providers and how it can help yours.
A PROPHIX solution can provide: • •
Advancing Continence Competency
“I liked this type of training as I could go back over areas I didn’t quite understand,” said one user recently surveyed. 61% of users from the same survey said that TENA Online Learning has changed their work practices relating to incontinence based on the knowledge they have gained. For a preview of a sample course see www.TENAonlinelearning.com.au or call 1800 623 347.
There is no anachronistic, expensive, mistake prone external bureau involved. There is no need for risky, often noncomplying, time consuming internal administration. Not only does Westpac offer the everyday living expenses EBC™, it additionally provides tax-free Meal Entertainment (MEC) and Leisure Accommodation and Venue Hire (LAC) Cards. These card benefits can increase your employees’ net pay by well over 20% ongoing. There are no tax-free dollar limits on these special cards.
All three cards have Australian Taxation Office (ATO) approvals and are therefore fully compliant. ATO audits have found non-compliance of over 50% with other approaches. Ensure you comply tax wise and switch today. Implementation of the Westpac EBC™ is simple with no lock in contracts or complex forms to complete. Contact PBI on (02) 9314 0288 or Westpac to see how easy it is to establish your facility or visit our website www.employeebenefitscard.com.au for more information.
There is no ongoing paperwork, receipts, reimbursements or GST concerns.
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product news
James Richardson launches new commercial fabrics that ‘feel like silk and smell of roses’
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ames Richardson is proud to unveil an exciting new range of commercial quality fabrics for the aged care industry in Australia.
The expert supplier of furniture and textiles understands that aged accommodation operators are bound by strict guidelines to ensure the safety and security of their residents. Even the seemingly simple task of furnishing a room must meet industry benchmarks. This is where James Richardson can step in to help. It has exclusive distribution of ATN Vinyls from Germany. The textiles are of commercial quality and vigorously tested to the most stringent of performance standards. The latest fabrics to feature in the range are the Silk and Roses vinyls, which can be upholstered to any chair or sofa. Silk, as its names suggests, feels as soft as natural silk while still retaining a high durability factor. It comes in a range of colours including pearl, chocolate, lavender and onyx. The fabric is UV resistant, flame retardant, and resistant to all fluids. And like other ATN Vinyls it has antimicrobial protection against bacteria, algae, fungi and mould. The Roses vinyl offers the same industry standard attributes as Silk. But in contrast, it’s a more contemporary design featuring attractive metallic flecks
Popular Australian Nurse Education Site Provides Low-Cost Education for Aged Care
W
ith the rapid flow of new treatments to benefit our ageing population, it is difficult for healthcare professionals to stay up-to-date with current developments. However, nurses have the opportunity to learn in their own time, at their own pace by utilising the resources now available at AusmedOnline. com. The goal of the website, developed by Australian publishing company Ausmed Publications, is to provide easy access to the most up-to-date information for nurses. “Education is an ongoing part of being a nurse. But it is difficult for nurses, who work round-the clock-shifts, to fit seminars and classes into their demanding schedules,” said Cynthea Wellings, RN, and Ausmed Publisher. “We designed AusmedOnline.
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and a stylish pattern of swirls throughout the fabric. It lends itself to an ambient texture of rich tones. With so many furniture and TM LMI Concepts fabric options on offer, aged care facility operators are now empowered to create warm and inviting spaces for residents combined with the assurance that it is health and safety compliant. The James Richardson collection of textiles also includes commercial grade wool, blends, natural fibres and Crypton with a guaranteed moisture barrier. The fabrics are designed to meet the individual requirements of industries such as aged/health care, hospitality, corporate and education. The textiles are sourced from local and international mills and are stocked to ensure efficient delivery leadtimes for customers. Since 2000, James Richardson has been the distributor of ATN Vinyls from Germany, Gabriel Fabrics from Denmark, Bute Fabrics from Scotland, Väveriet from Sweden and Crypton from the USA. For more information on James Richardson’s commercial quality textiles or high quality furniture visit www.jamesrichardson.com.au or call 1800 812 440.
com with a ‘School of One’ education model in mind. Nurses can create a personalized study plan, and work at their own pace.” The website offers hundreds of lectures on topics, such as infection control, law, documentation and management – all delivered by highly regarded healthcare experts. A new video lecture series on “How Medicines Work” focuses on the special needs of older persons when selecting and administering medicines. New programs are continually being developed. All lectures on the site have been peer reviewed. AusmedOnline.com operates as a membership program. With one annual fee, nurses have unlimited access to all resources: audio and video programs, books, articles, and power point presentations. It is also an excellent resource for nurse educators as it offers tools and useful teaching resources.
Membership feedback is considered when identifying new content or revising existing material. This is just one of the reasons Ausmedonline.com is already so popular among Australian nurses. Every resource on AusmedOnline.com counts towards a nurse’s annual continuing professional development (CPD) requirement if related to their context of practice. In addition, there is an online CPD calculator and free CPD Organiser to help nurses keep track of their continuing education. There are already 1000s of members using the site and since July 2010, nurses have downloaded more than 29,000 items of content. To find out more visit AusmedOnline.com.
AusmedOnline.com