Aged Care Australia Spring 2010

Aged Care Australia Voice of the aged care industry

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contents

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National Update CEO’s Report President’s Report State Reports Congress 2010

Cover Story 21 East meets West in the NEC Connection 23 Enhancing Aged Care through Cloud technology

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Technology ACIVA – Winning achievements ITAC and Australia’s Healthcare Future IT Awards in Aged Care 2010 Provider Assist: more funding > more resources > more care Japan takes another step in replacing humans with robots

ACAA OFFICE HOLDERS PRESIDENT VICE PRESIDENT DIRECTORS

EDITOR PRODUCTION

Bryan Dorman Francis Cook Tony Smith Mary Anne Edwards Viv Padman Geoff Taylor Kevin O’Sullivan Rod Young Jane Murray

Profiles ACAA Board Member, Tony Smith Professor Chris Nordin: A profile of a remarkable man

Workforce 43 Industry Feedback 44 All of the Kudos… None of the Cost

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Sponsor Articles Notes from an Architect’s Diary – Aged Care Projects New online courses – available now PROVEN* 10% Saving of Energy Contracts via the Auction Process Sanctions – prevention is better than the cure

ACAA - NSW

ACAA - WA

PO Box 7, Strawberry Hills NSW 2012 T: (02) 9212 6922 F: (02) 9212 3488 E: admin@acaansw.com.au W: www.acaansw.com.au Contact: Charles Wurf

Suite 6, 11 Richardson Street South Perth WA 6151 T: (08) 9474 9200 F: (08) 9474 9300 E: info@acaawa.com.au W: www.acaawa.com.au Contact: Anne-Marie Archer

ACAA - SA

81 Product News

Unit 5, 259 Glen Osmond Road Frewville SA 5063 T: (08) 8338 6500 F: (08) 8338 6511 E: enquiry@acaasa.com.au W: www.acaasa.com.au Contact: Paul Carberry

AGED & COMMUNITY CARE VICTORIA

FEDERAL

ACAA - TAS

AGED CARE QUEENSLAND

PO Box 335, Curtin ACT 2605 T: (02) 6285 2615 F: (02) 6281 5277 E: office@agedcareassociation.com.au W: www.agedcareassociation.com.au

PO Box 208, Claremont TAS 7011 T: (03 6249 7090 F: (03) 6249 7092 E: smithgardens@bigpond.com Contact: Tony Smith

PO Box 995, Indooroopilly QLD 4068 T: (07) 3725 5555 F: (07) 3715 8166 E: acqi@acqi.org.au W: www.acqi.org.au Contact: Anton Kardash

ACAA OFFICES

Editorial Funding the future of aged care: A Deloitte and Aged Care Association perspective SAGE visits China and Hong Kong Calendar of Events / 2011 Diary Dates Australian scientists achieve major Alzheimer’s breakthrough No time like the present: the importance of timely diagnosis Fragile Facilities: Serious Risk Exercising – Balance and Motor Coordination Entrepeneur of the Year Award

Level 7, 71 Queens Road MELBOURNE VIC 3000 T: (03) 9805 9400 F: (03) 9805 9455 E: info@accv.com.au W: www.accv.com.au Contact: Gerard Mansour

Aged Care Australia is the official quarterly journal for the Aged Care Association Australia

Adbourne PUBLISHING

Adbourne Publishing PO Box 735 Belgrave, VIC 3160

Advertising Melbourne: Neil Muir (03) 9758 1433 Adelaide: Robert Spowart 0488 390 039 Production Claire Henry (03) 9758 1436 Administration Robyn Fantin (03) 9758 1431

DISCLAIMER Aged Care Australia is the regular publication of Aged Care Association Australia. Unsolicited contributions are welcome but ACAA reserves the right to edit, abridge, alter or reject any material. Opinions expressed in Aged Care

Australia are not necessarily those of ACAA and no responsibility is accepted by the Association for statements of fact or opinions expressed in signed contributions. Aged Care Australia may be copied in whole for distribution among an organisation’s staff. No part of Aged Care Australia may be reproduced in any form without written permission from the article’s author.

www.agedcareassociation.com.au

www.adbourne.com

Front Cover: Tania Jose, Registered Nurse, working at the nurses station at Mosman Trust – Peter Cosgrove House. Photo courtesy of Caroline Lee, Director and CEO, leecareplus.

national update

CEO’s Report

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Rod Young CEO, ACAA

COMPLAINTS INVESTIGATION SCHEME Quality System – Compliance Failure?

It is difficult to understand why the Department of Health and Ageing takes such a legalistic, compliance focussed attitude under the banner of the Complaints Investigation Scheme.

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There is no intent in the CIS to systematize quality improvement. It is simply a compliance monitoring system that fails to address the fundamentals of any standard quality improvement system.

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t seems to stem from a perception that the only people capable of defending the interests of our clients, the care recipients of our care, are the employees of the Department of Health and Ageing.

It will come as a surprise to most people doing the real work in aged care that this is the case; as most of the care and nursing staff I meet across aged care believe they are the ones with the interests of their clients as their primary focus.

This conflict of perceptions, is I believe, one of the primary disconnects between the quality performance employed in aged care services with the focus on demonstrable quality improvement systems and a compliance process that does not integrate with the quality systems being deployed in aged care services to ensure that customer feedback is an integral component of quality performance in aged care services.

If you are a staff member in an aged care facility, it is hugely confronting to be visited by a CIS investigation team who take a highly legalistic approach to a complaint the nature of which you may know little or nothing about. You are treated as guilty until you can prove you are innocent.

Why, one must ask does DoHA take this approach? After all, they are supposed to be investigating a complaint and determining whether there is an issue that the provider needs to address. It should be recognized that in most of these ‘investigations’ there is no attempt to find a resolution for the complainant simply a determination as to whether or not the aged care provider has or has not met their obligations under the Aged Care Act 1997.

If you are a client of this system and expect some form of quality service from DoHA you are very likely to be highly disappointed.

You are unlikely to receive a logical resolution to your complaint. Just a letter often six to nine months later that the approved provider has/has not complied with their obligations under the Aged Care Act 1997.

What would be very welcome would be a commitment by DoHA to achieve

a customer outcome equivalent to that expected of aged care providers. For example, could the aged care industry expect from DoHA a commitment to respond to finalize a complaint within 90 days, to work with both parties to achieve a resolution, to work with aged care providers to ensure complaints are an integral part of a quality improvement system; that the CIS recognize that aged care providers are required under the accreditation standards to have robust grievance management processes and to deploy these systems to manage any complaints from clients or their representatives.

There is no intent in the CIS to systematize quality improvement. It is simply a compliance monitoring system that fails to address the fundamentals of any standard quality improvement system.

Professor Merilyn Walton in her review of the CIS system strongly recommended to the Minister that the system be significantly over hauled. In her report Professor Walton recognised that the current scheme does not even approach a quality improvement system.

A fundamental question asked by Walton and aged care providers is where is the link between the aged care services quality systems and the CIS scheme? There appears none. DoHA believes the two are closely connected, which again demonstrates the world view of quality improvement systems and DoHA’s rather narrow view that compliance CIS style achieves the same outcome.

ACAA does not believe that the Minister’s response to the Walton report by giving DoHA an additional $50m over four years is an answer. That it fails to recognise the huge gap between supporting industry quality improvement and the very unnatural compliance regime imposed on the system by the Department.

ACAA believes there is an urgent need to reform the CIS to ensure it complements the industry’s quality systems not acts in opposition to the industry’s objectives. n

aca Aged Care Australia | Spring 2010 | 5

national update

President’s Report Bryan Dorman, President, ACAA

REFORMING AGED CARE The Long Term Funding Options During the preparation of the ACAA submission for the Productivity Commission we conducted a workshop with Deloitte to explore the issues surrounding long term funding of aged care.

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If a major change in public policy over the next 20 years is to expand the range of choices and options available to consumers then it is essential that consumers be in a position financially to exercise choice through the ability to pay for different levels of care and service.

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he work of the workshop was converted into a discussion paper and submitted to the Productivity Commission as part of the ACAA submission.

What I found quite interesting about this process was the almost total unanimity among aged care providers, bankers, valuers, accountants and financial advisers that the aged care system needs an additional funding stream. That the current dependency on a single funder the Commonwealth Government with a smaller contribution from clients through fees means aged care service providers are far too dependent on a single income stream for survival.

With the current financial year Commonwealth Government contribution to aged care set to cost $10.7B there is inevitable pressure within the Government to keep a lid on their fiscal exposure to aged care expenditure.

If, as estimated the Commonwealth’s outlays to support aged care will double in real dollar terms by 2030 then aged care will be a cost to the Commonwealth per annum of approximately $21B based on 2010 dollar values.

With client contributions based on the current scheme and no additional copayments being generated aged care will have total income in the order of $28B by 2030.

If a major change in public policy over the next 20 years is to expand the range of choices and options available to consumers then it is essential that consumers be in a position financially to exercise choice through the ability to pay for different levels of care and service.

However, choice cannot be provided if all the clients contributions are being applied to basic service provision. Nor can choice be assured if Government is being asked to provide a substantial budget outlay to support aged care.

The other issue of fundamental importance to this issue is that if the Commonwealth retains the role of primary funder, regulator and legislator then there will be an ongoing desire to limit choice and innovation in the name of political safety.

All of these issues led the Long Term Funding workshop referred to above to come down strongly on the side of a third funding stream for Australian aged care.

As the sheer numbers of Australia’s over 65 aged group start to impact all forms of health and aged care service provision these rapidly escalating costs either get absorbed by the taxpayer which will within a decade; start causing severe intergenerational costs to the younger generations or Government makes some significant decisions to prepare for our ageing population through a range of funding options, such as: • • • • • •

Long term care insurance Health savings accounts Preserved additional superannuation contributions Social insurance compulsory for all from an agreed age e.g. 40 years Expand the medicare rebate and extend to aged care services Extend Private Health Insurance to cover a range of health and aged care services for the older generation

These are a range of outcomes that the workshop considered and strongly recommended in the submission to the Productivity Commission. ACAA does not believe that the aspirational desire of enhancing the choice of future aged care clients can be satisfactorily achieved without some form of third party payer system being created as part of the reforms flowing from the recommendations of the Productivity Commission’s review process. n

aca Aged Care Australia | Spring 2010 | 7

national update

ACAA – SA Paul Carberry, CEO ACAA - SA

Celebrating our Staff Our annual dinner and awards night, held on 20th August, was a great success, from two important perspectives.

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irstly, it’s satisfying to hold a social event under the ACAA-SA banner, which brings together our members and many of their staff, along with many of the major suppliers to our industry.

Winner of the 2010 Aged Care Excellence Award, Lynn Skewes, from Ananda Aged Care L-R: John Dennis, CEO of Ananda, Lydia Boyle, Executive DON, Lynn Skewes, Dr Prabhash Goel, Proprietor

Held at the Intercontinental Hotel in the heart of the City, the dinner was a night of good food, entertainment, prizes and fun.

The dinner is also the occasion at which we present the SA “Aged Care Excellence Awards”, now in their fourth year. The Awards recognise staff who go above and beyond the call of duty in their work, who demonstrate initiative and who make a real difference to the lives of relatives and residents.

