INsite August 2016 by NZME. Educational Media

August/September 2016 | $10.95

AGED care & retirement

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Aged Care

Are our small rest homes doomed? Clinical

Tackling the big issues – progress with bariatric care Management

Meet the new man at Metlifecare

policy

Rates Rebates for Residents focus

Get ready for ‘the eat and tweeters’ –

here come the baby boomers

Next issue:

October/November

Clinical Focus in Aged care With ‘superbugs’ like norovirus and C difficile finding their way into New Zealand aged care facilities, the co-morbibities of elderly patients, a dizzying array of pharmaceuticals to choose from, and the variety of complex wounds found in the aged care setting, INsite’s clinical focus helps rest home and retirement village staff navigate the challenging world of patient care.

Aged care news, views, trends and analysis If you want to know what your colleagues are thinking or doing in the aged care and retirement sector, subscribe to INsite. Multimedia format includes: » Four print editions per year » In-depth website, newsfeed, opinion pieces and sector updates.

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Ed’s LETTER

One of the questions pivotal to discussions at the recent RVA conference in Auckland was, what will baby boomers want when they enter our retirement villages and aged care facilities? Generally speaking, until recently, providers and operators have provided a service and their customers have accepted this service without quibble. The boomers, so everyone says, won’t be quite so obliging. But do we really know what they are going to need, want and expect from our villages and facilities? In this issue – I like to think of it as our foodie edition – we hear from New Zealand Nutrition Foundation CEO Sue Pollard about what she, as a boomer, is likely to want when it comes to food in aged care. ‘Proper’ coffee, music while eating, BBQs and picnics in summer, wine service at dinner, room service options – these are just some of the things on the boomers’ wishlists. Meanwhile, overcooked veges, old-fashioned food like stews, eating dinner at lunchtime, ordering all food the day before, and eating in the same place each day are all ‘no gos’ as far as Pollard is concerned. Kitchens would do well to heed such advice as the opinionated baby boomer generation gradually makes its way into facilities. The RVA conference also provided much food for thought in the area of technology and the impact it is set to have on our retirement and aged care industries. As with guessing at boomer preferences, we’re left pondering a future that features wearable devices, sensor technology, robotics and artificial intelligence. According to futurist Morris Miselowski, such things are already here, and like the boomers, they’re set to make their presence increasingly felt.

Editor, Jude Barback

In this issue... FOCUS: Nutrition and diet in aged care

The plight of the small rest home

Food: does yours cut the mustard?

Active ageing

What do baby boomers want?

Get ready for the ‘eat and tweeters’

The right nutrition: counter frailty and improve your bottom line

Tackling the big issues in aged care

In need of some respite

Airbnb meets home care

Rates rebate for residents

Resident chitchat

On the soapbox… Julie Haggie

Let’s snoop around... Copper Crest Village Estate

Spotlight on... depression in our later years

A day in the life of... Debbie Dillon

Conference updates

Last Word... Glen Sowry

Editor Jude Barback 07 542 3013 editor@insitemagazine.co.nz Advertising & Marketing Manager Belle Hanrahan 04 915 9783 belle@nzme-ed.co.nz

For aged care news, views, trends and analysis visit: www.insitemagazine.co.nz Connect with INsite magazine on Twitter Follow INsite for breaking news, the latest innovations, and conversations with editor Jude Barback on the professional issues close to your heart. Find us on Twitter@INsite_NZ

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August/September 2016 Volume 10/Issue 3 NZME. Educational Media, Level 2, NZME. House, 190 Taranaki Street, Wellington 6011, New Zealand PO Box 200, Wellington 6140 © 2016. All rights reserved. No part of this publication may be copied or reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopy, recording or otherwise without the prior written permission of the publisher. ISSN: 2324-4755

Errors and omissions: Whilst the publisher has attempted to ensure the accuracy and completeness of the information, no responsibility can be accepted by the publisher for any errors or omissions. www.insitemagazine.co.nz | August/September 2016 1

Aged care

The plight of the small rest home In an effort to boost occupancy levels and compete with larger operators delivering a broader continuum of care, smaller residential aged care facilities are increasingly providing hospital level care at the rest home level of funding. Without policy and funding intervention, are our smaller facilities sustainable? By JUDE BARBACK.

esidents and their families are devastated at the recent announcement that Matamata’s Rawhiti Lodge is closing. “It has been devastating for them,” says manager Hazel Lamberth, of the residents who now must be relocated to other facilities. “It is as emotional for them as it was for them when they left their family home to come here.” Rawhiti’s closure has nothing to do with quality of care; on the contrary, the home received a “perfect audit” in May, confirming what Lamberth and her staff knew already - that they offered an excellent service to residents. No, Rawhiti’s closure was symptomatic of the problems affecting many small rest homes around New Zealand. Indeed, Rawhiti is not alone. Other small rest homes around the county are also closing their doors. Among them, is Lady Ascot Rest Home in Auckland. Closing the facility was a “heartbreaking decision” that has left its residents and their relatives in tears, according to providers Monica and Suren, writing in the June 2016 edition of e-newsletter Jelica’s Link. Why are smaller facilities like Rawhiti and Lady Ascot shutting their doors? Small rest homes are not struggling in terms of the care they provide – if anything, the care is more individualised to the needs of their residents. They’re not struggling in terms of their food – smaller rest homes often cater for differing tastes among their residents without too much hassle. Not in terms of their atmosphere – a small number of residents means they often feel part of a family. Not in terms of activities – a smaller facility can better tailor its activities to what residents want to do. Yet, many are struggling with low occupancy levels and to make their funding stretch to meet all their costs.

“

homes suffer as a result of the Government’s emphasis on keeping people in their homes. “You need look no further than the Health of Older People Strategy, where the focus is to obviate the risk of older people accessing residential care. Though no one has a quibble with keeping people at home for as long as possible, there is a consequence which impacts severely on the smaller facility – the client group is so fragile that when they can access residential care many go straight to private hospital care.” It was this situation which contributed to the closure of both Lady Ascot and Rawhiti Lodge. Rawhiti was licensed for 24 residents and had just 15 at the time of closure. At one stage there were 13. It is contracted to deliver Stage 2 rest home level care, offering a narrow window between independent living and hospital level care. Lamberth believes assessment thresholds of frailty and acuity are increasing and people are remaining longer in their homes, so that by the time a needs assessment results in a rest home referral, the resident is actually on the cusp of needing hospital-level care. Lamberth says they have had three residents in the last year who have been assessed in their homes as needing stage 2 rest home level care, only to find that they need to be reassessed and transferred to hospital-level care at a different facility within a few months. Northland DHB’s Sandie Kirkman, who sits on the Needs Assessment Service Coordination Agencies (NASCA) Executive, confirms that clients are now more of a higher acuity and are generally entering residential care when they are requiring a higher level than aged residential rest home level, such as aged residential hospital level, secure level or psychogeriatric hospital level. “This is predominantly because there is more availability of home care support services that are able to assist people to live in their own home longer, particularly if they have a carer at home,” says Kirkman. “Carer burden is reduced with the assistance of home care agencies so they are likely more

Many smaller facilities offer fantastic care and play a vital role in their communities.”

The squeeze on rest home level care

New Zealand Aged Care Association chief executive Simon Wallace says he frequently 2 August/September 2016 | www.insitemagazine.co.nz

hears concerns about occupancy levels from providers. He says the rising acuity levels of people entering residential care are partly to blame. Indeed, people entering New Zealand’s rest homes are more frail than ever; acuity levels are increasing. The Ministry of Health makes it clear that a needs assessment must show a person as having “high or very high needs, which are indefinite”. Further, the needs assessment – conducted by a DHB or NASC (needs assessment service coordination) agency – must determine that the person cannot be safely supported within the community. Consequently we find ourselves in a position where our home and community support service providers are stretched and our smaller aged care facilities are struggling to fill their rest home level beds as people are remaining in their homes for much longer. While needs assessments still result in people requiring rest home level care, it is often only a short time until a further needs assessment is required, resulting in a move to a higher level of care. Victoria Brown of Care Association New Zealand (CANZ) says smaller

Aged care able to keep their loved one at home. There is also an increase in those clients assessed as very high needs – in other words they would qualify for aged residential hospital level – who also continue to remain at home rather than enter care.” However, Lamberth believes that remaining at home for longer is not necessarily the best option for people with high needs, and they are likely to receive better care in a rest home. She says those remaining at home are more likely to suffer from social isolation. Consequently, it is difficult for smaller rest homes to compete with larger facilities in the area that offer a continuum of care. Mitchell Court in Tauranga is another rest home facing similar issues. It is a 35-bed facility, but has low occupancy. Manager Linda Rodrigues says smaller homes like Mitchell Court often get forgotten about or overlooked as all the attention tends to go to the larger facilities. She believes smaller homes play an essential role in providing residential care in their communities. “It is very important that we survive,” says Rodrigues, speaking about smaller facilities in general.

The role of DHBs and NASCs

It would appear those carrying out the needs assessments have a role to play in this, when perhaps they shouldn’t. A guidance paper that has been circulating since 2010 outlines where the responsibilities of DHBs and NASCs lie, making it clear that they should not be directing prospective clients towards one facility over another. However, Wallace says that anecdotally there was some evidence of DHBs and NASCs advising clients to only consider facilities that offered hospital level care. These concerns prompted Chris Fleming, DHB Lead for Older People’s Health, to write to the DHBs and NASC portfolio managers in April this year on behalf of the ARRC Joint Steering Committee managers, reminding them of their responsibilities towards prospective clients and that they shouldn’t be suggesting certain facilities over others. Of course, when taking into consideration the increasing levels of acuity for eligibility into residential aged care, the DHBs and NASCs can hardly be blamed for pointing out to people who might be requiring hospital level care very soon that they should probably consider a facility that offers hospital level care. It must be difficult for assessors to remain completely neutral about all facilities when some are a better long-term fit for people than others. Kirkman says one of NASC’s core roles is to provide all options to the clients and carers so that they are able to make an informed decision. “There are many other sources available for clients to seek advice from when choosing

a facility. Needs assessors are able to point clients to these resources for assistance.” Kirkman says that these include the Eldernet services resource via a booklet Where from here and their website, the Seniorline 0800 number and local advisory services, including Age Concern. She says clients may also seek the opinion of a health professional, such as their GP, the ward doctors, nurses and social workers, when choosing a facility.

Is hospital level care becoming the new rest home level care?

The real problem is the squeeze on rest home level care. It would appear that hospital level care is fast becoming the new rest home level care. According to research led by Dr Michal Boyd and published in the Journal of American Geriatrics Society, in the last two decades, the proportion of older adults living in residential aged care facilities has decreased in many countries due to increased community care, eligibility requirement changes, and other factors: “These trends have resulted in a resident population with steadily increasing dependency and healthcare complexity, but the model of care in many residential aged care facilities has remained relatively unchanged.” Wallace says members have informed him that due to the increased acuity levels of people entering residential care, they find themselves providing care that is more aligned with hospital level care, but funded at the rest home rate. The problem – and it’s a good problem in many ways – is that residential aged care facilities of all sizes are genuinely committed to delivering top quality care to their residents regardless of the level of funding. As a result, it is common for facilities to provide a level of care beyond their subsidy level. Mitchell Court is contractually allowed one hospital level bed as well, although this – just like the palliative care that the home provides on occasion – is subsidised only at the rest home level fee. The NZACA is calling for a distinct palliative care supplement in answer to the fact that many are providing this care by default, without the necessary funding. It seems that unless clearer definitions and corresponding funding levels are developed, the Government is likely to continue to take advantage of facilities’ willingness to deliver care beyond their means. Wallace agrees the funding model needs to be carefully looked at as well as what defines the various levels of care. “There is no silver bullet to this,” he says. Indeed it is difficult to effect change based on anecdotal evidence alone. In time, interRAI is likely to provide some answers. “When interRAI data is made available, it will give us a much better idea of what’s going on and will help inform policy,” says Wallace.

Are smaller homes sustainable?