Staff at all levels of their organisation are eligible for the Awards, and nominations are submitted in writing by the person’s senior management, in consultation with other members of staff. The written nominations are then submitted to a panel of judges, who are given a clear set of criteria to judge against.

To ensure complete independence, the three judges are from outside the aged care industry; however they all have a background in management and staff development. They are asked to select four finalists and then allocate points to each finalist to determine the winner.

The pride on the faces of the finalists as they came forward to receive their awards told the story. We all like to be recognised for our work and achievements, and being, firstly nominated by their management, and then independently chosen as finalists is a great honour, which the finalists clearly felt.

But, it’s much more than that! Holding these Awards and promoting their importance, provides a strong message about the importance and value of our staff. We can’t hold awards every week, but employers can do something every week to recognise, acknowledge and reward the work done by their staff. Most of these things cost little or nothing.

The regulatory and compliance system under which aged care operates is intent on catching people doing something wrong. We need to catch people doing something right, and make them feel good about it.

ACAA-SA is grateful to the major sponsors of the dinner and the awards. – Bankwest, Guild Insurance, Hesta Super Fund and Lee Total Care. n

national update

ACAA – NSW

In response to member requests, ACAA-NSW worked with a group of NSW providers who had made a decision to move to agreement making, and for the first time worked to create a model agreement for NSW aged care providers.

Charles Wurf, CEO ACAA-NSW

The consolidation of agreement making in aged care During the last quarter the aged care industry in NSW has continued its measured transition to enterprise level workplace agreements.

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he advent of the modern award system from 1 January 2010 and the commencement of the deferred transitional arrangements to 1 July 2010 provided the momentum for another round of first-time agreements.

The outcome for those members has been a single agreement for the workforce, and the agreement has now been favourably assessed to meet the BOOT test against the Nurses Modern Award and the Aged Care Modern Award.

With agreements completed to date and others in the pipeline, somewhere around 100 facilities will move to their first agreement via the ACAA-NSW model agreement. This agreement now provides those facilities with a future choice when the agreement expires to renegotiate to suit

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the requirements of each organisation, or to remain in any renegotiated model agreement.

Added to the recent history of agreement making in NSW, a significant majority of aged care staff in NSW are now covered by a variety of enterprise agreements, creating a diverse and flexible labour market.

While the mechanisms of enterprise level bargaining are now well entrenched in aged care, macro level aged care workforce considerations will still continue to have a significant impact on enterprise level outcomes. Our ultimate workforce outcomes expressed through agreements will continue to be constrained by the regulatory and funding regimes within which we are bound.

Aged care has probably reached the outer limits of current workforce productivity given the constraints of the regulatory, funding and indexation systems.

As all who work in aged care know, the reform of those constraints awaits the incoming Federal Government. n

national update

Aged & Community Care Victoria there is the added pressure of program boundaries which limits the industry’s ability to provide a continuum of support and care for people who remain in their own homes. Together these situations threaten to place both families and carers in the invidious position of not being able to find the right care in the right place when they need it in years ahead.”

Gerard Mansour, CEO Aged & Community Care Victoria

“In order to be sustainable, the industry needs acceptance within the community that aged and community care providers must obtain a reasonable return on their investment. This applies universally irrespective of the legal or organisational structure of individual providers. Just as the community accepts it is the right of key health providers like General Practitioners (GPs) and pharmacists to make a reasonable financial return from government sponsored programs, aged and community care providers are no different.”

One message. Many voices.

ACCV launched its Strategic Plan 2010 - 2013 in July to provide a framework for the strategic priorities ACCV aims to meet over the next three years.

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onsistent with the spirit of our new Strategic Plan, in August, our Victorian aged and community care industry joined forces in responding to the key Productivity Commission Inquiry into Aged Care, Caring for Older Australians. There can be no doubt this Inquiry is a ‘line in the sand’ for the industry.

As an industry association, Aged & Community Care Victoria (ACCV) consolidated the views of members from across Victoria through a regional and metropolitan member meeting structure, as well as through various reference committees and taskforces.

In addition, ACCV conducted 13 specific forums across the State regarding the Inquiry.

ACCV led the charge of more than 50 organisations across the State, handling more than 40 submissions to the Productivity Commission in a significant gesture of an industry that stands united. The number of submissions prepared by aged care providers throughout the State is a true reflection of the desire of the industry to drive fundamental reform.

The Productivity Commission Inquiry is a significant and real opportunity for Government to put the essential long-term system redesign in place to create a quality aged care system to support the needs of a rapidly ageing population. It is vital that current programs and funding are reviewed and reinvigorated to ensure their sustainability for the future. It is also important that any transitions to new models and structures capture what the industry does well now, while not destabilising the industry in the process.

Commencing now, and for the next four decades, Australia requires a sustainable aged care system so that social and economic life can adapt successfully to the ageing population. Decisive action is required and this Inquiry is the first step towards instigating vital aged care reform.

Some of the solutions proposed by ACCV include: •

Flexible funding mechanisms, regulatory and workforce approaches for small and remote rural aged care services which acknowledge the different conditions under which these services operate in order to address their communities aged care needs. In practice this will require the creation of new models of funding such as block-funding models and robust, targeted viability supplements.

•

A whole of government approach to the support and care of Culturally and Linguistically Diverse (CALD) elders. This must include strengthening access to language and cultural support services through a CALD funding pool.

•

Immediate restoration of the annual 1.75 per cent Conditional Adjustment Payment increment with its extension to community programs including Community Aged Care Packages (CACP), Extended Aged Care at Home (EACH), Home and Community Care (HACC), National Respite for Carers Program (NRCP) and Day Therapy Centres. This is a transition step until long term reformed funding arrangements and mechanisms have been bedded down.

The collaboration of members’ views also placed ACCV in a unique position to speak on behalf of the entire aged and community care industry in Victoria. ACCV also submitted an all-encompassing submission to reflect the key issues and solutions proposed by members throughout the State, calling for decisive long-term reform.

Along with the submission, ACCV submitted the Vision 2019 document as a core policy basis for long term reform.

The ACCV submission provided a range of key comments about key short and long term actions for the industry: “As a result of rigid policy settings, financial constraints and overwhelming red tape there is now a crisis in the confidence of the industry about its capacity to meet the demands of an ageing population.”

“In regard to residential care, there is fundamental concern about the industry’s capacity to construct the required number of aged care homes in the future to meet community demand, need and expectations. In regard to community care,

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•

•

Ensuring that any move towards a deregulated (market) system of attaching places to people, not providers, will be balanced by appropriate incentives and compensatory mechanisms approaches for all aged care providers. However, special attention will be needed in areas such as rural communities, special needs groups such as homeless, social disadvantaged and CALD, and where market mechanisms are unable to respond.

Addressing the conflict of interests inherent in the Commonwealth Department of Health and Ageing (DoHA) performing the roles of regulator, complaints body and funder of the aged care industry.

ACCV’s Vision 2019 scopes the core principles and strategic steps that underpin reform. The steps consider the long-term actions for reform and the short term transitioning and remedial steps essential to stabilise a system, which is in crisis, until longer term reforms are achieved.

Steps include: • •

Positive ageing within our communities: As Victorians age, they will be supported to maintain the best possible health as well as their interests, social and community connections.

A responsive service system: A network of aged and community care services that are integrated with the broader health, housing and human service system.

• • •

A vibrant and capable workforce: A workforce that is inspired, skilled and valued so older Victorians experience quality care and a fulfilling life.

A financially viable and environmentally sustainable industry: A financially secure and green industry that meets the needs and expectations of our ageing population.

An accessible and quality aged care system: All Victorians can access and depend on high quality aged and community care services.

Our real fear is that decisive reform and greater industry support gets put in the “too hard basket”.

In implementing any change, the government needs to work in genuine collaboration and partnership with the aged care industry, consumers and the community.

And now we wait for April 2011 when the Productivity Commission will deliver its Final Report and, coincidentally or not, it’s also the first year that Australia’s Baby Boomer generation will reach the retirement age of 65. n View the full ACCV submission at: http://www.accv.com.au/ Publications/ACCV_Submissions_Position_Papers.aspx

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national update

Aged Care Queensland Anton Kardash, CEO Aged Care Queensland

The past year has been one of evolution, in which ACQI has further developed its services to members, and improved its internal functioning.

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he growth of services to members has progressed the four pillars of association business, that is; Lobbying, Member Support, Education and Information/Advice giving.

While ACQI has always been strong in member support we have augmented this activity with the establishment of a consultancy arm, which has provided members with ACFI support, mentoring, pre accreditation and post sanctioned support.

ACAA - WA Anne-Marie Archer, CEO ACAA-WA

Time to talk in common language with a clear message As the financial and regulatory pressures mount we are all out there trying to make sure our message is being heard – but can anyone really understand what we are saying?

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while ago I attended a meeting with industry and government representatives from health and aged care services and next to me was an invited guest from a local government association who was keen to understand the issues.

Not long into the meeting I saw the look on his face and realised the UN has a better set up with translators on hand to feed comprehensible information via an ear piece to each delegate.

I started whispering the expansions of each acronym and what they were – which probably led to more confusion as he had no

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“

Our lobbying and advocacy Our lobbying activity has become more and advocacy activity sophisticated with regular media in radio, print has become more and television. With the sophisticated with assistance of media advisors, ACQI has been able to regular media in radio, maintain a positive aged care image. This year saw some print and television. experimentation with the use of YouTube messages to politicians to supplement our regular face to face meeting.

”

Internally the association has undertaken a constitutional review, the recommendations will be put to members who voted upon in early September. The changes proposed seek to consolidate the move to a board of governance, simplify voting procedures, provide for succession planning within the board and expand the definition of ‘member’.

The ACQI board has completed work on the association strategic plan, revised its delegation and governance policies manuals.

Financially ACQI has finished the year ahead of budget with a small surplus, despite investments in its internal infrastructure. The association has limited member fees to COPO levels and has grown its business activities to ensure ongoing financial viability. n

way of keeping up with the conversation or putting any of it in context.

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The combination of mixed messages delivered with assumed knowledge seems to be something we are guilty

I am not sure what he took away from that meeting and I know I am not faultless when it comes to ‘health speak’, no matter how of at times. conscious I am of this when being interviewed or when speaking with politicians and the wider community.

”

This was further compounded at a meeting with a prominent WA MP as mid-way through our discussion said they didn’t know what to believe or what the industry really wants as they are regularly visited by individual providers, groups of providers and now the peak associations all telling them different things and they all seem to suggest that different things will work.

I was respectful of the frankness and although I was not in a position to provide any clarity or continuity regarding any of the previous discussions as I was not privy to them, some overarching industry positions were provided post that meeting.

The combination of mixed messages delivered with assumed knowledge seems to be something we are guilty of and contributing to at times.

My State report for this edition is as much a timely reminder for me, as it is for others to ensure we use language that can be understood with a message that is clear and is one that can be comprehended. n

congress

It’s Time to Book in for ACAA Congress 2010

14 – 16 November 2010 | Adelaide Convention Centre Keeping up with changing technology, changing workforce patterns and changing financial structures, it’s all there, at a one stop shop at ACAA Congress 2010.