But can we afford to wait in hope that things will change? As things stand, the sustainability for smaller facilities is of great concern. Small rest homes still bear the same types of cost as their larger counterparts. The costs associated with interRAI, compliance with existing and new legislation, auditing and wages are just some of the many components that facilities need to pay out of their meagre government subsidies. With low occupancy levels compounding this, many smaller facilities find themselves in a financially grim position. Lamberth says Rawhiti’s operation wasn’t financially viable for over a year, before it eventually closed. Wallace is adamant that we need to continue to offer resident choice. “Many smaller facilities offer fantastic care and play a vital role in their communities,” he says. “I keep reminding DHBs that we need to provide all kinds of options for people.” In an effort to recognise the good things accomplished by smaller facilities, the NZACA is introducing a new award category to this year’s Excellence in Care Awards – the Invacare Small Operator Industry Award. The managers of Lady Ascot believe that if things continue in the current vein, we will regret the loss of our smaller rest homes. “My greatest regret is that the government is oblivious to the problem that is being fostered by their policy and while the politicians and the DHB officials are languishing in their push for ‘bigger is better’ we, wearing our hats as taxpayers, will be required to pick up the huge costs of a correction when a shortage of rest home beds will become imminent following the gradual closure of small rest homes,” they state in the recent Jelica’s Link e-newsletter. Brown agrees that smaller rest homes are certainly needed. “It is not just that these homes are part of a community enriched by their presence, nor that they provide employment to tens of thousands of caregivers, nor that they provide a real option of care in a home. It is because of the vast numbers of aged people who are predicted to need care. By 2026 the estimate is that up to 20,000 more residents will need residential care. Home care services express concern that they struggling to cope with demand and informal carers are buckling under the strain.” Indeed, no one wants to see the small rest homes disappear. Like our small schools and corner shops, they help define our communities. But if we want to keep them, we are going to need more than an award and reminder letters. We are going to need policy and funding to keep pace with the realities faced by our smaller care facilities. www.insitemagazine.co.nz | August/September 2016 3

Aged care

Food:

does yours cut the mustard?

President and Chair of Dietitians New Zealand CLAIRE TAHU discusses the importance of aged care facilities having regular access to a registered dietitian.

ietitians are not ‘on the list’ of health professionals to provide free/taxpayer funded dietetic services to aged care facilities, yet this is a setting where good nutrition is crucial to wellbeing. Being able to list Dietetic Services on your facility profile is a great selling point and gives confidence to residents and their families that this important aspect of their loved one’s care is covered. Food served in institutions is always a hot topic and you should never underestimate the power of word of mouth to your facility’s reputation. These days many people are active on social media, including your residents’ families. Both happy and unhappy consumers are quick to post comments on Facebook and Twitter, and the messages spread. Working closely with your dietitian is another way to ensure you have your bases covered. Risk management is the modus operandi these days, and along with other aspects of care, nutrition risk needs to be controlled. Aged care facilities have the responsibility for ensuring that residents’ meals meet their nutritional needs, as well as being culturally and socially appropriate. Having a dietitian oversee the nutritional wellbeing of your residents is an insurance that you have mitigated the risk of inadequate or inappropriate nutritional care, and this does not need to cost the earth.

How can a dietician help?

A registered dietitian with expertise in aged care nutrition can provide your facility with a wide range of valuable professional services, including: »» expertise in menu planning and auditing »» guidance for the nutrition management of medical conditions such as dementia, diabetes and other chronic conditions »» assessment and interventions for residents with specific dietary needs (e.g. gluten-free and vegan diets) »» optimising nutrition care for residents with pressure injuries, clinically proven to improve outcomes »» support for patients requiring tube feeding (dietitians have enteral feeding in their scope of practice and may legally prescribe the feeding regimen) »» hands-on and up-to-date staff training on food safety, nutrition and special diets »» assistance with the development and implementation of nutrition policies 4 August/September 2016 | www.insitemagazine.co.nz

»» fortifying meals to increase energy and protein »» providing nourishing drinks between meals »» frequent weight monitoring.

»» expertise in kitchen design and equipment selection, kitchen organisation, staffing levels and job descriptions, potentially saving your facility tens of thousands of dollars.

Malnutrition a growing concern

Did you know that according to international studies, 40 to 60 per cent of residents in aged care facilities are at risk of malnutrition? We do not yet have published data in New Zealand, but a couple of national studies have been conducted and results are proving similar. Malnutrition risk and unplanned weight loss are the most common nutrition-related conditions among our aged care population. It is crucial that your facility has a welldocumented nutrition screening protocol in place to identify malnutrition risk. Your dietitian can work with you to develop a nutrition policy. A number of nutrition screening tools have been validated to screen for malnutrition in older people, including the Mini Nutrition Assessment (MNA) or MUST (Malnutrition Universal Screening Tool). The InterRAI assessment identifies a nutrition issue via a Clinical Assessment Protocol (CAP). If a resident is identified as being at increased nutritional risk, it is imperative that timely action is taken to prevent further deterioration in nutritional status. In the first instance this may include: »» offering extra high-energy snacks

If these measures do not reverse the resident’s weight loss, or if the screening tool identifies a high risk of malnutrition, the resident should be referred to a dietitian for intensive dietetic intervention. Bear in mind that older people are a vulnerable group and even short-term illnesses, such as a cold or a UTI, can have a dramatic impact on their nutritional status. Therefore, residents should be screened regularly (and at least quarterly or more often if concerns such as decline in health, poor intake or weight loss arise). Managing nutrition risk (whether malnutrition, or other nutrition risk such as poorly controlled diabetes or pressure injuries) is as important as managing any other risks. Using a registered dietitian is a significant strategy for your toolbox, and it gives you peace of mind that you have done all you can to keep your residents nutritionally safe. Dietitians New Zealand recommends that you contract the services of a registered dietitian as a key member of your team, and budget for this service accordingly. The dietetic service can be tailored to meet the needs of your facility by: »» contracting a dietitian to work a set number of hours a month, to cover both clinical as well as food service needs »» referring nutritionally at-risk residents as per the nutrition screening policy »» including a full menu audit undertaken at least every two years »» providing staff in-service for continuing education.

Stay in the loop

New information is constantly crossing our desks and Dietitians New Zealand is keen to ensure that aged care facilities are kept up to date. Our main avenue for informing aged care facilities of items of topical interest is our e-bulletin Dietitians New Zealand talks with aged residential care facilities. This e-bulletin is circulated quarterly to around 600 facilities and includes a feature topic, a few tidbits of information and a recipe. It’s only four pages, and it is always good to see this posted on staffroom noticeboards. It’s written in a conversational, jargon-free style.

Clinical

Active ageing JUDE BARBACK looks at why active ageing is more than just keeping physically fit and why it is so important.

t Beyond Fitness in Tauranga, there is a man named Ross who is 75 years old and can perform a perfect full-range squat on a BOSU ball. The exercise itself is impressive, but given Ross’s age, even more so. There will no doubt be many people like Ross dotted around the country who are actively looking after their physical health and fitness as they get older. But similarly, there are many older New Zealanders who are not. “There are pockets of the population who are well informed about the benefits of exercise and staying active as they get older,” says Philippa Batts, operational manager for AUT’s never2old programme. “However, a lot of people, whether through lack of opportunity or social challenges, do not see it as a priority.” Batts is keen to make it a priority and the growth of the never2old programme is testament to the increasing importance older people are starting to place on their health, fitness and general wellbeing.

The never2old programme

Phillipa Batts has just returned from the World Congress on Active Ageing in Melbourne and is pleased to report that when it comes to older people’s health, the university’s never2old programme is right up there with international best practice. AUT has been running never2old since 2002. The programme was actually born out of a student project. Dennis, who was 69 years old at the time, enrolled on a short course at AUT looking at exercise in older adults. As part of the course requirements he carried out a three-month project with 15 older adults that aimed at looking at how strength training could help maintain muscle mass and functionality. The project was a big success; the participants noticed significant results and were keen to continue. The never2old programme has blossomed since then. Batts says it has expanded dramatically. They have support from the World Health Organisation, the Ministry of Health and the American College of Sports Medicine. They have teamed up with the

YMCA, which delivers the programme in some of its facilities. The programme operates out of 15 centres, the largest at AUT itself. Batts says they have over 300 people on their database, with 200 regularly participating in one or more of the eight sessions it runs each week. The sessions cater for those with high frailty to higher functioning older adults, says Batts. The programme now carries a four-pronged approach, addressing the areas of strength and power, cardiovascular fitness, flexibility, and falls prevention.

The Poynton pilot

The AUT never2old team teamed up with Metlifecare’s The Poynton in Takapuna, to launch a six-month pilot that took the never2old concept into a retirement community setting. Poynton manager Craig Peploe says one of the residents, a retired physiotherapist, had asked Metlifecare if they could have an exercise class to rival Ryman’s Tripple A programme. The never2old programme looked like the perfect solution and a pilot was announced. Peploe describes Poynton’s residents as “very active, very competitive”. “We even have a 90-year-old table tennis player. He’s amazing,” he says. As such, he was unsurprised that 43 residents put their hands up to be involved. This had to be whittled down to 21, and of these people, 18 stuck with it for the entire six months. Phillipa Batts says the pilot is geared for the retirement village setting, without all the

usual gym equipment – just things like swiss balls and elasticated bands. Each week for an hour, the residents participated in many different exercises, including a warm-up, a lot of running around, weaving in and out of things, jumping over low obstacles, sit-ups and press-ups. The Poynton pilot participants got a lot out of it. Russell Fox, aged 83 years, says he hopes doing the programme will help him to maintain his health and vitality as long as he can. “Thirty years ago I had cancer,” he says. “Now I live for today.” He and his wife Shirley, aged 81 years, had participated in the never2old programme when it first began at AUT many years ago so they were delighted to take part in it again when they heard it was being offered at The Poynton. Shirley says that she enjoyed the programme immensely. “Parts of it were no trouble – I’d call it a Bobby Dazzler – but others were more challenging.” “I’m not a sporty person at all, but I definitely think exercise is important as I get older.” “I’ve had heart surgery and I have breathing difficulties so it’s hard to say if I improved much,” she says, “But a lot of the others did.” The participants were assessed at things like how many times one could stand up and down with arms crossed and other such measures. Batts says the assessment protocol could be tweaked slightly. She says many participants displayed obvious improvements that weren’t www.insitemagazine.co.nz | August/September 2016 5

Clinical necessarily reflected in the assessment data, which was perhaps too broad. Apart from that, however, all agree the pilot was a success. Craig Peploe says he has residents knocking on his door asking when the never2old programme will start up again. “Of the focus groups held afterwards, all but one said they’d like to be involved again.” Peploe says they’re looking to start never2old up again this month and it looks likely that an agreement with AUT will be signed to allow the programme to be expanded to other Metlifecare facilities, starting with the North Shore villages.

Why is exercise important?

Gary Syme, founder of the Born Again Bodies fitness and wellbeing programme, says that from our mid-thirties, if we are not doing resistance exercises, we lose approximately 150 grams of muscle a year. This means we could potentially no longer have the strength to do the things we used to do, such as lifting objects from the floor or hopping out of bed in the morning. “As we get older, we consider all this loss of muscle and associated strength to be inevitable. But it isn’t. Nor is all the associated bone loss. Nor is the loss of balance, nor the loss of flexibility. With age, we gradually do lose these things, but not at the rate most people are losing them right now – through lack of knowledge, lack of action, and lack of self-belief. The fact is you can lose muscle mass at any age. However, it is possible to slow – or better still – reverse these losses.” Exercising with weights strengthens muscles, bones, tendons and ligaments. Resistance exercises help with coordination, flexibility and cardiovascular fitness. It also helps reduce the risk of falls.

At the right level

Of course, not every older person can lift weights and move with ease. Many programmes rely on a certain base level of fitness or functionality for people to participate, however, some classes can be adapted to cater for those who are frailer than others. Craig Peploe says that while the never2old programme required residents to be fairly fit and mobile, the Poynton offered other exercise classes aimed at more residents who were more sedentary. Batts says the wider never2old programme offers different versions and also aims to modify certain exercises to cater for the different ability levels. For many years Ocean Shores Village in Mount Maunganui has offered an Exercise to Movement class that focuses on functional exercises and a Sit to Keep Fit class, which caters for the slightly more immobile residents. 6 August/September 2016 | www.insitemagazine.co.nz

Resident Jean Outram has participated in the Sit to Keep Fit class since she moved to Ocean Shores 18 years ago. “Due to a car accident years ago, I’ve got no kneecap on one leg so the sit-down class is ideal for me. It keeps me going,” she says. Outram is 89 years old, but some of the residents in the Sit to Keep Fit class are well into their nineties. She says she’s always been active. “My husband and I used to walk up and down the beach a lot. We used to go to gymnasiums as well.” She sees the exercise classes offered at Ocean Shores as an essential part of keeping physically fit. “I’m totally convinced that exercise is the key,” agrees Ocean Shores manager Sandy Quigley. She says they do all they can to engage the residents in staying fit and healthy. “Last year we ran a health and safety programme and used it as an opportunity to focus on some of the health aspects. We did things like get a physio in to demonstrate some functional exercises and we provided residents with some healthy recipes.” At the end of the day it is down to the individual to make their own choices. “It is independent living so it is up to the resident, but with nurses on site we can help steer people on the right path,” says Quigley. “I think peer support definitely has a large influence as well.”

The social and mental benefits

Certainly the social aspect of exercising is important. As AUT’s Philippa Batts says, the social opportunities that relate to engaging in such fitness programmes are a significant part of an older person’s health and wellbeing.

“We never discourage people who appear to be there more for the social side than actually taking part in the exercise,” she says. Resident Pat from Ocean Shores says she values the friendships gained from the exercise class and the morning tea they have afterwards together just as much as she values the class itself. Quigley says the instructor always ends the class with a joke and they all have a laugh together. They leave feeling positive and energised. Craig Peploe agrees that this is an important aspect of the never2old programme. “It’s great fun to watch. There’s lots of laughter, lots of camaraderie,” he says. Phillipa Batts believes exercise for older adults is as much about combatting loneliness and depression than it is about maintaining strength and muscle mass. Her efforts to incorporate cognitive mental health into the never2old programme will help strengthen this aspect. Batts says they’re currently looking at developing a fifth prong to the programme – that of mental health. “When people talk about active ageing they tend to think it’s just about physical fitness – but it is much more than that. It is also about cognitive mental health as well as social inclusiveness and opportunities.” Residents agree. “It’s just as important to exercise the brain,” says Jean Outram, from Ocean Shores. She stresses the importance of older people keeping mentally as well as physically fit. “We have bridge and computer club here too, you know,” she says. “Plenty of things to keep our brains and bodies working.”

Aged care

What do baby boomers want? New Zealand Nutrition Foundation chief executive SUE POLLARD gives a personal perspective on what baby boomers want – and don’t want – when it comes to food.

am one of those ‘baby boomers’ we hear about in the media. We are not the same as our parents’ and grandparents’ generations. We are living longer, we are more active, we are still working into our 70s. I completed my training as a dietitian in the 1960s, and over the years worked in many different dietetic roles, including foodservice management in hospitals, and nutrition and dietetic services in the community. For the past 10 years I have been the CEO of the New Zealand Nutrition Foundation. We have an active Healthy Ageing programme, which initially concentrated on nutrition communication and education for health professionals and caregivers in the aged care sector, but which now concentrates on nutrition initiatives for community living older people. Recently my own mother died. She was in her 90s, and until she had a stroke was fully independent and driving herself to the Bridge Club most days. She was very well cared for in an aged care facility as she faded away. Over the three years she was there I gained insights into what I would want in a rest home, and in hospital care, should I need to live there at the end of my life. So, from my own experiences as a health professional, a daughter and as a future potential ‘customer’ of residential care services, here is a personal perspective on what we baby boomers want when we come to your facility to live.

What baby boomers want General ‘wants’

»» Tasty, nutritious and familiar food – and of course dietitians should be involved in the meal and menu planning and as required for special nutrition needs, as they are the experts in the specific nutrition requirements of older people. »» Meals to be served at times the residents prefer – and over a reasonable period; for example, dinner could be served from 5.30 to 7.00 pm each day. »» Morning and afternoon tea and coffee (‘proper’ coffee) with a selection of snacks and fruit to be available between meals and for supper – served in the TV room and/or lounge. »» The opportunity for residents to contribute to the menu planning process. »» Regular new additions to the menu – encouraging the residents to try something new. »» Able to see the food being prepared (sometimes) and served (usually). »» Able to receive serving sizes of their choice and have seconds. »» Preferably a short-order kitchen next to the dining area. »» Able to invite visitors for meals (for which they pay). (A café on-site would be a bonus.) »» Special occasions, with special menus. »» To eat with others of their choice – or not, as they wish. »» Music while they eat.

Breakfast

»» Room service on request as well as self and table service in the dining room over an extended period. »» Cereal choices (hot and cold), fruit, freshly cooked toast, continental breakfast plus cooked eggs every day, other cooked breakfast options occasionally.

Lunch

»» Self and table service in the dining room. Picnics outside sometimes. »» Café-style food – sandwiches, salads, fruit, soup, light meals.

Dinner

»» »» »» »» »»

A ‘homely restaurant’ atmosphere for dinner, with wine service. À la carte dinner menu at least some of the time. In summer – BBQ meals, families invited. Menu choices preferably made at meal times. Vegetables self-served from dishes at the table.

What baby boomers don’t want

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Institutional atmosphere and surroundings. Dinner at midday or too early in the evening. Old-fashioned food that their grandmothers ate. Overcooked veges and too many stews. Too much repetition. Ordering all meals the day before. The same place at the same table every day. (There may be exceptions to this!)

Is this a tall order? I hope not. It’s how baby boomers eat at home these days. www.insitemagazine.co.nz | August/September 2016 7

technology

Get ready for the

‘eat and tweeters’ The baby boomers take a very different approach to food from their parents before them. JUDE BARBACK says retirement village operators and aged care providers need to prepare themselves for a generation of diverse and adventurous eaters.

know two very different baby boomers very well. First there is Alastair. He is such a safe eater that he considers pasta a fairly ‘out there’ alternative to the meat-and-three-veg dinners with which he has become so accustomed. Rice, ditto. In his defence, he claims that at least he understands that rice is an appropriate ingredient in a main meal; his father, Frank, by contrast was so baffled that his Meals on Wheels dinner should contain rice in the main course he phoned his son immediately. “They served me rice today,” Frank told his son in astonishment. “Not in the pudding! With the meat and veges!” The interesting thing about Alastair is that despite appearances, he hasn’t lived a sheltered life. He has travelled the world extensively – it’s just that wherever he goes, he manages to source a good steak dinner. Then there is Barb, who also loves to travel. However, she is a much more adventurous eater, with a love of spicy, exotic ingredients. Much to her children’s horror, she has embraced the ‘eat and tweet’ culture of frequently posting photos of her food onto social media. The generation before the baby boomers is largely defined by their acceptance of old age. They are generally happy to let new-fangled technology pass them by. They’re not really interested in trying new things – particularly when it comes to food. Exhibit A: Frank’s incredulity that rice can be used outside of rice pudding. The baby boomers, by contrast, are seldom separated from their smartphones and are keen on their food. It’s true. In a restaurant, there will inevitably be a table of weary thirty- and forty-somethings who have struggled through a hard week at work and paid above the odds to get babysitters for a night out. There may be the odd family. But it will generally be the fifty- and sixty-

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The generation before the baby boomers is largely defined by their acceptance of old age … the baby boomers, by contrast, are seldom separated from their smartphones and are keen on their food.” 8 August/September 2016 | www.insitemagazine.co.nz

somethings and the baby boomers dominating the tables, thumbing through the wine lists. Similarly at Nosh or Farro, the wannabe younger foodies are often found gazing longingly at the almond butters and the truffle-infused oils, while the boomers are loading their trolleys and swiping their VIP loyalty cards.

From mumsy cookery to food porn

Foodie culture has gone gangbusters in the last 10 years. The humble chef is now a culinary rockstar. The mumsy cookery show has been transformed by the likes of My Kitchen Rules and Masterchef, such shows commonly referred to as food porn. The ‘eat and tweeters’ like Barb – or ‘foodie photo junkies’ as they’re also known – have reached cultlike status. Indeed, as Smithsonian magazine said, perhaps cultural historians will one day refer to these first two decades of this century as ‘the era of oral gratification’, such is the level of our food fetishisation. But what happens when times like these coincide with a generation that is experiential by nature, is au fait with technology and has money to spend? The opportunity to develop taste profiles and food services that appeal to the baby boomers is a smart move, and as Trendhunter.com says, “opens up the definition of what it means to be a senior into something focused more toward discovery – in the realms of flavour and otherwise – than ageing”. But let’s not get carried away. Remember Alastair and his preference for meat, potatoes and peas? That’s not going to change as he gets older. And will Barb’s love of Thai-fusion food follow her into aged residential care, as her sense of taste and smell wanes and she finds some textures harder to swallow and certain ingredients harder to digest? The fact is, we don’t really know what baby boomers are going to want as they get older. We do know that right now they are a generation of more diverse and adventurous eaters than their parents. When it comes to anticipating what to bring to the table, it is really a case of ‘wait and see’. Care providers are going to have to be prepared to confront a wide range of tastes and opinions. And with ‘eat and tweeters’ about to embark on aged care, providers are going to be held accountable to what goes on their residents’ plates.

Aged care

The right nutrition:

counter frailty and improve your bottom line Author of Eat to cheat ageing NGAIRE HOBBINS discusses why it is so important to get the food right in residential aged care.

ood provision in residential aged care homes and all the services around it are too often seen as costs to the system that are best reduced, when in fact the opposite can be true. The provision of age-appropriate nutritional support is cost-effective because it not only enhances lives, but more importantly for tight budgets, helps reduce the very costly burden of frailty. Most people I know enjoy their food. But when people become older many things can impact on that enjoyment. Appetite is often reduced due to a combination of physiological changes, side effects of medications, social and food security problems, grief and other emotional and psychological issues. Add to that the paucity of older-age-specific nutrition advice and the all too common provision of food that is not up to the standard most of us would accept at younger age, and you have a recipe for malnutrition. We know malnutrition is common in aged care situations as well as in the community, but what is too frequently overlooked is the impact that has on your bottom line. Malnutrition underpins frailty mostly by contributing to loss of muscle mass and sarcopenia, but also due to micronutrient deficiencies in individuals. Frailty greatly increases the cost of care in so many ways: »» Increases required levels of assistance with ADLs, adding to manual handling costs in terms of equipment, time and effort. »» Increases assistance needs, also increasing potential injuries to care staff. »» Increases rates of illness, infection and delays recovery. »» Increases the incidence of pressure and other skin injuries. »» Increases rates of depression and worsens cognitive impairment. »» Delays wound repair, thus increasing costs in terms of staff time, medication requirements, dressings, infection control and, of course, quality of life and mobility. »» Reduces mobility, increases the likelihood of falls occurring. »» Reduces QOL and increases levels of dissatisfaction/complaints among residents and from family/friends of residents. Of course, at the end of life gentle and caring assistance is essential and some degree of frailty is often present. But there are many in

residential, and even in community aged care, for whom frailty is avoidable or even treatable with food and appropriate exercise/ activity planning.

Countering frailty

Frailty can be countered by combining targeted nutrition with exercise strategies to boost body muscle and activity levels, both of which not only improve health and quality of life, but also facilitate better food intake. One of the major components of frailty is sarcopenia, which is predominantly a consequence of loss of body muscle – caused by factors including age related changes in physiology, sedentary lifestyles and inactivity. And because body muscle acts as a reserve of protein to maintain an efficient immune system, for body organ repair and maintenance, for reserve brain fuel supplies and much more, losses eventually hamper many body systems. Lose enough muscle and multiple systems can fail – that is part of frailty. Protein requirements are about 50 per cent higher for people 75+ than they are for younger adults (0.8 g/kg bodyweight at 50 years vs 1.2g/kg bodyweight at 75 years) and are further increased by acute illness, surgery or infection.

Protein intake

Nutrition support is of great benefit: ageappropriate eating impacts on muscle in two main ways. If protein intake is inadequate for requirements two things happen: muscles need to release their protein to make up for the shortfall, so more body muscle is lost; and also, those low protein intakes reduce the ability of muscles to use the protein they get from food to rebuild. Sadly, protein intake is often inadequate in residential aged care due to a combination of inappropriate menu planning, unawareness of the importance of protein foods, poor appetite and the reduced intake of higher protein foods (often exacerbated by cooking methods that make chewing/ swallowing more challenging). It’s not easy for people with reduced appetites to eat enough food to get the protein they need, even if there is enough available on the menu. It can often be useful to fortify usual foods with protein so that the levels in everyday foods and drinks are higher.