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t’s a once in a year chance to mix it with your industry peers, to meet new players, to listen to speakers who will still tell you aged care is a good investment. It’s all about finding capital.

It’s about coming together to flex your industry muscle, to let politicians of all persuasions know that this industry sector matters, that it needs more attention than its getting now.

It’s also about celebration, of what you do and why you do it, of the rewards of providing aged care to an increasingly ageing society.

It’s a chance to meet and mix with people like Shalain Singh, an aged care specialist and a senior partner with NAB Health. Yes the NAB has an aged care section and specialises in servicing the sector. Shalain Singh, Sally Evans from AMP, David Nelson from Nelson Partners and others are part of a discussion panel on making aged care an attractive investment.

This is the sort of discussion that might help you decide to expand, to re-build or to reevaluate your future direction.

These are tough economic times and having an opportunity to attend a discussion like this can be critical to your businesses survival.

‘In my view,’ says Shalain, ‘there are three aspects to economic survival. One is the ACFI, the basic funding everyone gets. The second is capital and that’s the tough one.

By comparison, when the 12 month term deposit rate is 6.5% and on the face of it the returns from Aged Care are well short of this, why would someone want to consider investing in this space?’

However, Shalain went on to say that ‘there are plenty of operators who are making money and a healthy return from the industry. The third aspect of economic survival is scale, so it almost goes without saying that the big players can get great economies of scale.’

Shalain Singh says that there are a number of things that successful aged care businesses do in order to survive and survive well, even in the current economic climate. Unfortunately, I am not going to share those secrets of success with you, well not just yet!

To hear more you will have to come to Congress 2010, because if I let you know now, what Shalain and others are going to say in November, you wouldn’t need to attend.

See you there. >

When you listen to someone like Shalain Singh from NAB, don’t think for a moment that this banker doesn’t know and understand aged care, far from it. Not only has the NAB been involved in this specialist sector for over 3 years, but Shalain’s grandparents, who are in their eighties, live with him and his family. He knows first-hand about the provision of care; of increased medical demands.

‘I know all about the frailties of the aged care system, both from a practical sense and a personal sense!’

www.acaacongress2010.com.au aca Aged Care Australia | Spring 2010 | 17

congress

ACAA 29th Annual Congress

14 – 16 November 2010 | Adelaide Convention Centre Exhibitors Listing • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

50Plus Aged Care Association Australia Aged Care Insite agedcareonline.com.au Aim Software Pty Ltd Air Liquide Healthcare Aqualogic Austco Communication Systems Australian Ageing Agenda Australian Medicines Handbook AutumnCare Systems Bond Select Brightsky Australia Campana Systems P/L CH2 (Clifford Hallam Healthcare) Clinicall Pty Ltd Colonial First State Commonwealth Bank of Australia Creek Solutions Dataline Visual Link DPS Publishing Ebos Healthcare EnergyAction Epicor Software Frontier Software Guild Group Health Industry Plan Health Metrics Health Super

• • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Health Vision t/a MPS Australia HealthX Hesta Super Fund HET Software Hills Healthcare Hynes Lawyers iCare Solutions IMB Ltd Independence Australia Invacare Australia Iona Medical Products James Richardson Pty Ltd Lappset Australia Laundry Machinery Solutions Laundry Solutions Australia leecareplus LS Quality Consultants Management Advantage Materialised McNeil Surgical Medicare Australia (Aged Care) Medicraft Hill-Rom Medirest (Australia) Pty Ltd Mercury Moving ON Audits Multitone Australasia Pty Ltd NASANSB National Australia Bank NEC Australia

• • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Paul Hartmann PeoplePoint Software Polyflor Australia Presidential Card Provider Assist QPS Benchmarking Questek Australia Pty Ltd Rehab Assist Rhima Australia Richard Jay Laundry Equipment RosterOn Pty Ltd Sebel Furniture Silverchain Nursing Association Simavita St George Bank / BankSA Statcom Systems Pty Ltd Superior Management Solutions TeleMedCare The Aged Care Channel ThomsonAdsett Unicharm Australasia Unique Care Villages Publishing VM3 Purefier Pty Ltd Webstercare Wellness & Lifestyles Wentworth Aged Care Furniture Westpac Zenith Insurance Services

General and Delegate Enquiries Conference Solutions T: 02 – 6285 3000 F: 02 – 6285 3001 E: acaa@con-sol.com

Trade and Sponsorship Enquiries

www.acaacongress2010.com.au 18 |

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Jane Murray, ACAA T: 08 – 9405 7171 F: 08 – 9405 6585 E: enquiries@acaacongress2010.com.au

cover story

East meets West in the NEC Connection Mike Swinson puts a personal perspective on the exciting convergence of an IT global giant and Australia’s Aged Care Industry.

P

icture this scenario. It’s winter in Melbourne and it’s a Sunday evening, so most ordinary folk are snuggled up at home or maybe going somewhere in the car with the heater on, because it’s cold outside.

At least Melbourne hadn’t turned on its worst weather; it wasn’t blowing a gale and raining cats and dogs. I was thankful for small mercies as I walked towards the Crown Casino complex, wondering where I would find the restaurant where I was booked for dinner.

I was in Melbourne to attend the annual ITAC (IT in Aged Care) conference that started next morning. When I arrived at my destination I discovered it wasn’t just me who was going. It was, I discovered, a select group of people, (excluding me!) by invitation only, who were gathered together to witness a unique event. A cause for some celebration, and certainly a time for reflection about where Australia’s Aged Care industry sits in the grand scheme of IT. In that vast labyrinth that is the casino complex, I managed to find the restaurant,

‘Rockpool,’ owned by the renowned Restaurateur Neil Perry, who says it reflects a meeting of Western tradition and Eastern technique. Well it certainly did at our dinner!

Obviously Melbournians love it, because this cold Sunday evening it was packed. I was shown to the secluded area where there were two tables, silver service no less, each set for 14 people.

Happily I see familiar faces, Rod Young the CEO of ACAA, Greg Mundey the CEO of ACSA, Suri Ramanathan, the chairman of the Aged Care Industry IT Council. I notice others such as Paula Carleton from Baptist Care, Greg Russell a member of the IT Council, Alan Turner from Silverchain in WA. It wasn’t just the big end of the aged care town that was there, because there was Tanya Gilchrist the CEO of Samarinda Lodge in Melbourne, a small aged care facility, but one that is well known as an early IT adopter.

There were others including our hosts, the NEC team. I was seated next to Suri Ramanathan and Paula Carleton both >

aca Aged Care Australia | Spring 2010 | 21

cover story

technology. Our Cloud model will allow more aged care operators to reap the benefits that technology offers.’

I’m wondering if you understand what is meant by ‘Cloud Computing? It took me a while to get my head around it. Can I suggest that you visit the NEC website, check the information page about this event and listen to the three ‘YouTube’ video interviews with Greg Mundy, Rod Young and David Cooke from NEC.

L-R: Rod Young – CEO ACAA, David Cooke – Group Manager, Health and Aged Care Solutions, NEC Australia, Greg Mundy – CEO ACSA

< wonderful dinner companions. Across the table was a Japanese gentleman, who I later discovered had flown in from Tokyo that morning and was going home the next day.

He had flown in especially for this dinner and the ceremony that followed. He turned out to be Atsushi Kuroda, from NEC Japan, representing President Endo, the global CEO of NEC Group. He was joined by Wataru Takeuchi , the Managing Director of NEC Australia. Also there was David Cooke, Head of Health & Aged Care Solutions from NEC Australia and others.

So what was the reason for this coming together of East and West? Why was the global giant NEC rubbing shoulders with Australia’s aged care industry, big and small, private and not for profit?

It is, I discovered, an exciting IT opportunity for facilities of all shapes and sizes, an opportunity to increase the uptake of IT, to increase productivity and to reduce costs.

Doesn’t get better than that!

This dinner was to witness the signing of a formal MOU between NEC and the aged care peak bodies, ACAA and ACSA. ‘It is the first sector driven partnership in what is now known as ‘Cloud Computing,’ said David Cooke. ‘An engagement – a national approach to assist the aged care industry to enhance productivity and contain costs.’

Atsushi Kuroda from NEC said while he was delighted to be in Australia to witness the formation of this exciting partnership, he said our aged care challenges mirror the challenges every Western country faces.

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‘Your challenges are being experienced in every developed economy – the aging population, the need to serve more with less, and the reducing numbers in the workforce generally, but in Aged Care specifically. In fact, in Japan, we lead the way in terms of the aging demographic – mind you, I am not so sure this is a good place to be,’ he said.

Atsushi Kuroda went on to say that his countries aging population combined with a low birth rate has meant that Japan’s population has been falling in absolute terms since 2005. Its population will drop from 127.5 million in 2009 to below 120 million in 2025, a drop of almost six per cent. In Japan, people over 65 account for 22% of the population, but by 2035 it will be 33%.

Every aged care facility in Australia understands his next point well.

‘The fundamental impact will be on the size of our workforce. In 2005, we had 3.3 workers for every elderly person. In 2055 there will be only 1.3. By comparison, in Australia, you have 5 workers per elderly person now, and this will only reduce to 2.7 by 2050,’ so Australia is better off than we are!’

So what can this partnership do for you in your facility, especially if you live and work in regional or rural Australia?

Wataru Takeuchi, the MD of NEC Australia put it this way.

‘Through NEC’s cloud computing solutions, we are offering a new option for aged care operators, particularly those that have not significantly invested in information

Rod Young, CEO of Aged Care Association Australia said: “Many aged care providers have been introducing IT systems to support staff in daily care and administration activities. However, making decisions about software products can be difficult and once IT systems are in place, they can be even more difficult. To assist aged care providers with such issues, ACSA & ACAA have entered into a relationship with NEC to provide a hosting service for a variety of software products, aged care provider data, integrated telephony and 24/7 technical support.”

David Cooke from NEC said “This agreement has the potential to significantly reduce the cost of delivering care to Australia’s elderly – something that is becoming ever more crucial in the face of an ageing population. Using Cloud computing, we’re making IT systems more cost effective, easier to manage and more accessible to aged care providers large and small, public and private. Integrated applications, telephony, and secure data management can make the delivery of care more efficient and cost effective, but until now they may have been out of reach for many aged care organisations.”

I can tell you this partnership has the capacity to help and support aged care facilities, big and small, to access IT systems that you thought might have been beyond your capacity and budget. Check it out, ring up, talk to someone who is using the NEC cloud based system.

By the way the food at Rockpool was wonderful, the service from Lucy, our waitress impeccable, the wine, just as good and as a parting gift, NEC gave everyone an autographed copy of Neil Perry’s book ‘Rockpool.’ I can’t thank the NEC team and the peak bodies enough for inviting me along! n

Enhancing Aged Care through Cloud technology The Aged Care industry peak bodies –Aged Care Association Australia (ACAA) and Aged & Community Services Australia (ACSA) – have chosen NEC Australia as a partner for the provision of an open ICT and Cloud computing services platform for the aged care sector.