Proactive involvement

It’s also extremely difficult to turn muscle loss and frailty around, even with good exercise and nutrition strategies in place so the proactive involvement of a dietitian in any residential or community aged care situation can pre-empt and thus help avoid potential problems. Weight loss is common in residential care as well as in the community and at a later age weight loss means muscle loss. And it can happen that individuals who have faced challenges accessing adequate food before their move into residential care, gain weight after moving in. Some weight gain can be useful, but if it is excessive, it reduces mobility and exacerbates various health conditions. In such cases, proactive dietitian involvement can lessen the impact of undesirable weight gain. I do want to emphasise that any residential care facility is a resident’s home, it is not a hospital. As such it is never appropriate to impose dietary restrictions on residents unless they request it. But that might be a topic for another discussion. Muscle loss and frailty prevalence is further exacerbated in residential care by physical inactivity. While programmes prompting movement are growing, commonly they are irregular, of low-intensity or are ‘seated’ activities that are an ineffectual countermeasure to the extended sedentary behaviours among residents. In situations where aged care providers have embraced current evidence and implemented programmes combining recommended protein intakes with effective exercise programmes, measurable change in residents’ health and wellbeing, including improved physical capacity, greater independence in daily activities, and reduced incidence of falls, depression and dysphagia have been demonstrated. In any residential facility, as well as in community care, an investment in activity planning as well as good food is an investment in reducing possible costs to the system. Not only that, but these are things that people moving into residential aged care are increasingly demanding, or certainly will be demanding very soon. Their provision provides a benefit to current as well as potential residents, increasing the desirability of a facility. Ngaire Hobbins is an Australian dietitian specialising in ageing, nutrition and brain health and is the author of two books that present the science in everyday language. Eat to cheat ageing and Eat to cheat dementia are available via bookstores in New Zealand.

www.insitemagazine.co.nz | August/September 2016 9

Clinical

Tackling the big issues in aged care INsite looks at the increasing number of older obese people and whether our aged care facilities are equipped to provide the care they need.

provision on a case by case basis, while others did not. Various schemes, such as the lending or sharing of equipment, or equipment libraries, have been trialled in the past, with little success.

ometimes it feels like everyone is claiming to be the fattest nation on the planet. The Americans, the Brits and even we Kiwis have all declared ourselves to have the highest proportion of obese people. While we can’t be sure who takes the unwanted accolade, the fact is that obesity rates are increasing all around the globe, including here in New Zealand. The Annual Update of Key Results 2014/15: New Zealand Health Survey found not only that almost one in three adults were obese, but also that a further 35 per cent were overweight.

Progress

Obesity in aged care

Unsurprisingly, the increasing number of obese adults in our society is having an impact on our residential aged care facilities. Residential aged care facilities are beginning to see more obese residents come under their care, including residents who are morbidly obese. Certain specialised equipment – known as bariatric equipment – is needed to safely handle the needs of these residents. The New Zealand Aged Care Association (NZACA) was alerted to the difficulties many of its members were having in supplying bariatric care. There wasn’t specified funding for residents in need of bariatric care and access to specialised bariatric equipment was reportedly difficult. The NZACA decided to investigate further and sent out a survey to its members about providing bariatric care, to which 99 members responded. The findings revealed that on average, care facilities have had 11 residents requiring bariatric equipment in the past 12 months. The most common items of bariatric equipment required by survey respondents were beds, followed by wheelchairs, shower chairs and hoists. Chairs and commodes were in lower demand. Bariatric equipment is expensive. A hoist can range in price from $3,000 to an eyewatering $10,000; a bed from $2,500 to $11,000. The costs don’t end there. In some cases, rooms, doorways, corridors and the built environment as a whole need alteration to handle obese residents and equipment. The survey found that half of providers purchased the necessary equipment, while 18 per cent leased it. For the remaining 32 per 10 August/September 2016 | www.insitemagazine.co.nz

cent such equipment was already available. Obese residents will typically require more time and staff to provide safe and effective care. It can take three staff to handle a morbidly obese resident. The survey found that on average, care facilities reported an additional 39 staffing hours per resident per week necessary to care for bariatric residents. Forty-five percent of respondents said they had extra staffing requirements when caring from bariatric residents. Perhaps the most compelling finding of the survey was that over a quarter (28 per cent) of facilities have refused admission to someone requiring bariatric equipment in the past 12 months. Following the findings of its survey, the NZACA saw bariatric care as a key issue in negotiating the terms of this year’s AgeRelated Residential Care (ARRC) agreement with the District Health Boards (DHBs). The NZACA argued that there wasn’t consistency among DHBs in the way they supported rest homes with their bariatric provision. Some DHBs looked at bariatric

However, progress of sorts was achieved in the area of a more formal equipment leasing arrangement. With the signing of the ARRC agreement, the DHBs are looking at a model to extend an equipment loan scheme to care facilities. NZACA chief executive Simon Wallace says progress has been made since then. The ARRC Steering Group, co-chaired by the NZACA, met recently to hear presentations from the chief executives of both Enable and Accessible on what they may be able to provide to NZACA members. Wallace says he will now be meeting with both organisations in July to work out how they can extend their leasing and/or buying schemes from DHBs to NZACA members. “Over time, my objective is for our members to be able to lease or buy bariatric equipment from both of these organisations at a competitive rate.” In its submission the NZACA also suggested setting a threshold on the weight rating of a standard bed or hoist. A resident above this threshold could qualify for extra funding with bands of funding applied at various stages of the obesity spectrum. This was not achieved in the ARRC contract negotiation process for 2016–17, but Wallace says it will remain as one of NZACA’s priorities going into next year’s negotiation. A review of the Ministry of Health’s assessment and provision of bariatric equipment is expected to take place over this year and next, which may help shape future changes with regards to bariatric care in residential aged care facilities.

Customised equipment

Discussions around the provision of bariatric equipment open the door into other areas of care that also require specialised equipment. As residents’ acuity levels increase, so does the need for more customised equipment to cater for their needs.

Bariatric equipment is just one form of specialised equipment. In its ARRC submission, the NZACA stated that its members were also reporting greater demand on other specialised equipment, such as gutter frames, pressure reflect mattresses, sensor mats, wheelchairs and wound dressings. “There needs to be a clear description of what is defined by customised equipment,” the NZACA’s submission states. Such equipment is currently excluded from clause D14 of the contract, yet care facilities are unclear as to what is ‘in’ and ‘out’ on this list. However, this wasn’t resolved in the latest ARRC negotiations and Wallace says he will continue to press DHBs for a clearer definition.

Clinical

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Perhaps the most compelling finding of the survey was that over a quarter (28 per cent) of facilities have refused admission to someone requiring bariatric equipment in the past 12 months.”

New Zealand’s

growing obesity problem A major study published in 2014 in The Lancet confirmed that obesity rates have climbed among New Zealanders since 1980. The study, ‘Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013’, was conducted by an international consortium of researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Associate Professor Tony Merriman of the University of Otago was a member of the study consortium. The study analysed trend data from 188 countries, including New Zealand. It found that the adult overweight and obesity rate in New Zealand is 66 per cent, up from 50 per cent during the past 33 years. Among children in New Zealand, 29 per cent are either obese or overweight, up from 18 per cent in just over three decades. What does ‘overweight’ really mean? Overweight is defined as having a Body Mass Index (BMI), or weight-toheight ratio, greater than or equal to 25 and lower than 30. Obesity is defined as having a BMI equal to or greater than 30.

Obesity rates high in older New Zealanders

An estimated 2.2 million adults in New Zealand are overweight, and of these, 960,000 are obese. Of the men, 450,000 are obese and 510,000 women are obese. Within the Australasia region, (Australia and New Zealand) New Zealand has the highest rate of obesity in both adults (29 per cent) and children (nine per cent). Half of all overweight women in New Zealand are obese. Obesity rates for women age 20 or older reached 30 per cent, more than triple the obesity rates among girls (nine per cent). Among boys, obesity climbed from about 10 per cent in childhood and adolescence to almost 28 per cent in adulthood.

By age group, there are four different ranges with the greatest proportion of overweight or obese men – all at 79 per cent: age 50 to 54, 60 to 64, 65 to 69, and 70 to 74. Women aged 65 to 69 are the most obese at 73 per cent, but women aged 70 to 74 and 60 to 64 rank second, both at 71 per cent. When looking at obesity alone, Australasia experienced the largest absolute increase in adult obesity since 1980 (from 16 per cent to 29 per cent) and the single largest increase in adult female obesity (from 17 per cent to 30 per cent) globally.

What is driving obesity?

Associate Professor Merriman said that it is widely accepted that increased calorific intake from energy-dense and nutrient-poor processed foods is a major driver of the increasing obesity rates in New Zealand and worldwide. “Decreasing levels of physical activity owing to societywide changes in lifestyle in adults and children also contribute.” He says the ‘obesogenic’ environment increases the average weight, but genes are a major part of the explanation as to why some people are obese and others aren’t, explaining 60 to 70 per cent of the inter-individual variation in weight. “These genetic variants, because they are inherited at conception, define biological causes of obesity. Many of these genetic variants have been identified – they highlight inadequate satiety signals and energy balance as important biological drivers of obesity.” Merriman says that intervention is needed to reverse the increasing obesity rates and will require strategic coordination by government. “It has to begin with public health approaches to reduce the total calorific intake of New Zealanders alongside approaches to increase physical activity. The former would require governmental policy change and specific interventions, such as reducing the price disparity between nutritious, healthy foods and energy-dense, nutrition-poor and unhealthy food.”

www.insitemagazine.co.nz | August/September 2016 11

Aged care

In need of some respite With respite and short stay admissions increasing, aged care providers are pleased to see some national consistency introduced for premium charging for respite residents.

Community care

any aged care providers have seen a steady increase in the number of respite and short stay admissions – with some facilities reporting over a third of their beds are occupied by short stay residents. Jenni Coles, Bupa’s Director of Care Services and Rehabilitation says she has seen an increase in respite admissions at Bupa facilities. “Some of our care homes see up to 40 per cent of their admissions in short stay/respite,” she says.

Coles puts the increase in respite care down to the emphasis on supporting people to remain in their own homes for longer. “The Health of Older People Strategy reflected the desire for the older people in our community to remain safely in their own homes for as long as practical,” says Coles. “Respite care and day care programmes are two services supported by the DHB to ensure that carers are also receiving the support they needed.

“The role of the carer is key in supporting an older person to remain at home. Respite care provides a break or holiday opportunity for the carer. For the older person respite care is often an enjoyable change – with new company, varied activities and knowing that the carer is taking a break.” However, respite care costs more to deliver. There are typically higher costs associated with admission and discharge, medication, servicing and staff costs.

Airbnb meets home care

JUDE BARBACK catches up with MyCare chief executive and founder Mark Jeffries about how the new home care worker matching service will work with New Zealand’s home and community support services sector.

ark Jeffries doesn’t have to give me the hard sell on MyCare. I’m well versed in online marketplaces, sourcing my babysitters and house cleaners from such sites. It was only a matter of time before an equivalent site emerged for the home and community care market. Based on the Airbnb concept, which matches hosts with travellers, MyCare is all about matching home care workers with clients. The site was born out of Jeffries’ growing concern of how to source home care for his elderly parents. Previously a partner at law firm Simpson Grierson, he now dedicates his time to IT start-ups. In the quest to find a solution for his personal situation, and that of his parents, MyCare was the obvious next project for Jeffries. He gives me a demo of the site, logging onto his mother’s profile. By clicking onto where she lives, it reveals a range of home care workers to select from. Each has completed a profile specifying their expected pay range, their qualifications and experience and what sort of work they do. Alongside each is four-tick system showing a robust verification system, including verification of telephone, email and address as well as a Ministry of Justice check. Since going live in December last year, the site has attracted an impressive 1,200 home care workers to log on. Of 350 jobs posted, there is an average of four matches with potential workers. Many already work for home and community care agencies, but as most agencies offer workers pay that hovers just over minimum wage and irregular hours, the site is clearly a good opportunity for workers to bridge the gaps in their employment.

12 August/September 2016 | www.insitemagazine.co.nz

“Agencies do a great job,” says Jeffries, “but the corporate model isn’t really working any more.”