T

he partnership between NEC and the Aged Care industry brings an array of IT productivity benefits, including many hosted high-value-add applications, such as iCare, Autumncare and ion.mycare.

Aged Care operators that want to invest in technology to achieve productivity and efficiency gains can now do so without an upfront capital expenditure investment model.

Aged care operators can now access the most powerful and advanced applications and IT environments with nothing more than a web browser, all for a modest monthly fee.

With increased pressure on care cost to income ratios and the constant headache of rising administration costs, Aged Care facilities are becoming increasingly interested in hosted and outsourced solutions.

Managing an IT environment involves a lot of ongoing concerns: high up-front cost, pressures on space, energy costs, staff retention, access to skilled staff especially in regional areas, as well as the time and effort it takes to navigate the complexity of a basic IT infrastructure. It all becomes just too difficult for many organisations and a lot of aged care providers have little more than the most basic IT infrastructure. They simply don’t have access to the funds or skills to

take advantage of the productivity benefits that effective IT solutions can deliver. Cloud computing addresses this by delivering highend IT with none of these challenges and for minimal cost.

an ongoing operational expense (OpEx).

Organisations can pay for their IT systems over a period of time as the business requires it and as cash flow permits, meaning less risk and quicker ROI.

And for those facilities that have already invested in technology to simplify and streamline their processes, many can enjoy lower costs as a result.

Rod Young, CEO of Aged Care Association Australia said: “Many aged care providers have started to introduce IT systems to support staff in daily care and administration activities. Making decisions about software products can be difficult. IT systems, once they are in place, can be even more difficult.

To assist aged care providers with such issues, ACSA & ACAA have entered into a relationship with NEC to provide a hosting service for a variety of software products, aged care provider data, integrated telephony and 24/7 technical support.”

The NEC partnership repositions the Aged Care industry, giving it the ability to address sector-wide challenges such as increasing client needs, falling staff numbers, remote care, community care, training challenges and skills shortages.

This partnership also puts the Aged Care industry at the forefront of IT evolution as cloud computing establishes itself as the next big thing. The challenges of high capital expenditure, managing complex and frequently changing IT environments and the access to skills are relevant across all industries. Today’s challenging global economic climate means many Australian organisations have been forced to reduce their IT budgets and IT staff are under increasing pressure to do more with less.

Financing expensive software purchases, as well as the hardware, data centre services and ongoing maintenance required to support them, is a real challenge for businesses. Many organisations dealing with tight cash flow and low credit have restricted capital expenditure, making Cloud services an attractive option both in the short and long term.

The predictable, pay as you go model and fast time to value of Cloud computing enables organisations to reduce big IT capital expenditures (CapEx) and manage IT as

NEC has established an Aged Care Portal with a wide range of Cloud computing solutions including a growing list of hosted Aged care software applications delivered via the internet in what’s known as a Software as a Service (SaaS) model. These applications include industry specific software, email and hosted telephony solutions. Working with NEC, Aged Care facilities will be able to complement their strategies for the future, ensuring the continuing delivery of productivity and efficiency gains with a reduction in the Total Cost of Ownership (TCO) of IT. With Cloud computing, customers plug into an existing, fully operational infrastructure, which means that they can be up and running quickly. In addition, customers need purchase only the capacity and applications they require, which means that they can scale their resource usage up or down according to requirements. >

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< NEC has been providing Cloud computing solutions for years, and has the expertise and practical knowledge to deliver a reliable and effective solution, tailored to specific needs. NEC operates its own Australia-based data centres; all data is locally stored within Australia and securely protected. It also has its own national broadband network giving a complete service to aged care providers.

Aged Care facilities that choose to plug into an NEC Cloud solution will receive the benefits of this new approach to shared resources, in addition to services such as initial consultation and system design, integration and ongoing support.

Greg Mundy, CEO Aged & Community Services Australia said: “The aim of the partnership is to help aged care providers gain better access to software products, reduce the need for costly capital investment in hardware and to provide seven day a week remote technical support for staff if the computer system crashes for some reason. If you are an aged care provider is considering IT purchases or system upgrades then we would recommend you have a chat with the NEC staff about the

level of support they can provide to support the system once deployed.”

As well as giving more effective IT to residential aged care providers, the partnership will also include a range of applications designed to deliver more effective ‘in-house’ care to keep the aged out of residential care for longer, further reducing the cost of delivering care and the burden on residential care providers. This is vital as Australia’s population ages and a greater percentage require state care.

David Cooke, Head of Health & Aged Care Solutions Group, NEC Australia said: “An ageing population has been billed as a potential disaster for Australia but it needn’t be. Technology will play central role in addressing the issues by keeping the aged engaged and participating in society and reducing the cost of providing aged care. NEC is working with aged care providers and the Government to drive technology initiatives over the next decade to achieve these goals.”

with between one and 200 staff experience the greatest benefits. NEC’s own research shows that the total cost of ownership (TCO) of implementing and providing email with Microsoft Outlook Exchange on-premise is $85,000 over five years. Via the SaaS model, the same application and functionality would cost the just $13,000 over the same timeframe. Likewise, larger enterprises experience massive savings using market leading email access via SaaS. The same example reduces the TCO from $768,000 (on-site) to $222,000 (via SaaS) over five years for an organisation of 200 users.

Ideal for organisations of all sizes

It’s also good for the application developers.

NEC is opening up new opportunities and markets for software vendors by hosting applications in the Cloud. NEC provides an open access platform to offer Cloud applications, allowing developers to remove all billing and customer management hassles, leverage additional functionality such as video and telephony integration, and share revenues and risk. n

While Cloud services deliver significant cost savings to large enterprises, organisations

www.nec.com.au/AgedCare

Why should your organisation move to the Cloud?

A

recent Gartner survey found that 37 per cent of respondents are transitioning from a current on-premises solution to a SaaS solution. This drive is particularly significant in Asia-Pacific where 50 per cent of respondents indicated that they are shifting away from on-premises.

The main reasons why you should consider moving to the cloud include:

SaaS offers zero or low up-front costs and speed of deployment

SaaS quickly and easily scales – add or remove users simply Ensuring IT systems are configured to meet a business’ current requirements for maximum efficiency is an ongoing challenge for IT departments. Using Cloud services, customers only pay for what they need, when they need it. They can increase or decrease software user numbers in accordance with their changing business requirements.

SaaS provides “No lock in” to a particular software vendor Businesses reduce the risk of being tied to an inappropriate or ineffective solution and their IT departments have greater power, enabling them to source the right solution at the right time to suit their unique requirements.

The biggest advantage of Cloud services, especially for small businesses and start-ups, is the low cost of entry and the very short set-up time.

Cloud customers have access to specialised, enterprise class software without having to cover high upfront purchase costs.

SaaS provides data security and simple software upgrades

Instead, businesses pay a monthly fee which covers software hosting, upgrades and support. This pay-as-you-go model is usually significantly less expensive.

SaaS enables businesses to access vital business applications remotely via a mobile device

SaaS requires minimal infrastructure on site Businesses only need a PC and Internet connection to take advantage of Cloud services. As such, businesses can massively reduce their onsite infrastructure and associated purchasing, upgrade, maintenance and operational costs. Less infrastructure onsite also means less people are required to manage it, further reducing costs.

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SaaS supports the external hosting of a business’ essential data, providing greater data security, disaster recovery and peace of mind.

With the growing pervasiveness of mobile devices like iPhones, Blackberrys and laptops, businesses are increasingly demanding mobile functionality from their applications. To reduce risk and mitigate the myriad of security, regulatory and data protection issues associated with remote access, many businesses are opting to outsource the hosting of applications with mobile functionality to SaaS providers. n

technology

ACIVA – Winning achievements ACIVA – the premier association for technology vendors to the aged care, community care and acute hospital industries has had a busy, rewarding and achieving few months.

C

aroline Lee (ACIVA President) said “since forming, ACIVA has continued to work with multiple government agencies to highlight key impact areas such as ACFI, and Accreditation. I am delighted to see ACIVA strengthen in terms of areas of engagement as well as member numbers.”

Caroline presented across multiple streams at ITAC2010 and updated delegates on ACIVA goals, membership and activities.

There is barely an area of the industry not covered by this active group. Recent activity has included;

PRODUCTIVITY COMMISSION

MEDICARE ACIVA is working with the IT council (ACIITC) on developing a medicare strategy that is inclusive of software vendor and their clients inputs and issues.

Submission to the “Productivity Commission - Inquiry into Caring for Older Australians” highlighting that IT is an increasingly important underlying infrastructure in aged care and there is a growing recognition that efficiencies and risk management require the monitoring and support achieved far more effectively and productively through software systems. And as such requesting consideration of technology in the commission deliberations.

OTHER ASSOCIATIONS

DOHA

OTHER ACTIVITY

ACIVA executive (Caroline Lee, Chris Gray and Mark Audley) have had a series of meetings with DOHA and are working on establishing closer communication ties.

NEHTA Key representatives from NEHTA attended the July ACIVA meeting and outlined the CCA (Compliance, Conformance and Accreditation) strategy. Updating the group on the new regulations governing Identification, Authentication, Connectivity.

Clinical standards and data sets were also covered. This helps ensure that future directions of technology developments is aligned with the proposed regulatory framework.

This was followed by Caroline Lee attending the NEHTA Workshop in August that has promoted ACIVA action.

Strengthening relationships with MSIA (Medical Software Industries Association) Strengthening relationships with AIIA (Australian Information Industries Association)

ACFI An ACFI submission is currently being worked on by the ACFI subcommittee.

Other areas of activity have included a survey of ACIVA members to identify the top areas to address – this identified that some key educational needs were increasing regarding – edocumentation and esignatures, the group is looking at conducting public workshops to address these knowledge areas.

ACIVA membership was well represented at ITAC2010 and 4 ACIVA member organizations (i.on my Care, LeeCare, iCare, and Simavita) took out accolades and winner awards at the Technology in Aged Care Awards announced on 27 July in Melbourne at the ‘MAD with Passion’ Gala Evening.

To support the growth and activity level ACIVA is about to launch their public web site and unveil the logo – www.aciva.org.au For membership inquiries please email info@aciva.org.au, or president@aciva.org.au n

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technology

ITAC and Australia’s Healthcare Future

By Mike Swinson ‘Our present healthcare system is unsustainable.

If we do not change the way we deliver healthcare, the way we pay doctors, we will not be able to afford to have a decent healthcare system at all.’

Dr Parkinson told the conference that ‘our current method of delivering healthcare based on a fee-for-service is destined to end in disaster. If we don’t change the way we visit the doctor, change the way we pay the doctor, then the American and Australian healthcare systems are headed for self destruction.’

Dr Parkinson’s four critical areas of action include: •

Everyone must have an online health profile

Rod Young, CEO of ACAA

•

Everyone must be able to make an appointment with a doctor online.

‘There are predictions that if we don’t change the way health is delivered and paid by 2055, health costs would consume every state government’s entire budget.’ (Currently health consumes up to 35% of state government budgets.)

•

Doctors must embrace and partner with technology, and not feel threatened by it.

•

People should focus more on eating well, exercising and building effective relationships with their health providers. Bad behavior is what makes us overweight, suffering from chronic diseases and raising the cost of healthcare to unsustainable levels.