A fairer wage

He says about 60 per cent of a customer’s payment for home care goes to the person carrying out the care, leaving the rest to cover overheads. Through MyCare, the worker receives a much higher percentage of the payment, making it possible for them to earn a fairer wage. I am unsure about how a system like MyCare will work with existing funding arrangements and Jeffries agrees that he wants to firm up this aspect before really promoting the site. He says the government is “very interested”. At present, based on a person’s needs assessment, he or she will receive funding for home care services. Such funding may come from the Ministry of Health, District Health Boards, ACC or the Ministry for Social Development, depending on the health need. These funders will then pay a home care provider to provide the service. At present each funder contracts to a small and limited number of providers – typically the large corporate players in the sector. Jeffries is in talks with the Ministry of Health about where MyCare would fit into the mix. MyCare can be used by those who are eligible for Disability Support Services, as determined by Ministry of Health-funded Needs Assessment Service Coordination agencies (NASCs). However, Jeffries perceives the site as a better fit for self-directed funding systems, like Australia’s consumer-directed care model. Certainly Jeffries thinks the site is better suited to New Zealand’s Individualised Funding model, which according to the Ministry “gives you increased choice and control

As such, aged care facilities have argued that they should be able to charge a premium rate for their respite care or short stay residents. In some parts of the country, this is already the case. Some aged care providers have tailored respite contracts with their individual DHBs which allow them to charge premiums. However, others are less clear on the matter. The New Zealand Aged Care Association (NZACA) pushed for all providers to be able to charge premiums on respite care in negotiating the Age-Related Residential Care (ARRC) contract. It felt the contract was ambiguous in this area. “With the ARRC Steering Group currently working to achieve national consistency on respite contracts, it is opportune that this review allows for all our members to be able to charge premiums on respite care,” read the NZACA’s submission.

The NZACA’s bid was successful and the ARRC negotiations resulted in all members being able to premium charge on respite and short stays, helping to offset costs in other areas. NZACA chief executive Simon Wallace regards this as a ‘win’ for aged care providers. “Anecdotally I have heard that some members are having up to 30 per cent admissions on respite and short stay care. This confirms the importance of the win the NZACA had out of the ARRC negotiation in being able to charge for premium services on these beds.” Coles is pleased to see a consistent approach to premium charging introduced for respite care. “The ability to offer a premium facility and services is welcomed, offering a choice of facilities and services and tailoring respite care to the interests of the older person.”

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The development of this service reflects the desire for people and organisations to use a range of means to find the right person to support the person they care for.”

to choose who provides this support, and how and when you use it”. Individualised Funding is available for people who are eligible for Ministry-funded Home and Community Support Services. People’s options range from engaging support workers and planning how their supports will be used, to employing their own care providers and managing all aspects of service delivery. Through individualised funding, the enduser should be able to engage a home care worker sourced via MyCare. In this way, MyCare could be a useful tool for the smaller agencies. Jeffries sees potential for the site to be their platform and means of attracting business. The flipside of this of course is that it could be a threat to the larger agencies. In any case, Jeffries believes funding, in whichever form it takes, provides for a very small percentage of a person’s actual care requirements. Home and Community Health Association chief executive Julie Haggie agrees. “I think that the development of this service reflects the desire for people and organisations to use a range of means to find the right person to support the person they care for,” she says.

“Government-funded support is gradually targeting more restorative and rehabilitative supports. People also need a range of other help, such as companionship, shopping, overnight care and social connection, and sometimes very specific support that is outside of what can be allocated.” Haggie is supportive of the MyCare initiative. “It is not always easy to find the right person, and matching services such as this could help with that. Also, there is a shortage of care workers across the sector. Members are keen to look at all options for matching the right person to the client.”

Mobile device access

Funding hurdles aside, the site ticks many boxes. Through their mobile devices (a mandatory requirement), home care workers can tick off each job as they do it and leave comments accordingly – effectively replacing the notebook on the side or the sticky note on the fridge, says Jeffries. What I also like about the site is the ability to keep other people in the loop. So while siblings on the other side of the world might not need to know about the minutiae of their parent’s care, they can still be included in the

general support circle. Similarly, neighbours, GPs, physios and other interested parties can be included where necessary. Like many online marketplaces, MyCare relies on self-regulation. Pay and the terms of employment are agreed between the client and the home care worker. Clients can post a review of the worker which is then visible for other prospective clients. With the Kaiawhina Workforce Development project happening in the backdrop, I ask Jeffries how well MyCare would adapt to the possibility of mandatory levels of training. There is a push for Level 2 to become the minimum requirement for home care workers. Jeffries says his goal is to develop online training capability on MyCare. He is currently working with Careerforce to develop a pilot that would help achieve this. “Ideally, I would like to get Level 2 for every worker on MyCare,” says Jeffries. He would also like to have scholarships available for workers. He aims to develop a ‘Learning Centre’ on the site; there is already a ‘Safety Centre’ up and running. Jeffries spoke about MyCare at the recent Retirement Villages Association conference – the retirement village industry is an interesting one with which to align. Some village operators view home care and community support services as a threat to their business as it keeps people in their homes longer. Others view the industries as complementary, with home care support serving to support village residents. Regardless of which view people take, one thing is for certain – technology is set to play an increasingly important role in aged care services. MyCare is just one iteration of the sort of innovation that will have a profound effect on the way our care industries will operate in the future. www.insitemagazine.co.nz | August/September 2016 13

Policy

Rates rebate for residents Could Ruth Dyson’s Rates Rebate Amendment Bill, drawn from the ballot in May, result in eligible retirement village residents being entitled to rates rebate? JUDE BARBACK reports.

n his address to the recent Retirement Villages Association conference, Minister of Housing Dr Nick Smith said that there needed to be more recognition that retirement village residents represent a proportion of home ownership in New Zealand. This statement is not particularly profound in 2016; after all, retirement village occupation right agreements (ORAs) are well accepted and understood as a different form of home ownership. Acknowledgement of the ORA should mean that retirement village residents are entitled to things that regular home owners are entitled, like rates rebate. After all, they pay rates, albeit in a different way – usually via the village operator through their weekly fees. So why are retirement village residents not entitled to a rebate and could this be about to change?

Changing times

In 1973, the Rates Rebate Act was passed. The purpose of this legislation was to provide some financial relief to ratepayers who would be financially stretched by paying local government rates on their properties. To qualify, a ratepayer’s annual income must not exceed $23,870 and he or she must be the named ratepayer on the rates demand. At the time the Act was passed, the concept of a retirement village with its unique ‘licence to occupy’ regime was unknown. Now, retirement villages are home to some 26,000 older New Zealanders. Many believe incomeeligible residents should be entitled to a rates rebate and there have been calls for some time to have the Rates Rebate Act to be reviewed. In 2007 the Report of the Local Government Rates Inquiry noted that the current rates rebate scheme had a number of exclusions and eligibility gaps that needed to be reviewed. The exclusion of retirement village residents was singled out as an example. The report recommended that residents be eligible for the rates rebate scheme. However, in order for this to happen, the Rates Rebate Act needs to be amended. 14 August/September 2016 | www.insitemagazine.co.nz

Dyson’s Bill

Then in May this year, the Rates Rebate (Retirement Village Residents) Amendment Bill was drawn from the ballot, sparking the possibility that retirement village residents could be entitled to rates rebate. The Bill was submitted by Labour’s senior citizens spokesperson Ruth Dyson, who describes it as “common-sense change”. “Most residents in retirement villages cannot currently claim a rebate because they pay them indirectly to the retirement village owner and therefore don’t get billed separately,” says Dyson. She says her Bill seeks to fix this inequity. “Some local authorities have recognised this problem and have changed their rating practices to bill retirement village residents directly. My Bill would ensure that – regardless of the billing practice of the local authority – residents are recognised as paying rates and are therefore entitled to apply for a rebate.” Dyson expects the first reading in August or September.

Arguments for and against

Not everyone agrees there is a case for change. Some officials have argued that retirement village residents are not ratepayers and are not liable for the village’s rates. However, under an ORA a resident is required to pay their fair share of the costs of running the village, which will invariably include rates on the village land. The costs are charged to residents as part of a weekly or monthly fee. The RVA argues that the rates demand from the council and residents’ fees are closely linked, as the rates component in their weekly fees can change if the village’s rates bill changes. The RVA says it is “but a step away” from stating that the resident is the ratepayer even though their names are not on the rates demand. A second argument against extending rates rebates to retirement village residents is that licence to occupy agreements (LTOs) are not registered as separate rating units and therefore the resident cannot be eligible for a rates rebate. While the RVA accepts this, it claims that as residents have paid a capital sum to live in

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the village, it is not a major step to amend the Act so they are covered. The RVA says that councils are increasingly charging rates across all units in a retirement village, rather than making one charge across the entire village, which suggests that councils see the individual dwellings in the village as rateable units. The third main argument is that any such change for retirement village residents could be seen as potentially unfair for tenants of rental properties. However, the RVA says there is a clear difference between retirement villages and residential tenancies. To live in the village, residents pay a capital sum, which the RVA describes as “analogous to the capital sum paid by a homeowner outside the village”. It can be considered a proxy title to the house, even though legal ownership typically remains with the village operator. The RVA describes it as “inconsistent” to deny a rates rebate to an income-eligible LTO resident when their neighbour over the fence is entitled to receive it, only because retirement village living wasn’t envisaged when the legislation was drafted.

Councils leading the way

Some councils already do provide rates remission for eligible LTO retirement village residents. Auckland, New Plymouth and Kapiti councils require that residents demonstrate some degree of hardship to prove eligibility, in the same way as any freehold resident ratepayer would do. A list of eligible residents is provided to the village and the total remission is deducted from the village’s rates demand. The remission is then passed on the resident via a discount in their weekly fee. The RVA says that while a modest amount of work is required by both the councils and the operators, they undertake this in good faith because they recognise the rebate is equitable for the resident. The RVA wants to see the practice extended across New Zealand by having the Rates Rebate Act amended. With the Member’s Bill now drawn from the ballot, it remains to be seen whether MPs share the RVA’s support for change.

My Bill would ensure that – regardless of the billing practice of the local authority – residents are recognised as paying rates and are therefore entitled to apply for a rebate.”

Retirement

Resident chitchat JUDE BARBACK joins a group of residents at Ocean Shores Village in Mount Maunganui for a cuppa to talk about food, exercise and village life in general.

s I’m told is tradition, the Ocean Shores Village exercise class finishes with the instructor sharing a joke with the residents. As it involves American politics and at least one sexual innuendo and one racial slur, I’m unable to print it here. But suffice to say it had the group in stitches. The majority of the exercisers head to a sunny corner of the dining room for a coffee and a catch-up. Today, I join them. They can either make themselves a free instant coffee or for a dollar have a fancier version from the machine. There are even two residents who would normally take part in the exercise but due to injuries they’re sitting it out this week. They join the group for a cuppa. “I don’t want to miss out on the coffee and the muffin,” jokes Nancy. Actually no one has a muffin and I admire their restraint as the muffins look warm and delicious. They strike me as a healthy bunch. Bev confesses that she’s normally “good” but will occasionally devour a whole bar of chocolate – a lady after my own heart. Another Bev says she’s never been much of a sweet tooth. Most in the group say that they’re simply continuing the good habits of a lifetime – that they’ve always been health-conscious and try to eat nutritious food. However, Margaret suggests that this group is perhaps the exception rather than the rule. The ladies agree that many of their generation don’t look after themselves as well as they could, with many eating unhealthily and not getting enough exercise. This can’t be said of these ladies, however. Pat says she is more active now than she’s ever been. While she and her husband moved to Ocean Shores four years ago, she only recently retired a few months ago from her job as receptionist at retirement and aged care facility Hodgson House. “I’ve suddenly got more time to participate in all that’s going on,” she says. Pat says her eating habits have also changed since retiring. While working, she’d hurriedly eat sandwiches in her lunch hour. Now she enjoys a more leisurely lunch, typically crackers and more fruit. Margaret is an avocado fan and will typically eat things like avocado and salmon with crackers for lunch. She also eats more fruit than ever. She doesn’t eat much between meals – none of the ladies do – but if she does, then it is a piece of fruit. “As you get older, you definitely eat less,” says Bev. “Even after exercising?” I ask. They all nod. I ask about their evening meals. I saw corned silverside on the menu as I entered the room but it transpires that no one around this table is likely to be eating in the restaurant tonight. “The restaurant should be used more than it is,” says Bev. “The restaurant is mainly used by those in the apartments,” says Margaret. The ladies around the table all live in villas. They all agree that the restaurant meals are excellent, however.