Dr Jay Parkinson, a keynote speaker at the 2010 IT in Aged Care conference

Dr Parkinson said healthcare is light years behind other sectors of the economy in its adoption of technology.

W

hen introducing Dr Jay Parkinson at this year’s ITAC conference, Rod Young shared a personal story of how the Australian healthcare system isn’t working.

‘I have recently been to two GP’s, two specialists and had three diagnostic tests; none of them provided the results to one another electronically. The GP would write a letter that I had to take to the specialist. The GP or the specialist would write a request that I had to take to the Pathology Lab or diagnostic centre. I would be given the test results in a sealed envelope, addressed to the GP and the X-Rays or ultrasound images to take back to my GP. Of course’ he said, ‘I would open that letter and read it, then hand it to my GP. In this day and age that system is unsustainable, it is beyond archaic, it is stuff from the Ice Age of IT.’ ‘Why are we not automating this whole process?’ said Rod. ‘Why can’t I simply talk to my GP electronically (or by phone) and be told what I have to do? Why do I have to hand deliver test results, why can’t they be emailed? Why don’t I have an electronic health record that every one of those involved in this process has instant access to?’

Those comments were music to the ears of Dr Jay Parkinson, the man who has been labeled by the American media as ‘The Doctor of the Future! He is also known as one of the ten most creative men in US Healthcare. Esquire Magazine included him in its list of the ‘Best and Brightest, Radicals and Rebels’ in 2009.

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‘It’s still driven by pens, pencils, paper and memories. You can’t advance pen and paper, its 19th century stuff. It has to change to survive and the adoption of new technology is the only way it can.’

Dr Parkinson was the first medical practitioner in the USA to take online patients and charge them on their visa card. His practice boomed. He told conference delegates that most people only spend a few hours a year with their doctor; most people look after their own health quite nicely.

‘I like to classify doctors into those who “get it” and those who don’t,’ said Dr Parkinson. ‘By “get it” I mean those who get the IT message and how those changes to the way they service their clients works. We should design the healthcare system and the healthcare payment system to service those who “get it” and not those who don’t! Unless those changes are made the healthcare system will be unsustainable.’

So what would the healthcare system look like for a patient of a doctor who had “got it?” First, your doctor would become a health consultant, someone with knowledge, but also an understanding that their patients have access to data and knowledge like never before. Second the payment system must allow online consultations. Third, everyone must have an online health record that they control, that they allow access to by various health providers.

‘Once this happens,’ said Dr Parkinson, ‘you can use your online health profile to find a doctor that you will like, or be happy with.

It should be much like a dating agency, so you get to find medical practitioners who you will be happy with.’

According to Jay, security isn’t a problem; just ask the banks how they protect your information.

Dr Parkinson began his medical career after completing a residency in paediatrics and one in preventive medicine at Johns Hopkins University. He started an e-practice for his neighbourhood of Williamsburg, Brooklyn in September 2007: 1.

2.

3.

4.

5.

6.

7.

Patients would visit his website See his Google calendar Choose a time and input their symptoms His i-phone would alert him He would make a house call, if needed He would be paid via paypal He would follow up by email, instant message, videochat, or in person

His website says this concept became ‘Hello Health’ so other doctors could see how to practice this way. ‘Hello Health’ is a mixture of a secure social network and electronic medical records that enables doctors and patients to connect both in their office and online via email, IM, and video chat.

In this new system, you still have face to face consultations, but the number of times you physically travel to see your doctor is reduced and your medical records are available to everyone you choose to see online. Dr Parkinson has a fascination with how technology can be used to make the healthcare system sustainable.

It was just before the recent federal election that the then Gillard Labor Government announced a $392m e-health package that included a Medicare rebate for online consultations and partial support towards a health informatics literate workforce.

Specifically, the package includes: •

• • •

Online consultations - $250m for Medicare rebates for 495,000 online consultations over four years to rural, remote and outer metropolitan areas (starting 1 July 2011) Incentives to GPs and specialists - $57m in financial incentives to GPs and specialists to participate in delivering online services E-health training - $35m to support the training and supervision of health professionals on how to use online technologies GP After-Hours Video Consultations - $50m to enable GP After-Hours video consultations (starting 1 July 2012)

It seems that the message is finally getting through; it’s just got to get through to those who continue to ignore the strengthening winds of change. n

technology

IT Awards in Aged Care

2010

By Mike Swinson

Any AFL devotee knows only too well the rivalry that exists in South Australia between the two teams, Port Adelaide and The Adelaide Crows. It stems from a mix of the ‘haves’ versus the ‘have nots’, blue collar versus silver tails. Well that might be a bit of an exaggeration, but I’m sure you get my drift.

P

ort Adelaide certainly doesn’t have a reputation as a thriving economic area. It can be rough, tough and has more than its fair share of battlers, migrants and others who have to struggle to cope with life.

Best Implementation of the Year 150 To 650 Places/Clients Uniting Care, Wesley, Port Adelaide

“You don’t do this sort of thing, you know, look after older and frail people, look after those way less fortunate than most of us, just to to win competitions. You do it because you care, because you are committed to service,’ she said, as she tried unsuccessfully to get the grin off her face.

Julie told me that the old Wesley Mission was centered on social justice, empowering people who were isolated and marginalised.

These days Uniting Care, Wesley, Port Adelaide has over 900 employees, many more clients than that, 473 aged care beds plus 39 community care places and 1000 independent living units.

Julie said “it’s so lovely to get an award like this; it’s great for all our staff. Implementing the LeeCarePlus program has been confronting for many of our people. We teamed up with the Adelaide TAFE to overcome literacy issues and low levels of computer literacy.

Now over 90% of our people are computer literate. It makes a huge difference to our care delivery, to leave the paper trail behind and to cope with accreditation. The LeeCare team have been stunning.”

UnitingCare Wesley, Port Adelaide provide community services that improve the quality of life for aged, unemployed and homeless people, families, children, youth, people with a mental health disability and people from culturally and linguistically diverse backgrounds.

Winner of the Best Implementation of the Year Under 150 Places/Clients; Alphington Aged Care “One day I bumped into a mate at the footy and he said ‘what are you doing?’ I said looking for a new business, he said, ‘here’s one you should look at’ and he was right.”

It’s amazing when you ask someone like Greg Harding how they managed to be in the aged care business. Some say, ‘My wife was an aged care nurse with a passion for older Australians’ or ‘My parents were in the aged care business and it seemed like a good industry to be in.’

So you can understand why one of the most excited winners at this year’s ITAC, IT in Aged Care Awards was Julie Hossack, the Manager of Quality Systems for Uniting Care, Wesley, Port Adelaide.

Julie wasn’t excited because her organisation had beaten other applicants from Adelaide, no way. She was excited because this was to be a celebration of success in a region where there isn’t much of that sort of thing going on.

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For Greg and Fiona Harding it was a case of being in the right place, a football match; at the right time, they were both looking for a business; when Greg’s footy mate told him about Alphington Aged Care and what a good business opportunity it was.

“When we bought the business the only computers were in the administrative office. The rest of the facilities operation was paper based. We decided our first IT upgrade would be to install ‘i.on my care’s’ governance, compliance, risk management and accreditation solution. “

Greg said “the results were startling; within a few weeks of installation we had an accreditation visit. It was so easy compared to when we were paper based. I didn’t know anything about cloud based systems, now I do and I’m so pleased with the software we chose.”

“Our next IT upgrade will be a care plan, but that’s down the track a bit yet. Budgets and cash flow dictate what we can and can’t do” he said.

Greg said he’s very happy that in choosing ‘i.on my care’s’ cloud based software he doesn’t have to pay licence fees and install and service hardware and servers.

“We looked at other systems; we got comfortable with the vendor because without trust there wouldn’t have been a sale. This win is great for our staff and makes us realise you don’t have to be a heavy hitter to win.”

Ken Baker, Director of Life Services at Baptistcare said that he was extremely pleased that the organisation had received such high accolades at a national level.

“This award,” he said, “could not have been achieved without a huge cross organisational effort; as the implementation allows staff to continually improve resident and client outcomes and operational effectiveness.”

Winner of the Best Implementation of the Year Award for Infrastructure (New category) Lansdowne Gardens

Alphington is a modern, purpose built facility providing 45 large and elegant bedrooms all with ensuites. All rooms look out onto trees, gardens or private courtyards.

Winner of the Best Implementation of the Year Over 650 Places/Clients Baptist Care WA For the large aged care provider, Baptistcare WA, the implementation of iCare’s Clinical and Care solution has seen a transformation in the way the organisation runs its core service. It is a huge operation, employing more than 1300 people, servicing 267 high care and 612 low care places at 14 facilities located in four metropolitan and 10 rural locations across sprawling Western Australia.

Before the implementation of the iCare software, keeping track of care records was a massive, time consuming paper based operation, that was, at times, inconsistent and inefficient. Like many other aged care providers before them, they wanted staff to have more time to provide face to face care to residents and clients. The IT package allows that to happen. The benefits already indentified include: •

Reduction in the duplication of documents

•

Organisational Transparency

•

Improvements in Corporate Governance

•

Increase in staff satisfaction

This architecturally designed facility has incorporated a state of the art Residential Aged Care facility into three significant heritage buildings.

Cranbrook Care is the parent company which controls and manages two Residential Aged Care facilities including Lansdowne Gardens.

Its vision is to be recognised, acknowledged and respected as the premier provider of aged care in Australia. Lansdowne Gardens boasts facilities, lifestyle and valet services that are comparable to the world’s top hotels.

Before the project began the buildings were in a state of disrepair, now the local community is able to enjoy the reinvigorated buildings from the outside whilst the residents enjoy a level of comfort and style never seen before in Residential Aged Care. >

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technology

IT Awards in Aged Care 2010 (continued) The award acknowledges the hurdles that were overcome during the entire refurbishment of 3 heritage buildings, including the installation of the latest in IT infrastructure.

Winner of the ICT Company of the Year Award for 2010 SIMAVITA One of Australia’s technology success stories was recognised as the aged care industry’s ICT Company of the Year, at the annual ITAC Awards. The ICT Company of the Year is Simavita, better known as the creator of the ‘Electronic Underpants.’

CEO of Simavita, Philippa Lewis told guests that the company has been in development for almost 15 years, since its founder, the late Dr Fred Bergman, a Melbourne GP, became frustrated with the way incontinence was treated in aged care facilities. Dr Bergman conceived the idea for a wireless monitoring device which could identify the level and type of incontinence by creating a real time bladder chart.

“Our unique technology is now recognised across the world. We have had interest from countries as diverse as China, Japan, Mongolia, Europe and the USA. We have just appointed a European licensee and will establish a number of showcase aged care sites across Europe,” said Ms Lewis.

“

It’s an acknowledgment from our peers and customers that our company and technology can be trusted to deliver on our promise, that our product does what we say it does.

”

“Simavita would not have been the success it has without the support of aged care providers across Australia,’ said Ms Lewis. “They have helped and supported our company during its developmental and commercial trial stages. We will forever be grateful to the Australian aged care industry.”