“Fish and chips on a Friday in the restaurant is the best,” says Pat. Residents can get their dinner to take away, or have it brought to their apartments if they don’t want to dine in the restaurant. There is apparently a good range of cabinet food regularly on offer too. I spot a sign advertising frozen takeaway meals for sale as well – macaroni cheese, meatloaf, fishcakes, roast beef and roast chicken meals among the selection on offer. I ask if they have people around for dinner. “Oh yes,” they all say in unison, looking surprised that I should ask. “I’ve actually got four people coming for dinner tonight,” says Bev. “My daughter has made me some lovely fish pies, so I thought I’d serve those with mixed salad and garlic bread. I’m thinking of doing a small seafood cocktail to start with, too,” she said. Everyone is impressed and there’s a chorus of “can I come?”, “where’s my invite?”, “room for one more?” and so on. Apparently a roast is a popular choice for feeding a crowd as well. What about dessert, I ask. “I rarely have dessert,” says Margaret. The others agree. “We used to always have dessert living on a farm,” says Nancy, “But we find we don’t need it anymore.” They really are a disciplined bunch. Busy, too. There’s a lot going on. “If you’re bored here, it’s your own fault,” says Nancy. “Just ask my kids. I’m never around!” She’s right – there’s plenty on offer to stop both boredom and loneliness setting in. The exercise class that they’ve just done is one small part of it. The ladies reel off a huge range of activities including lawn bowling, line dancing, walking groups, aqua fit classes and more. “Don’t forget the dress-up nights. We’re always dressing up here,” says Nancy, as half the ladies laugh, while the other half groan. “Nancy has so many costumes,” says Bev. And that’s just the activities within the village. Margaret believes it’s important to keep in touch with what’s happening outside the village. She fears becoming too insular if she doesn’t broaden her activities to the world beyond Ocean Shores. As a result she and her husband walk for about an hour most days. She belongs to the RSA Ladies club, plays cards on Thursday and enjoys bowls in the summer. She admits the move to a retirement village wasn’t easy. The move from a big house into a much smaller unit was a big step. Her husband was especially reluctant at the time. “He didn’t like the thought of all the old people.” She laughs at the irony but I do know what she means. ‘Old’ and all its connotations is not a word befitting these ladies. “I think he was also worried about losing money and spending the kids’ inheritance,” says Margaret. With one child in London and another in Auckland, however, Margaret says they need to be able to live independently. Continued on next page >> www.insitemagazine.co.nz | August/September 2016 15

Community Care

On the soapbox… Julie Haggie As the Home and Community Support Services (HCSS) sector is inching towards change, chief executive of Home and Community Health Association (HCHA) JULIE HAGGIE reflects on what it all means for employers, employees and clients.

“

Moving towards guaranteed hours will be a seismic change for employers and for workers.”

hange appears to be the one constant factor for the home support sector, and the pressures aren’t likely to ease up in the near future. Employers are edging towards a business-as-usual situation with paying workers for travelling between client visits. There is still work going on in relation to monitoring the model that has been put in place and in supporting workers and employers who are experiencing financial disadvantage as a result of the change. The whole initiative came out of an agreement between unions, employers and government, and that agreement had two parts. After a somewhat uncomfortable hiatus the parties have started talking about the second part of the agreement, which includes workforce ‘regularisation’ (guaranteed hours, more access to qualifications and payment to workers for being trained and a means of ensuring that workers have a safe workload according to the needs of clients). That requires a focus on interconnecting issues such as contracts and funding that will enable employers to deliver on those goals. Moving towards guaranteed hours will be a seismic change for employers and for workers. It has resource implications but the main issues will be around people, and we are going to need a lot of discussion, planning and patience to make the transition. Quality and sustainable service delivery requires a partnership approach between clients, workers, employers and purchasers. We are also hopeful that pay equity negotiations will resume, as

being able to offer decent pay is essential to recruiting and retaining staff. The turbulence caused by all the activity saps the energy of all staff, particularly business owners, managers, finance and administrative staff, clinical staff and coordinators. Many people in the sector comment that they look

forward to being able to focus more of their resources on clients. Recent service reviews in Capital and Coast and Hutt DHBs and in Bay of Plenty have resulted in contract changes, with some in and some out. The change that is now publicly known is in Capital and Coast/Hutt with those two DHBs opting to contract together with a single home support organisation. In making this decision the Boards of CCDHB/ Hutt would need a high level of confidence that risk factors involved with contracting a single provider have been covered. Those organisations exiting the service in these DHBs have given very good service over many years. We extend our commiseration to them as well as congratulating the successful tenderer.

A personal reflection on aged residential care As a last comment, I’d like to take off my home support hat and make a personal reflection. For several years my family has been supporting a family member living in aged residential care. I want to raise my personal hat to the individual care workers, the clinical staff and the management of this residential facility, as well as external specialist supports. It is somewhat of a collective journey that we have all been on, with many challenges and probably more to come. But I have seen them act upon the words of ‘person-centred care’. Our family is deeply appreciative of their compassion, patience, skill and professionalism. - Julie Haggie

<< Continued from previous page She said her husband also feared losing his privacy. “He thought people would be just coming into his house all the time,” she said, “In actual fact, we live very privately here.” Pat said despite moving to Ocean Shores four years ago, she didn’t really get involved with village life until she retired this year. Her husband is still working. “My husband and I didn’t really know our neighbours and kept to ourselves really. So I’m sort of a newbie!” she laughs. Pat said her husband had similar concerns to Margaret’s about moving into a retirement village. “I think he thought he would become old by moving here,” Pat said. However, having worked at Hodgson House until recently, she saw firsthand how difficult it was when people left the decision to move too late. “If they leave it too late the trauma of moving catches up with them,” she says. These ladies are all active and astute and good fun but I sense they have moved to the village with their eyes wide open about the realities of getting older. 16 August/September 2016 | www.insitemagazine.co.nz

Margaret says she and her husband consciously made the decision to move while they were both in good health. “If something happens to one of us, then the other is in a good position,” she says. It strikes me that all these lovely and lively ladies are in ‘good positions’ – and it is clear that they have contributed to this themselves by pursuing a lifestyle that is healthy and fun.

Retirement

Let’s snoop around…

Copper Crest Village Estate A television ad inspires JUDE BARBACK to visit a charming retirement village in Tauranga.

y visit to Copper Crest Village Estate was prompted by a TV advertisement. On a particularly uneventful week night, while I was watching a home improvement show of some description, Copper Crest popped up during an ad break. “You should do one of your INsite ‘snoop around’ articles on that village,” said my husband, idly. Mildly impressed that he’d read enough of the magazine to know about the ‘snoop around’ column, I made a mental note to call them. A week later and a short drive away I found myself driving down the wide, grand entrance to Copper Crest, amazed that I’d never ventured to this part of Tauranga before. Situated up on the hill with sweeping views across the harbour, the site has a real presence about it. It is one of those beautiful mild winter days we get in the Bay of Plenty – fresh to start with, but clear, windless, sunny and even warm as the day progresses. On a day like today, I can see what attracted Astrid Martin and her husband Bruce to this site. Together with their good friends, Joyce and (the late) Jim Wheadon, they purchased the 30-acre site in 2006. Prior experience with developing a nearby subdivision had prompted them to venture into the retirement village industry. They built eight units, sold two and then the infamous Global Financial Crisis hit, grinding progress to a firm halt. The Martins distanced themselves from it all, heading overseas for a year, leasing a boat and cruising down rivers in Europe. By the time 2010 rolled around, things were starting to gain momentum again, with 11 units sold and two more under construction. Fast forward to today and there are 100 units, home to 170 residents. There are 12 under construction. Eventually there will be 170 units here. There are no vacant units. In sharp contrast to those murky GFC days, business is booming at Copper Crest. However, Astrid says even during those turbulent times, they held faith in the demographic trends, which clearly indicated a demand for independent living options for the over 65s. Many retirement villages I’ve visited aspire to the youthfulness of Copper Crest. In fact,

here, the average resident age is around 70 years. Around 85 per cent of the residents are couples. Astrid says some residents still work, and some like knowing they can ‘lock and leave’ their home while they travel the world. In fact, the word ‘retirement’ is nowhere to be seen. It is marketed as a ‘village estate’ and there is a strong emphasis on independent living. People choose this place because of the appeal of living independently rather than the ‘organised fun’ that sometimes characterises villages with engineered activities. Rather the ‘fun’ finds its own ways of surfacing into village life. Today there are a large number of men playing bowls. Two women are getting their hair done. There is a library, an indoor swimming pool and spa. The lounge and balcony are bathed in sunshine and I can well imagine a group of friends enjoying a bottle of wine here in the evenings. Astrid tells me about a peanut growing competition between residents, a recent Royal morning tea to celebrate the Queen’s 90th birthday, and a kindly male resident who welcomes all newcomers with a freshly baked batch of pikelets. There is a strong fellowship group in the village. While there are scheduled happy hours and themed meals from time to time for those residents who want to participate, most activities are not

‘planned’ as such. As Astrid says, “they just happen”. There is no care facility on site but Copper Crest has a Memorundum of Understanding in place with nearby Althorp Private Hospital, which provides hospital-level and specialist dementia care. The MOU essentially gives Copper Crest residents a fast-track pass into Althorp. With Althorp now under the Radius umbrella, Copper Crest’s MOU extends to other Radius facilities, allowing them rest home-level care should their needs assessment head them in that direction. This continuum of care agreement is an excellent proxy for a care facility that I’m not sure would really fit the Copper Crest vibe anyway. Astrid and I jump on a golf buggy and careen down the hill in the sunshine to check out the village and have a look at a stereotypical villa. With two bedrooms, two bathrooms, a den and sun room, it is sunny and spacious. The décor is rather too beige for my liking, but no doubt a safe choice. Astrid is pleased to hear it was the TV ad that attracted me here. It was her idea to try television advertising and they also currently have an ad aimed at the Auckland market. As with the rest of the Bay of Plenty, villages are enjoying the flood of Aucklanders heading south for a more affordable and dare I say it, more attractive, lifestyle.

www.insitemagazine.co.nz | August/September 2016 17

Clinical

Spotlight on…

depression in our later years Chief executive of New Zealand’s Mental Health Foundation SHAUN ROBINSON discusses why depression in older people needs to be taken seriously.

Aged care

hile current world rates of clinical depression are thought to be no higher for people in the 65+ age group than for other sectors of the population, there is no room for complacency. With increased life expectancy and the bumper crop of baby boomers now reaching retirement age, depression in later life will become more of a public health issue in future, so it’s important that information about depression and older people is widely available. The fact that many older people are reluctant to seek treatment or are often misdiagnosed may account for some underreporting of late life depression. It may also reflect the stigma that still exists, particularly in older age groups, around admitting ‘weakness’ or having a psychiatric illness. These factors may partly explain why the risk of suicide climbs steeply with age, especially among men. Depression in older people can also manifest differently. For example, it will often present via physical symptoms that camouflage underlying emotional issues, the elder equivalent of a child complaining of a ‘sore tummy’ and not wanting to go to school.

Often GPs don’t have time, or are not trained to ask, the emotional questions. With conditions such as heart disease, stroke, Parkinson’s or Alzheimer’s, depression can be part of the illness, rather than a reaction to it. Blood pressure medications, tranquilisers, sleeping pills and yes, alcohol, can also depress mood so need to be monitored. Trigger points for depression can come with the transitions or crises of later life: things like a change in selfimage, retirement, redundancy, financial uncertainty, divorce, the death of a partner or spouse, a major illness or loss of hearing or eyesight.

What is depression?

So what is depression? That unwelcome black dog that no one ever whistles or welcomes? The key thing about depression that differentiates it from grief or loneliness is that it is a state of persistent and ongoing unhappiness. It is more than having the blues or being in the doldrums for a while. The depressed person loses interest in life’s pleasures. They may be irritable and withdraw from others.