According to Ms Lewis, there is no other technology like this in the world, and it has the capacity to change the lives of people who suffer from incontinence.

‘With this product, they no longer have to suffer the constant indignity of carers checking pads and underpants, as the pads only send an alert to carer’s when it detects moisture. The ICT Company of the Year award gives Simavita much needed validity in the international market,” she said.

‘It’s an acknowledgment from our peers and customers that our company and technology can be trusted to deliver on our promise, that our product does what we say it does. One of the big hurdles in marketing a technology product internationally is trust and the award will help to establish that with new clients,’ she said. n

Footnote The awards (sponsored by the IT Informer) were announced at a gala dinner in Melbourne, (sponsored by IBM) as part of the annual ITAC (IT in Aged Care) awards. The ITAC conference and awards are an annual event run by both aged care peak bodies, ACAA and ACSA, together with the Health Informatics Society of Australia. (HISA)

technology

Provider Assist

more funding > more resources > more care

P

rovider Assist (formerly Aged Care Specialists) has for over 8 years been driven by two principles:

1. Aged care professionals (personal carers included) are an extraordinary group.

2. Passionate and specialised business support services can make a significant contribution to resident wellbeing by maximising the financial wellbeing of providers.

And the one goal of everyone in aged care is optimal resident care. Providing optimal resident care requires more resources and the best way providers can afford these additional resources is to maximise their funding. This is where Provider Assist makes its vital contribution.

Case Study – ACFI Maximisation (ACFI Max) Success Story from regional South Australia – ACFI Funding substantially increased!

After completing ACFI Max (our service where we maximise your ACFI funding) with one of our regional SA clients, we were able to assist them to identify residents whose funding did not match their assessed care needs and work with them to submit accurate funding claims, resulting in a substantial increase to their monthly care funding.

While conducting ACFI Max we identified a resident had a significant clinical issue that could be managed more appropriately.

We provided the client’s care team with recommendations that rectified the situation, increased the funding and highlighted the need for (and afforded) more care resources.

The significance of the outcome overall was the improved care for the resident along with the learning experience for the client care team. We provided recommendations and assisted in the implementation of corrective measures that increased funding which more than provided for the resources requires to significantly improve resident outcomes immediately and ongoing.

For our client there were three immediate benefits with long-term effect – their funding was dramatically increased, enabling investment in additional care and ACFI resources leading to the ultimate goal, a significant improvement in resident care.

Case Study – Non-Care Funding Review We have also been privileged enough to review the non-care funding of more than 94,000 residential beds across Australia.

These non-care funding reviews have reinjected millions of dollars in much needed Supported, Concessional, Assisted and

Pension supplements back into the hands of approved providers.

We have countless stories of wonderful outcomes from the review, from contributions to major building projects to the installation of air conditioning units for the residents in the north-facing wing.

Lifestyle programs hold a big place in our hearts and we are always eager to hear about the impact increased resources have had to resident lifestyle programs.

In every State and Territory across Australia we have been able to resurrect substantial funding. With clients from the largest organisations in capital cities to the smallest remote 6 bed facility, our team have been onsite investigating potential missed funding and we continue to assist our clients every day to ensure they maximise their funding entitlements. The core function of Provider Assist is to support the aged care industry so they have access to more funding which means more resources and leads to everyone’s ultimate goal, more care. n

more funding > more resources > more care

Contact us now on 1300 419 119, before your entitlements are lost forever - www.providerassist.com.au - and apply now for our National Scholarships.

aca Aged Care Australia | Spring 2010 | 35

technology

Japan takes another step in replacing humans with robots The replacement of humans by machines in the workplace took another step recently, as Japanese researchers unveiled a model they hope could lead to humanoid menial workers.

I

Designed to help researchers develop models that could replace humans in repetitive manual labour, the latest “athlete” model in a near 10-year-old series updates the feminine, catwalk-strutting, karaoke-singing HRP-4C. But the tone this time is altogether more serious, according to a joint statement from its developers.

ts makers, Kawada Industries and the National Institute of Advanced Industrial Science and Technology (AIST), hope the robot will be a step towards creating a model that can help ease greying Japan’s looming labour shortage.

“It is Japan’s urgent task for the early 21st Century to develop robots that could carry out simple, repetitive works ... in a bid to complement the workforce in a country that is rapidly ageing with fewer and fewer children”.

“We designed a working robot in the image of a lean but wellmuscled track-and-field athlete,” Noriyuki Kanehira, robotic systems manager at Kawada, told a news conference to unveil the blue-andwhite “HRP-4.”

Standing at 151 centimetres (59 inches) tall, the robot in a demonstration stood on one foot, twisted its waist, struck poses, walked in accordance to given voice commands and moved its head to track objects.

The HRP-4 boasts joints that move more freely than its predecessors and can run a range of separately-developed software applications, its makers said.

Kawada and AIST will start selling the robot to universities and research institutes in Japan and abroad from January 2011.

The price tag for what is described as a â&#x20AC;&#x153;low costâ&#x20AC;? model is 26 million yen (A$326,000) each. Its creators hope to sell three-to-five units a year. n

profile

ACAA Board Member, Tony Smith

By Mike Swinson ‘Worthwhile relationships are priceless. I grew up in a happy and supportive family. I am very close to my kids and to my brother and sister, even though he lives in Sydney and travels the world as a Cabin Manager with Qantas. My sister and her family live in Legana in Northern Tasmania. I am married for the second time to Maddy, as my first wife Bev and I separated. Not long after that separation she died from cancer. We were still business partners when she died.’

M

eet Hobart based ACAA Board member, Tony Smith. Owner and operator of a small aged care facility in Claremont, a suburb of Hobart in Tasmania.

In 1963, when Tony was 18 years old, his parents decided to uproot the family and migrate to ‘The Land Down Under.’ His Mum’s sister lived in Launceston and had obviously been talking up the opportunities that existed in her adopted home.

‘It wasn’t easy for the first few years,’ said Tony. ‘I had grown up living and playing in the suburbs of London, so when we moved to Launceston, it was a real culture shock. It was virtually a big country town and they all loved this weird football game called AFL.’ Tony is now a committed supporter of ‘that’ football club. The one everybody loves to hate. Collingwood. Why? Well, the story is worth sharing.

‘Not long after we moved to Australia, I was in Melbourne doing a training course and I went to an AFL game. It was Collingwood playing Essendon. At half time the mini league game was on and when it finished the crowd booed the Collingwood kids as they came off the ground. I thought that was terrible. You should never boo kids, so I thought I would become a Collingwood supporter.’

Don’t tell anyone, but Tony is able to have a bet either way when Collingwood fail to measure up, because he also supports the Saints. Makes me wonder who he barracks for when the Aussies front up at Lords on an Ashes tour? He wouldn’t tell me so I guess he could be a secret supporter of the ‘Balmy Army’ or maybe it depends on who is winning!

His first job was working at Coates Paton woollen mills when he won a management cadetship, specialising in increased productivity, known then as time and motion

“

Payments from the Federal Government are not keeping pace with cost increases...

”

studies. Other jobs followed until his wife, a nurse with a passion for aged care, convinced him there was a good business opportunity in the aged care sector. So it was that they took on the lease of a nursing home, a small 25 bed facility in Newtown, a suburb of Hobart.

‘We leased that for two lease periods,’ said Tony. ‘Then the lease conditions became too onerous, so an opportunity came up to lease the Hathaway Nursing home and we took that over. It was then 29 beds, so when the Mayfair nursing home closed we bought their 16 beds so we went to 35.’

Tony said ‘after a while we realised that while the nursing home was a great piece of real estate it didn’t lend itself to being an efficient nursing home. It was a converted building.

We couldn’t remodel it because the land was limited, so we decided to sell it and build a new facility on a green field site and in 1993 we opened The Gardens.’

The Gardens is now a 56 bed facility that underwent an upgrade in 2001, reducing the number of double rooms and increasing communal areas available for residents.

The facility was the first and only aged care home in Tasmania to be accredited by the Australian Council on Healthcare Standards and is now fully accredited by the Aged Care Standards & Accreditation Agency. However, like many other smaller facilities around Australia, things are getting tight financially.

‘Payments from the Federal Government are not keeping pace with cost increases,’ says Tony. ‘We are facing steep increases from

aca Aged Care Australia | Spring 2010 | 39

Profile: Tony Smith

The Gardens, Claremont TAS utilities, things like electricity, water and rates are rising more rapidly than our income. ‘ ‘To make matters worse, our occupancy rates are dropping a bit, because people are staying at home longer, so we have taken on some low care residents to try and lift our income. Any facility that is smaller than 60 beds is a marginal operation and we have 56. It’s getting tighter and tighter.’

The sector is waiting with bated breath for the next report on that cost price squeeze from the Productivity Commission, due out soon.

The trouble is that the last report from the Productivity Commission in 2003 was ignored by both governments, Labor and Liberal.’

‘It cannot keep going like this,’ said Tony. ‘The government have to address the crisis facing our industry.’ n

profile

Professor Chris Nordin A profile of a remarkable man

By Mike Swinson Professor Chris Nordin is one of, if not the world’s experts on calcium metabolism and osteoporosis; he is a keynote speaker at this year’s ACAA Congress. I would walk over broken glass for a chance to listen to and meet this remarkable man.

When I first met Professor Nordin, it was on the phone. It was Wednesday 13th August, 2008 and I was recording an interview in order to write a profile for a magazine. Disaster struck, for the first time I can remember, I didn’t label the cassette tape and the next day I recorded another interview on the same tape and erased the interview with Chris.

T

o make matters worse, my deadline was Friday 15th August. So back to the phone, to ring him and do the interview again, but there was no answer.

You can imagine how stressed I was getting.

My Editor was not known for his patience and understanding; I had left things too late, again! I now know why Chris Nordin did not answer his phone that day.

Two hours after I had finished the original interview, Chris had a nasty fall. He came out of a petrol station after paying for his fuel, tripped on a gutter, crashed to the ground, broke three ribs and his wrist. That night he had a metal plate inserted in his wrist and it was set in plaster, his broken ribs were strapped.

Two days after his accident, despite the pain and discomfort he flew from Adelaide to Melbourne to speak at a conference, then flew back to Adelaide that night. I presume he took a few painkillers along the way. It’s a reflection of the ‘can do’ and no nonsense sort of bloke he is.

That’s fine I hear you say, you probably know people like that who just get on with life, no matter what the circumstances.

Let me tell you a secret. Professor Nordin was 88 then, that’s right, 88 years old. How many eighty eight year olds do you know who behave like Chris?

I’m left shaking my head, if I can be half as sprightly as that when I’m seventy or so I’ll be in seventh heaven, let alone when I’m 88. I’ll be happy to be alive!

Now, with that little insight to one side, let’s get on with the story of this amazing man.

Professor Chris Nordin is one of, if not the world’s experts on calcium metabolism and osteoporosis; brittle bones and he is a keynoter speaker at this year’s ACAA Congress. I would walk over broken glass for a chance to listen to and meet this remarkable man.