They will experience a change in sleeping patterns, loss of appetite, or sometimes a weight gain, and often have difficulty concentrating or become forgetful. It is important to seek help early from your GP if you or anyone you know is experiencing some of these signs of something changing or of not being quite right. Depression in older adults can be complex; it is often accompanied by anxiety and sometimes there is confusion between depression and dementia. Older adults who are depressed can really slow down and their cognition, motivation, even their facial expressions can change and these things can be misconstrued as dementia. On the other hand a GP may diagnose depression when someone is really in the early stages of dementia. Another common issue is the blurring of lines between depression and grief. In its early stages, grief can be identical to depression. But grief occurs in response to a specific loss, and will gradually resolve over time.

Treatment, recovery and prevention

Treatment options for depression may include an antidepressant, a sleeping medication and ideally, psychotherapy sessions that include addressing unhelpful thinking patterns, advice on lifestyle changes, relaxation exercises and the importance of keeping up friendships and connections.

A day in the life of… Debbie Dillon INsite asks DEBBIE DILLON about her jobs as executive chef at Atawhai Rest Home and area kitchen manager for Oceania Healthcare and about her journey into food.

INsite: How did you get to be where you are today? Debbie Dillon: My mum and grandma are phenomenal cooks. Food, family and laughter were the basic ingredients in my upbringing. It is also the same for my children, and just quietly my daughter shares the same affinity with food. I really shouldn’t have been surprised when I fell into food. It was never a decision to become a chef, it just happened organically. A genuine love of food and the opportunity to learn from butchers, bakers, fishmongers and chefs drove my passion. My first job was at a supermarket and the product knowledge and skills I obtained from that experience helped set me up for my future career. 18 August/September 2016 | www.insitemagazine.co.nz

Several years, many kitchens, lots of learning, a qualification and a couple of cool kids later, I’m with Oceania. This was a choice that allowed me to stay with a career that I love but with hours that suit family life. I’ve worked for Oceania’s Atawhai Rest Home for almost three years. I started at Atawhai as kitchen and household manager before becoming executive chef and then area kitchen manager, managing four Oceania sites around Hawke’s Bay.

INsite: What does a typical day involve? Debbie Dillon: As area kitchen manager, I spend a lot of time mentoring. We go over plating and garnishing, planning menus, different ways of preparing the food, processes,

budgeting. Our cooks and chefs come from a wide range of backgrounds so we share, expand their knowledge and mine. We should all be continuously learning and willing to think about things differently. This collaboration inspires passion and creatively. Cooking is very creative and even though our chefs follow a national menu, they can put their own spin on it. We run ‘restaurant nights’ at our Gracelands and Atawhai rest homes; Duart will be starting

“

Depression in older adults can be complex; it is often accompanied by anxiety and sometimes there is confusion between depression and dementia.”

Going through a late-life crisis The Five Ways of Wellbeing – staying active, connecting to others, learning new things, taking time to notice and be mindful of the small joys in life, and giving to others – are practical but powerful ways to assist in recovery from depression. They are also great ways of ‘inoculation’ against the development of depression. Because depression can be linked with cerebrovascular disease, lifestyle changes in mid-life can be another key to warding off late-life depression. These include reducing blood pressure and cholesterol levels, giving up smoking, regular exercising and eating a diet rich in fish, grains and greens.

Support

Supporting an older person who is experiencing depression can be frustrating. Friends and family just have to hang in there. It’s about sensitivity and understanding what’s going on. Learn about depression and try to understand that it’s the depression that’s doing the talking, not the person. Telling them to snap out of it or pull their socks up is a big no-no. You can be the one to help pull the socks up for them. Drop in for a cup of tea. Invite them to accompany you somewhere. Be the trigger for something nice to happen for them. And most importantly, don’t give up!

soon. These nights give the chefs some freedom to express themselves, and residents and family the ability to share a comfortable and affordable dining experience. We also run theme days, picnics, parties, high teas, barbecues, and tributes to Elvis – it goes on and on. I have an incredibly supportive team and, together with amazing activities staff, healthcare assistants and the clinical team, we make it all happen.

INsite: What do you love about your job? Debbie Dillon: No day is the same and no day is an easy day. It’s so rewarding to be able to make a real difference to someone’s life. What our residents eat affects both their physical and mental wellbeing. When the food is tender and easy to eat, it helps them maintain their independence. It can bring back nostalgic memories, it can improve mood and provide a social outlet. If a resident isn’t thriving, we get together as a team to work it out because if someone isn’t eating well, their quality of life is affected. I also love mentoring staff. I

Nine years ago, Lance Girling-Butcher could easily have turned his back on the world. At 63 he was beginning to anticipate an active retirement from his high-profile job as editor of the Taranaki Daily News. Lance Instead, he was literally plunged into darkness, spending Girlingseveral months in hospital and eventually losing his sight. Butcher (photo “The whole thing was very depressing,” he says, recalling a by Jim series of horrendous treatments that included three operations Tucker and courtesy in one week. of the “It was a double whammy. As well as the emotional NZ Blind Foundation reaction to losing my sight, I reacted to anaesthetic. I had this overwhelming sense of panic and deep despair – it was absolutely terrifying and it came in waves. It did fade away, but at the time I didn’t get a lot of help in coping with it.” Luckily, as an experienced solo sailor he’d taught himself to handle panic. As well, he had the loving support of his family. Although not clinically depressed, Lance went through a period of mourning. “I couldn’t write, I couldn’t read, I couldn’t do anything. I’d lie awake at night thinking about all the things I wouldn’t be able to do.” The turning point came late one night when he heard a radio programme about a blind pilot who’d flown halfway round the world using talking instruments. “I realised that technology was going to be the answer for me,” he says. A screen reader from the Blind Foundation allowed him to read and write again. Nowadays an IPhone6 Plus with GPS provides another vital technological aid. Blindness has opened up a new and different world for Lance, who was recently named as the first Supersenior Champion by Senior Citizens Minister Maggie Barry and awarded the QSO in the last Queen’s Birthday Honours for services to the blind and seniors. Among his many activities, he talks to older people who are experiencing sight and hearing loss. “This is a generation that hasn’t grown up with technology. It’s the worst time of life when they’re least adaptable – the temptation is to just give up. Fear is the greatest inhibitor when you can’t see.” Some days, he admits, he still has to make a conscious effort to go out the door. “It would be so much easier to stay home.” Luckily, he has a positive attitude and a good sense of humour. He also has an acute awareness of how vulnerable some older people are. “They isolate themselves so they’re left lonely, lost and bored.” “The message is that it isn’t the end of the world,” he says of his own life-changing crisis. “But you can’t avoid going through the rough stuff.”

just really like people and being given the opportunity to help them develop.

INsite: What do you find challenging? Debbie Dillon: Our residents’ needs are always changing so you have to be on top of it all the time. If a resident has been ill or starts losing weight, we need to ensure there is extra fortification in their meals. If someone says they don’t want what’s on offer that day, we’ll find something that appeals to them. Food is all about hospitality – they are our customers and we’re here to please them. INsite: Tell us about your recent awards and the impact they’ve had on your career. Debbie Dillon: In 2015 I came second at the inaugural Senior Lifestyle Cuisines Competition and Atawhai won the NZACA Excellence in Food Service award. Those awards really lifted my profile and they are changing people’s perceptions of food in aged care. The reality is that our food is excellent and our menus are modern

and exciting. I think events and awards like these are wonderful for the whole industry. It shows that aged care is a viable option for serious chefs – that you can excel and have a really satisfying career in this industry. This year we provided the local winemakers from Church Road their meals over a busy vintage. They received exactly the same meals as our residents (only about three times bigger) and were really blown away. I do a lot of recruiting and the calibre of people who now want to work for us is amazing.

INsite: What do you want to achieve? Debbie Dillon: I come up with some unconventional ideas at times but I’m always striving to be better and to create new experiences for our residents. I’m lucky that I work for a progressive company and that my manager lets me run with things. I’ve also worked hard to earn the trust of our residents so when I put something new in front of them, they’re willing to give it a go. But they’re also very honest and if they don’t like it, they tell you! www.insitemagazine.co.nz | August/September 2016 19

Conferences

RVA Conference 2016 Things get a bit techy at the annual RVA conference in Auckland. JUDE BARBACK reports.

he theme for the recent RVA conference was ‘The technology in our lives’. The conference theme generally clues delegates up on what to expect, however I was not prepared for what the first keynote speaker, business futurist Morris Miselowski, had to say about just how techy it’s all about to get. Self-driven cars, family robots, exoskeletons, artificial intelligence, wearable technology, the Internet of Things – all featured in his presentation of a brave new world that will impact on us all. Unsurprisingly, Miselowski’s presentation focused on how technology will affect the next generation of older people. “Baby boomers are not afraid of technology,” he said, “After all, they created it.” Even so, I found myself mildly scared of the prospect of having my hair washed by a robotic machine one day, years from now, when I find myself in care. Thinking about the future is scary, to a degree. Exciting, yes, but also scary. Arguably the scariest point about Miselowski’s presentation about the future, was that many of the technological revolutions are mere years, rather than decades away. Also looming fast is the first wave of the baby boomer generation about to embark on retirement village living.

Baby boomer expectations

Miselowski had a lot to say about baby boomers and their expectations. He thinks the word retirement should be replaced with ‘reinvention’. Baby boomers are not accepting of old age, instead they are experiential by nature and are likely to keep doing, working, travelling, experiencing as they get older. They are no longer preoccupied with the quarter acre section, but rather interested in compact high-spec dwellings. They are less defined by the acronym DIY than they are by JDIFM (just do it for me). They want quality of life, a sense of independence and control, lifestyle, maintaining family relationships and easy solutions. Interestingly, Summerset CEO Julian Cook made the point in the CEOs’ forum later in the conference that no one can predict exactly what baby boomers are going to want. “I’ve heard it said that 50 is the new 40, 60 is the new 50, 70 is the new 60 – but 80 is still 80,” said Cook, to the amusement of the audience. 20 August/September 2016 | www.insitemagazine.co.nz

Keynote speaker, Morris Miselowski.

Major issues

The CEOs’ forum, which featured the bosses from Summerset, Metlifecare, Selwyn Foundation, Arvida and Oceania, highlighted some of the major issues for the retirement village sector. The biggest problem, according to Oceania CEO Earl Gasparich is that the industry has “got it so good at the moment”. He felt that the success of the retirement village model made it ripe for attack and scrutiny from industry outsiders. “If the public thinks we’re making money at the expense of the elderly, then we’ve got a problem,” he said. “We’ve got to do a lot to protect our model.” In sharp comparison with that sentiment, a question of wage rates came from the floor, prompting an uncomfortable discussion around what measures should be taken by the larger employers in the sector. Ultimately the CEOs felt the onus lay with government and society, as taxpayers, to increase funding to care providers to allow better wages for aged care workers. All agreed that care was underfunded and discussions revolved around the need to find new models for care provision, whether it be selling ORAs for care beds, or a move to a model more like Australia’s bonding system, or better collaboration with home care services. Arvida’s Bill McDonald felt collaboration was needed on this point. “As a sector we need a unified approach,” he said.

Conferences The winning team: Liz McKenzie, Chris May, Geoff Penrose and Terry Middlemost.

Integrated communities

The forum also discussed the need to move away from the gated community feel to villages that were more integrated with their communities. Metlifecare’s new CEO Glen Sowry gave the example of Metlifecare’s Memorandum of Understanding recently signed with the Auckland Kindergarten Association as a means of closing the intergenerational gap. He also talked about villages providing “a more seamless interface with retail and services”. Sowry’s predecessor Alan Edwards took the stand later to share lessons learned from his time at the helm of Metlifecare. Another panel discussion of interest was that between CBRE’s Michael Gunn and JLL’s Justin Kean. The former colleagues found little to disagree about in their discussions around oversupply, colocation models, geographic trends and the evolving preferences of customers. Minister of Housing Dr Nick Smith also addressed property issues in his talk, including concerns around the impact of the changes to

the Resource Management Act on the retirement village industry, Auckland’s housing problem and net migration trends.

Australian model

The Australian retirement village industry was of key interest to delegates although RetireAustralia’s Alison Quinn conceded that there is more they can learn from New Zealand than vice versa. Even so, her discussion around the collaboration between the village, care and home health sectors was compelling. Chris Baynes led a discussion on websites that rate and review villages and care facilities in Australia. Marketing, advertising, economics and media management also featured on the agenda, leaving no stone unturned for delegates. And of course the conference was punctuated by its usual array of excellent social activities. While I missed the golf and foodie excursions, I enjoyed the gala dinner immensely, and couldn’t resist a quick spin on the dance floor as the fantastic Lady Killers belted out some old favourites.