Professor Nordin would probably forgive you if you described him as a zealot on fracture prevention, particularly in women.

aca Aged Care Australia | Spring 2010 | 41

Profile: Chris Nordin He is especially well known for his work on the relationship between calcium deficiency and osteoporosis, particularly in postmenopausal women. I don’t, for a moment describe him as a zealot, I think that term depreciates what he has done with his life and how simple his message is and how it’s right on the mark.

His life goal is to reduce the high hip fracture rate of older Australians, by providing adequate doses of vitamin D and calcium, and to enable every woman at the menopause to know her bone density so that she can take steps to prevent osteoporosis developing in the future.

Professor Nordin’s work over the past 50 or so years reinforces his simple message; the key to prevention of fractures is a high calcium intake. Couple it with a dose of Vitamin D and most people shouldn’t break their bones as easily later in life.

“

His latest crusade is to convince health bureaucrats to begin a national bone density testing program for women who have entered menopause.

”

Chris Nordin had an unusual early life. His Swedish, Finnish father met his English mother before the outbreak of World War 1. They were living in Milan where they were both studying to become opera singers. They met again after the war, married and lived their lives travelling between Scandinavia and the UK. As a result, Chris’s school life suffered till he was 13, when he went to live with his Mum and Grandparents in England and was sent to regular schools.

He was 19 when war broke out and was in Sweden. He spent the Second World War working for the British Legation in Stockholm, as he was fluent in three languages. After the war it was off to University, graduating in Medicine and moving into research.

His work over the years has established beyond doubt the link between lack of Calcium and Osteoporosis. Yet pharmaceutical companies have according to Chris, largely hijacked the debate.

Organisations that are happy to muddy the waters whilst at the same time make large profits out of supplying drugs to sufferers of osteoporosis.

According to Professor Chris Nordin, older women, particularly those with low bone densities, should take a Calcium supplement every night before going to bed. Combine that with a Vitamin D supplement and it will ensure that their Calcium levels remain relatively static, instead of gradually declining, day-by-day, week-by-week, month-by-month.

His research confirmed that Osteoporosis is caused by a Calcium deficiency.

His latest crusade is to convince health bureaucrats to begin a national bone density testing program for women who have entered menopause. His persuasive argument is that once those women with low bone density are identified, they can be encouraged to start a Calcium and Vitamin D supplement program.

If you attend this year’s congress and listen to Professor Nordin, you will hear why this health prevention program deserves your support and is a vital part of helping the healthcare system to become sustainable.

Everyone involved in the delivery of service to the aged care sector should attend this vital presentation.

I look forward to seeing you in Adelaide in November. n

workforce

Industry Feedback Dear Mr and Mrs Padman, Thank you for providing the wonderful Nursing Home Ridge Park at Myrtle Bank.

Our loved one was indeed fortunate to move from the country into Ridge Park. Particular qualities that impressed were the private nature of the home and the greater freedom of choice that brings in care choices, the sensitive and competent manager Mille, the beautiful heritage and historical setting and ambiance of the building, the location of it near to city and to major roads to country, the off street parking and well developed grounds. I called it a dress circle location in Adelaide as it is near to many of our most prestigious and highly regarded locales.

May Ridge Park continue and extend these find traditions into the future to the great benefit of South Australia.

With sincere gratitude and best regards from Nola McCallum (on behalf of the late Mr Eric Minge, Ridge Park Resident 2009)

ACAA would like to encourage anyone who works in the industry to submit their positive feedback received from clients and their relatives for publication in future editions of Aged Care Australia.

ACAA will be recognising the best client response at the 29th Annual Congress to be held in Adelaide on 14 â&#x20AC;&#x201C; 16 November 2010.

Submissions can be emailed to

editor@agedcareassociation.com.au

workforce

All of the Kudos… None of the Cost

T

he new version of the ACAA Employee Benefits Program (EBP) has been operating now for several months and we are pleased to say that we appear to have “hit the nail on the head”.

In the past, I often met resistance from organisations to implement an organisational funded Program based on the availability of funds, and the perception that “We don’t think our employees would use the Card”.

From every negative, it is possible to find a positive. Hence, the Employee Opt-In Program was born. The decision as to whether the Program represents sufficient value at a cost of $29.90 is left entirely to the employee. From experience, we are finding that 85% of employees that attend information sessions DO perceive the value and purchase a Card on the spot.

So…the answer to the question of perceived value from the employees’ point of view has

been answered. That’s great…but what’s in it for the organisation?

• A fully branded Card & Website • No financial outlay • The kudos of having provided employees the opportunity to purchase a Card at $40 less than RRP • The ability to provide an Employee Benefits Program at no cost to the organisation It is a win / win scenario for both employee and organisation alike. With Presidential card getting personally involved with implementation sessions with your employees, we are able to project a strong message of your organisation being a caring employer for providing employees the opportunity to enrol in the Program at a greatly reduced cost.

Of course, we are still happy to support organisations that wish to fund the Program

on behalf of their employees (at a reduced cost of $24.90 INCL GST). We have even devised a hybrid option, where organisations can choose (for example) to fund the Program for all full time employees and offer an Opt-In Program to casual and part time employees.

Whilst each website is co-branded in with your organisation’s logo and welcome message, our generic website can be viewed using the following login details: www.presidentialcard.com.au/acaa LOGIN: ACAA00003 PASSWORD: ACAA For full details, please contact me personally.

Brad King Manager Business Development Presidential Card 0413 839999 BKing@PresidentialCard.com.au

ADVERTORIAL

RosterOn… it’s about Time!

One of the key components in the successful harnessing of technology in Aged Care organisations is the ability to provide the most suitable carer-client interaction possible... the right carer being there at the right time, with the right skills... and at the right price for both parties! And within Aged Care residences and hospices there needs to be the right skillmix to deliver the organisations services!

T

he provision of staff rostering technology is becoming increasingly a ‘must have’, particularly with the ever-present need for employers to optimise their workforce, to provide fair and equitable treatment of staff for their shift allocations, and to ensure best-practice for their residents and clients.

The Australian-made and Australian-owned company that has a track record in delivering this clever technology to Aged Care and Healthcare facilities across the country, started creating its software in 1994, writing it specifically for Health and for Australia’s unique working conditions. Now arguably the dominant solution for Aged Care staff rostering, RosterOn provides simple, smart and powerful rostering, manages time and attendance, creates business rules that organisations need to have as a backbone to their system, through their Awards/ EBAs interpretation, and integrates with the

markets leading PayrollHR applications to provide key benefits…including electronic timesheeting!

Royal District Nursing Service voted it ‘the ideal management tool!’, Melbourne Health confirmed it is ‘the best Staff Rostering solution available!’, Hunter New England Health said ‘the best the market has to offer!’ and Aged Care organisations across Australia continue to embrace its functionalities.

Founding Directors Dean Seeley and Peter Collins are rightly proud of their product, Collins adding “RosterOn is really about improving our clients’ process, their labour costs, their unique trademark and their staff morale… and we think it’s about time, too!”

www.rosteron.com Stand 25 at the ACAA Congress in Adelaide 14-16 November 2010

See us at the ACAA Congress

Stand 25

sponsors

Notes from an Architect’s Diary – Aged Care Projects “If it works as a diagram it should work as a building” Matthew Hutchinson ThomsonAdsett

There is something simple and logical in this statement.

W

hen we analyse a site, both developed and undeveloped, from a master planning point of view we invariably reduce the big issues of the site into a simplified diagram known as a site analysis plan. The macro issues such as general orientation, fall of the land, traffic and pedestrian access points and patterns, neighbouring building proximity and heights, services easements and other natural features such as vegetation can all be summarized into a simple diagrammatic plan which assists to understand the story the site is telling.

This simple review will soon reveal where the opportunities and constraints exist.

Obviously other considerations such as

the condition of the current buildings, what development is proposed and general town planning constraints inform a design response also but the site itself generally suggests a best or good way to arrange development. This applies to any scale or type of development, in my opinion, but certainly is true for Aged Care and Retirement Living developments.

The extension of the site analysis plan is then in making decisions about placing and arranging new buildings and possibly demolition of existing ones if it is a currently developed site. The logic of a proposed plan for a site must include consideration of big decisions such as the position of the main entry (where should my front door be?), parking for visitors and staff and delivery of services. How do residents and visitors move about? How are services delivered through the building?

Will they conflict with other movement patterns? All of these determinations shape the ultimate building form.

All of these issues can be analyzed and decisions made through representing the design through simplified diagrams. If a diagram is looking complex then it is quite likely the building will be also. If the diagram

is clear, simple and logical then the legibility and user orientation of the finished building should be also.

There are situations, particularly on sites developed over time, where different types of buildings have been constructed over stages as funding permitted. Development may have been in accord with a long term master plan but often it appears more organic and less planned than that. The legacy can often be disparate buildings on different levels constructed to a budget with covered links and inappropriate graded ramp connections.

These sites present the largest challenges when trying to simplify the diagram. It is easy to be critical of decisions made decades ago but that is not appropriate nor the point here.

The point is that at what ever stage a site is at or condition buildings are in getting back to basics and analyzing it at a diagrammatic level is a very useful way of determining a good way forward. It may mean making some tough decision about demolition, or decanting residents temporarily, taking beds off line for a while, or even moving altogether but in the longer term this type of review should yield a site that is making best use of its potential. For no matter where the site is land is valuable. Use it as best you can. n

sponsors

New online courses – available now As part of ACAA and e3Learning’s strategic partnership, the following titles are now available for purchase on the ACAA online store. http://acaa.e3learning.com.au

C

ontact us at: info@e3learning.com.au to discuss enterprise wide pricing and implementation.

Preventing and Managing Occupational Violence and Aggression in Health Care Settings

• • • •

Being prepared for incidents Identifying that an incident is occurring Evaluating the incident and taking appropriate action, and Post-incident review and debriefing.

The course is approximately 90 minutes in length and has been approved for 1.5

•

What you should do when you suspect or observe elder abuse.

The course is approximately 60 minutes in length and is in the process of being reviewed for CPE accreditation by the Australian Nurses Federation. Points will be applied retrospectively. n

To purchase, visit the ACAA online store: http://acaa.e3learning.com.au For further information contact: Adam Dunkley Ph: 08 8221 6422 adam.dunkley@e3learning.com.au Developed in partnership with Grampians Health Services and the Victorian Department of Health (Grampians Region) this course is designed for health service staff who are increasingly being confronted with incidents of occupational violence and aggression.

The course will cover: • • • • •

Key definitions used in occupational violence and aggression (OV&A) literature Types of OV&A Laws governing the management of risks associated with OV&A Australian standards related to OV&A Employer and employee responsibilities in regard to preventing and managing OV&A

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CPE points from the Australian Nurses Federation. The course is designed for all health service staff nationally.

Prevention and Management of Elder Abuse in Health Care Settings Developed in partnership with Grampians Health Services and the Victorian Department of Health (Grampians Region) this course will assist health service staff in preventing and managing incidents of elder abuse in their workplace.

The course will cover: • •

Key definitions used in the literature exploring elder abuse Types of elder abuse, and

LearnX 2010 Award Winners • Best Blended Learning Solution • Best Bespoke Learning Solution

e3Learning is ISO 9001:2008 Quality Certified

Electricity Savings Offer: All Fees Waived Until 16th November 2010 In conjunction and with the endorsement of the Aged Care Association, we are pleased to help reduce your future energy spend.