A word from the RVA Executive Chair To readers who attended the RVA conference this year, we thank you for the support and the almost universal praise on its content. For those of you who could not attend, you missed one of the best. RVA conferences have been an annual event since 1995 when it took the form of a half-day event at the now defunct Hotel De Vin. Over the years the topics covered have, much like the industry, expanded and matured. GST, legal structures, refurbishment, valuations and legislation are issues that all dominated until recently, when the increased scale and level of sophistication of the industry turned its thinking to more strategic and forward-looking topics. This past conference continued that theme with a rich mix of speakers, who without exception got the audience’s attention and challenged delegates in their thinking. While the underlying premise of what we offer will always be around security in its many forms, if we think the retirees of future years will accept yesterday’s or

Graham Wilkinson was re-elected RVA President by the Executive at this year’s RVA conference. Here, he shares what he learned from attending.

today’s offerings, we are very mistaken. While the baby boomer village invasion is still not upon us, it is inevitable that technology, branding and hospitality will all play a part in satisfying a more demanding clientele, than the ‘builder generation’ we currently appeal to. This conference reminded us that the future is going to be exciting but also dangerous – and technology can affect industries overnight. It also reminded us that while the current increase in house prices is welcomed, it cannot go on forever, although it is difficult to pick when a change may occur and to what extent. Another issue touched on related to ethics and social responsibility. We deal with the elder end of the human lifespan, but our youngest speaker outlined the issues overwhelming those at the other end. Global warming, ecological degradation, crumbling economies, refugees, house prices and elimination of careers as we knew them. This makes today’s world a scary place for a 20-year-old. What can we do to assist and to also ensure our offerings are always fair and ethical?

Perhaps the most gratifying aspect of conference was around the collegial manner in which our many large and small companies compete (generally speaking) and contribute. The phrase “a rising tide lifts all boats” is more usually attributed to the effect of public expenditure on lower socio-economic society, but in industry it also applies. Conference reminded us that our competition is not the other village down the road, but the family home, potential technology disruptors, house price swings, and complacency leading to a failure to recognise that change is required to remain relevant and competitive. In hindsight, the first event being at a hotel which failed to recognise its future now seems quite poignant and it is the same for the RVA conference. Fortunately, despite the high standard achieved his year, I remain confident we will not fall into this trap, and we will meet or surpass delegates’ expectations once again in 2017.

www.insitemagazine.co.nz | August/September 2016 21

Conferences

NZACA 2016 conference New Zealand Aged Care Association (NZACA) 2016 conference Theme: The pursuit of excellence – building on our strengths Where: Auckland, When: 4–6 October 2016

his year’s NZACA Conference aims to celebrate the quality of care provided by New Zealand’s aged residential care sector as well as confront the challenges faced by the sector. The programme, while still in the finetuning phases and subject to change, looks set to address issues relating to palliative care, interRAI, dementia care, the sector’s

workforce and much more through a selection of local and international experts on a variety of topics. Technological change is having an impact on many facets of aged care, from the business operation of facilities to the care they deliver. The conference will look at some of the trends emerging with digital technology and how providers are managing the change.

It will also look at how to manage the growing expectations of its customers in a highly regulated, tightly funded and competitive environment. As usual, the feather in the conference cap is the gala dinner, at which the winners of the annual Excellence in Care Awards will be announced. Delegates should start dusting off their sequins for the ‘disco’ themed evening.

NZACA speaker profiles Jamie Fitzgerald

In 2007 Jamie became the first ever Kiwi to reach the South Pole unsupported on foot with fellow adventurer Kevin Biggar. This 52-day expedition created media attention worldwide as they implemented a businesslike approach to reaching success. Jamie’s professional career has included marketing, financial, agricultural and education sectors. Whether using examples from growing his farm fencing business, or improving bottom-line performance during his various bank manager roles, Jamie’s rich supply of theory and real-life examples proves his ability to translate theory into action steps is very hard to beat.

22 August/September 2016 | www.insitemagazine.co.nz

Shamubeel Eaqub

Claire Madden

Shamubeel Eaqub is an experienced economist who makes economics easy. He is also an author, media commentator and a thought-leading public speaker. He has over a decade of experience as an economist in Wellington, Melbourne and Auckland in leading international banks and consultancy. He is on various boards of charities and commercial firms. He writes books in his own time on issues that matter to New Zealand and gives voice to the unheard. Shamubeel is currently on a career break to be a full-time dad and lives in Auckland with his wife and son.

Claire Madden is a social researcher, media commentator, keynote presenter, TEDx speaker, business consultant, and founder and director of the strategy and communications agency, Hello Clarity. Claire is in demand for her skill in effectively identifying the changing social trends and effectively communicating the engagement styles of the emerging generations. Claire is a professional in interpreting what this means for educators, managers and business leaders. In addition to delivering keynote presentations at conferences in Australia and overseas, Claire is booked to conduct training days for corporate and not-for-profit clients, facilitate panels across an array of industries and deliver workshops across diverse generations. Claire is uniquely placed as an expert on social trends, organisational culture and generational engagement.

Conferences

Chance for stand-out individuals to shine at this year’s awards Chief executive Simon Wallace has been at the helm of NZACA for one year now and he says he has been highly impressed by the quality of care provision. He urges facilities and individuals to enter the NZACA/ EBOS Excellence in Care Awards in recognition of their hard work. “Every day in this role I am consistently awed by the dedication and commitment of our members and the thousands of individuals who work across their care homes providing outstanding care and support for New Zealand’s elderly.” Following a review of the awards, this year they will be divided into two main categories – care home awards, and individual awards. Three new awards have also been added: the TENA Legendary Contribution to the Aged Residential Care Sector Award, the Leecare Solutions Stand-Out Individual Award and the Invacare Small Operator Industry Award. Wallace says the addition of the individual awards is particularly significant. “Aged care homes would be nothing without the individuals who work in them – from management to caregivers, chefs, gardeners, nurses, admin workers and volunteers. That’s why we have expanded the awards programme to include two new individual awards.”

The 2016 awards are as follows:

»» Overall winner »» EBOS Healthcare Overall Excellence in Care Award

Care home award categories

»» »» »» »» »» »»

Invacare Small Operator Industry Award Medi-Map Community Connections Award Health Ed Trust Training and Staff Development Award QPS Benchmarking Innovative Delivery Award Jackson Van Interiors Built and Grown Environment Award Bidvest Excellence in Food Award for Care Homes and Hospitals

Individual award categories »» Leecare Solutions Stand-Out Individual Award »» TENA Legendary Contribution to the Aged Residential Care Sector Award Entries close at 5pm on 11 August. The finalists will be announced in September, and the winners presented with their awards and prizes at a gala dinner on Wednesday 5 October, part of NZACA’s 2016 Conference at the SkyCity Convention Centre in Auckland.

HCHA 2016 Conference Home and Community Health Association (HCHA) Conference Theme: Looking in, looking out Where: Wellington When: 28–29 September 2016 The year’s HCHA conference will explore the challenges and opportunities of changes occurring in home and community services. It will give delegates the chance to look inwards at: »» clients – physical, mental, social or cultural needs, gifts and challenges »» workforce development including regularisation and training »» ways of thinking about the best ways of working with people and other organisations »» organisational quality, health and safety, information technology, financial management, privacy and governance. And it will also offer opportunities to look outwards at: »» health strategy planning and funding, medium and long term planning »» robotics and other technologies »» emerging and future care and support options »» what’s new in rehabilitation, restoration, injury and illness prevention and health and wellness promotion »» intersections between home support and other social systems. Programme details are yet to be confirmed, but more information can be found on the HCHA website.

www.insitemagazine.co.nz | August/September 2016 23

management

Last Word… Glen Sowry JUDE BARBACK interviews new Metlifecare chief executive Glen Sowry about his new role.

t is hard to believe Glen Sowry has been in the Metlifecare chief executive position for just two months. He could have fooled me that he’d been at the helm for much longer, such was his knowledge of the organisation and the retirement village industry. “The learning curve has been vertical,” he concedes, as we sit down for a quick chat during the recent RVA conference in Auckland. As part of his introduction to Metlifecare he has visited each one of its 25 villages that span the North Island, with 14 in Auckland. “Each village has its own idiosyncrasies,” he says. “Each reflects its community.” A highend premium village like The Poynton, for example, has a very different feel and resident profile from Pakuranga Village. Sowry is keen to maintain this localised approach and views it as one of the strengths of the business. I ask him about the ‘care’ in Metlifecare. As things stand, just nine per cent of its product is devoted to care. These days – and this is true of all operators I can think of – no one is building standalone villages anymore, rather most incorporate a care facility into the village development. Care facilities are seen as increasingly important in retirement villages. While perhaps not making village operators a whole lot of money, they offer their residents a continuum of care, thereby adding value to the village experience. However, Sowry makes it clear he is not keen to simply follow suit when it comes to expanding Metlifecare’s care operation. He takes a considered, future-focused approach to development. “The big question is, what will the future of care look like?” he asks. With changing resident expectations and technology enablers, he believes we need to be careful not to blindly follow traditional care models. He points to the Government’s emphasis on Ageing in Place and the DHBs contracting models for home and community care provision, which he expects will continue to evolve in the next few years. Sowry also suggests that the value the resident places on care and what they will pay for care also come into the equation. It strikes me that this is perhaps a very different conundrum to the sort that Sowry 24 August/September 2016 | www.insitemagazine.co.nz

“

Each village has its own idiosyncrasies. Each reflects its community.”

was used to facing as chief executive for Housing New Zealand and I ask him about the jump from public to private. “I believe you’ve got to be true to yourself and I realised that a career in the public sector was not for me,” he said candidly. Of course, he has had ample experience in both public and private sectors, having previously held an executive role with Air New Zealand. He was keen to give a CEO role a go and the Metlifecare position presented itself as the perfect fit for his ambition.

He felt Metlifecare was already in a strong position yet had untapped potential. “I saw there were opportunities for growth both on the macro level but also for Metlifecare to be more impactful.” The latter relates to better meeting the needs of the resident of the future. His previous positions have equipped him for this challenge. He says his Air New Zealand days in particular have taught him the importance of customer centricity and embracing innovation. “I firmly believe that no business has a divine right to customers,” he says. With his appointment to the helm, Sowry has inherited a generous staffing pay structure negotiated with the union. “It is the right thing to do,” says Sowry. Its improved pay scale will see Metlifecare in a better position than most to adapt to any pay levels that could potentially be enforced as a result of the equal pay dispute. But more importantly than this, Sowry believes Metlifecare holds a leadership role in the sector, particularly when it comes to looking after people. His philosophy is that by looking after people in whatever role they play in the organisation, whether they are staff, customers or shareholders, all will benefit. “I believe in meritocracy rather than seniority,” he says. I think back to the time I was given a chocolate heart wrapped in red foil during a visit to a Metlifecare village several years ago. I remember thinking it was a clever – and delicious! – way of reinforcing the company’s branding with its heart at the centre of its logo and message. I’m interested to see this heart continue to filter down to every corner of the business, even with new leadership in place. Sowry sits on the RVA executive team and has a flurry of meetings to attend throughout the conference. I am conscious of this as I dominate his time, but before he goes I’m eager to know what he is most excited about as he gets stuck into his new role. “The competition,” Sowry says, lighting up. He alludes to both existing players and new competitors to the sector. He relishes the challenge that competition presents, in terms of driving innovation and improvement and striving constantly to raise the bar.

Subscribe to INsite is a magazine at the heart and soul of New Zealandâ&#x20AC;&#x2122;s aged care, retirement, and community care sectors. Through its close ties with industry associations and attendance at conferences, INsite provides extensive coverage of the issues that are important to the sector. INsiteâ&#x20AC;&#x2122;s four themed editions include retirement villages as a business, long term care needs, nutrition, diet and clinical focus. Each issue is packed with in-depth feature articles and opinion from your colleagues. INsite reaches the decision makers. It is targeted at owners and managers of New Zealand aged care facilities, chief executives, financial officers, directors of nursing, government departments and decision makers directly involved in the aged care and retirement sectors. Subscribe to INsite today so you can be in the know about what really drives the sector.

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