O

ur company, Energy Action, have been chosen as the Preferred Supplier to all the ACAA members and affiliates for Energy Contract procurement.

Although your electricity contract maybe a period away from expiration, we secure more attractive rates NOW than you could at a later date.

We are also confident that there will be a substantial rate increase over the next few months.

Energy Action is an Auction House that trades contracts “on-line” through a reverse auction platform. We invite all energy retailers (AGL, Origin, TRUenergy, Country Energy, etc) to bid against each other over a 10 minute transparent window, viewed by the client, to win the lowest price for your current or future electricity contracts.

Simply put, Energy Retailers compete on the auction platform to win your business and it purely comes down to which Energy Retailer can provide the best price. Furthermore, it is an open and transparent system with no hidden agendas, designed to save you time, effort and money.

EnergyAction also monitors daily meterage demands, consumption, errors, anomalies and potential refunds including analysing the Network Tariffs for $ savings.

The good news is that our fee of 1.5% is paid to EnergyAction by the successful retailer and your application and administration fee has now been reduced to only $450.00. This fee is waived until the 16th November 2010.

Energy Action began trading in 2000 and since 2005, we have conducted more than 4000 online energy auctions, with a combined value in excess of $5 billion whilst during 09/10 we conducted over 1200 online energy auctions.

Our client base includes many of the ASX Top 100 listed companies including Ramsey’s Heath Care and numerous Aged Care Facilities across the nation.

Initially, all we require is a copy of a recent electricity bills from each site (front and rear sides of 1st page) and then we can proceed with your application.

Fax through your bills to (03) 8677 9633. n

For more details on EnergyAction contact: Peter Naylor Ph 03-9832 0855 Fax 03-8677 9633 peternaylor@energyaction.com.au www.energyaction.com.au

aca Aged Care Australia | Spring 2010 | 49

sponsors

Sanctions – prevention is better than the cure T

he Tribunal’s decision reflects a positive outcome for the provider and the industry as a whole. It also serves as a timely reminder to all providers that when it comes to sanctions, prevention is certainly better than the cure.

Julie McStay Partner – Hynes Lawyers

On 20 July 2010, after a long and no doubt arduous battle, BlueCare, were finally successful in overturning sanctions imposed on one of its north Queensland facilities when the Administrative Appeals Tribunal delivered its decision in The Uniting Church in Australia Property Trust (Q.) and Secretary, Department of Health and Ageing [2010] AATA 536 (20 July 2010).

The Tribunal held that the Department of Health and Ageing (Department) had no basis for imposing those sanctions.

In February 2010, in recognition of the significant effect the withdrawal of funding had on the provision of aged care services to the community, the Department lifted that sanction.

The Tribunal made it clear that had there been more comprehensive discussions between the Agency and the facility on the first day of the Agency site visit that the sanctions (and the costs ultimately incurred in trying to overturn those sanctions) could have been avoided.

The provider also requested that the Department review its decision to impose sanctions on the basis that the Agency’s decision that there was “serious risk” at the facility was based on errors of fact. The Department refused to overturn its decision.

The provider then sought relief from the Tribunal.

Facts

Legislation

On 16 December 2008, the Agency undertook an unannounced support contact visit at the facility and concluded that it was not compliant with its responsibilities to ensure care recipients receive adequate nourishment and hydration.

Under the Aged Care Act 1997 (Cth)(Act) the Department is responsible for imposing sanctions, not the Agency.

The next day, the Agency reported to the Department that they considered there to be “serious risk” to care recipients at the facility.

On the basis of that report, the Department found that there was an “immediate and severe risk” to the safety, health or wellbeing of the care recipients in the provider’s care and imposed the following sanctions: •

that the provider must appoint a nurse advisor or have its approval as a provider of aged care services revoked; and

•

that the provider could not claim Commonwealth government subsidies for any new residents for a period of six months commencing on 17 December 2008.

As sanctions are imposed against a provider and not a facility, the Department’s decision to withdraw funding for all new care recipients had a very significant effect on the provider who operated multiple facilities. Consequently, the provider sought urgent relief for this sanction to be lifted.

The Agency’s role under the Accreditation Grant Principles 1999 (Cth) is to: •

immediately notify the Department if it decides that a failure of the approved provider to comply with the Accreditation Standards has placed, or may place, the safety, health or wellbeing of a care recipient at ‘serious risk’; and

•

recommend whether sanctions should be imposed.

Ordinarily the Department is not permitted to impose sanctions without first notifying the approved provider. However, the Act provides that the notice requirements may be dispensed with if the Department is satisfied that the non-compliance poses an ‘immediate and severe risk’ to the safety, health or wellbeing of the care recipients in the approved provider’s care.

The Act provides that when deciding whether to impose sanctions on an approved provider that the Department must consider: •

whether the non-compliance is of a minor or serious nature;

aca Aged Care Australia | Spring 2010 | 51

sponsors

Sanctions – prevention is better than the cure (continued)

“

Providers should ensure that their managers and staff receive appropriate training to ensure that they have a thorough understanding of the Agency’s role and the basis on which a finding of “immediate and severe risk” can be made.

”

• • • • •

whether the non-compliance has occurred before and if so, how often; whether the non-compliance threatens the health, welfare or interest of care recipients; whether the approved provider has failed to comply with any undertaking to remedy the non-compliance; the desirability of deterring future noncompliance; and any other matters specified in the Sanctions Principles.

“Serious risk” is the threshold used by the Agency to determine the timeframe in which to notify the secretary and whether to recommend that sanctions are imposed. The threshold for imposing sanctions without notice is ‘immediate and severe risk’ not ‘serious risk’.

Tribunal’s decision After 11 days of evidence and argument, the Tribunal ultimately concluded that: •

• • •

while there were some minor shortcomings in relation to the facility’s information systems, those shortcomings were not nearly as serious as the Department and the Agency reported; the minor deficiencies in the facility’s systems did not warrant the imposition of sanctions by the Department; the non-compliance was minor; and the non-compliance had never posed “an immediate and severe risk” to the health, safety or welfare of the care recipients at the facility.

Lessons The Tribunal stated that sanctions may never have been imposed if there had been more comprehensive discussions between the Agency, the Department and Blue Care before the sanctions were imposed.

The Tribunal found that as a result of that inadequate communication:

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•

The Department failed to take into account information which would be relevant to deciding whether there was “immediate and severe risk”.

For example, the Department did not obtain the opinion of the care

recipients’ treating doctors before making the finding of “immediate and severe risk”. If they had done so, information about the individual residents’ medical conditions would have demonstrated that changes in the condition of those residents were an expected consequence of their medical conditions and not due to any lack of care.

•

The Department placed too much weight on certain pieces of evidence.

For example, the Department concluded that there was no or inadequate monitoring of care recipients’ nutrition based on a conclusion that the weight charts were not being regularly reviewed by clinical staff. However, further inquiries would have revealed that the weight charts were reviewed daily by clinical staff.

The Agency assessors inappropriately inferred, after finding additional desserts in the facility fridges, that the care recipients had been denied adequate nutrition when in fact, it was routine practice for additional desserts to be left in those fridges to cater for the unusual eating patterns of dementia patients.

Practical tips When there is “immediate and severe risk”, the Department is not required to notify an approved provider prior to making a decision to impose sanctions. However a provider who is concerned or suspects that there is a risk of a finding being made by the Department of “immediate and severe risk”, should communicate with the Agency and the Department to determine the basis on which they consider the risk exists so that the provider can take all possible steps to satisfy those concerns before the finding is made.

To demonstrate compliance with the standards during an Agency site visit we recommend that providers: •

Ask the Agency to immediately inform the provider of any concerns it has about what they have observed so to maximise the opportunity of the provider to respond.

•

Ask the Agency to detail the evidence it intends to rely upon to support their concerns.

•

Where possible (and especially when an indication has been given that there are concerns about a finding of “immediate and severe risk”) the provider should ensure that a senior member of staff is dedicated to communicating with the Agency and responding to any queries or requests for information by the Agency.

•

Providers should systematically consider each issue raised by the Agency and provide any additional information to the Agency that the provider wants the Agency to consider before making their findings.

Finally, there is no doubt that Agency visits, especially when there are concerns about a possible finding of “immediate and severe risk”, can be extremely stressful events for staff and managers alike.

Providers should ensure that their managers and staff receive appropriate training to ensure that they have a thorough understanding of the Agency’s role and the basis on which a finding of “immediate and severe risk” can be made.

This training will better equip those staff members to deal with the Agency and enable them to take all possible steps to address the concerns of the Agency and hopefully avoid the imposition of sanctions. As this decision has shown, once in place, it is a very difficult and expensive process to overturn sanctions and undoubtedly, prevention is better than the cure. n

Discover the Cater Care difference.

editorial

Funding the future of aged care

A Deloitte and Aged Care Association perspective The Productivity Commission

Introduction:

established a public inquiry

population. The submission

While long-term demographic projections contain an unavoidable element of uncertainty, it is widely accepted that the number of elderly people in the Australian population will rise rapidly in coming decades. Much of that increase will involve a rise in the number of people who are very elderly, including centenarians. However, what is less certain is how the health status of that elderly and very elderly population will evolve over time. Even if the average health status of the elderly and very elderly population were to improve greatly relative to earlier decades, the sheer numbers surviving to very high age brackets would result in a very large increase in the population requiring care because of frailty or other conditions for prolonged periods of time.

An expansion must occur in the formal care sector if care needs of a changing population are to be met.

was based on a national

Financing future aged care:

into Caring for Older Australians and invited a variety of stakeholders to prepare submissions for them to consider. In early August 2010, Deloitte and Aged Care Association Australia (ACAA) provided a joint submission to the Productivity Commission about funding strategies for the future of an aging

strategic workshop hosted

by Deloitte and the ACAA, and attended by providers, financiers, operators and other key stakeholders.

Ensuring that older Australians can help finance their care costs requires a carefully designed, long-term transition path, which will assist planning by consumers, care providers and care financiers such as banks and super funds. Measures will also need to be put in place which can help consumers set aside and then access the financial resources they require.

One of the main issues in aged care is how an expansion can be financed, as the current financing arrangements are not capable of supporting the increase in supply that is needed. At present aged care funding is financed from current tax payments and changing demographics will result in a significantly lower percentage of current tax payers compared with elderly people

requiring financing. Also problems arise from the inability to charge entry bonds into high care. This has made the availability of funding for expansion of the accommodation stock in high care dependent on the level of other, regulated, charges.

The level of those charges has proven inadequate to finance that expansion. This means that a rising share of the growth in high places has occurred in the extra service segment (where bonds can be charged), but the decision to implement the policy cap on extra service places at local area level has now closed off that option in many of the places where capacity expansion is most needed.

The problems this creates are compounded by the differential trends in demand between high and low care. The Aging in Place policy, as well as minimising the disruption to clients, has also allowed providers to cover at least some part of the common costs of high care places through entry bonds charged in low care. However, while low care continues to expand, it may not expand as rapidly as the required growth in high care places. As a result, the needed growth in high care places will not be able to be financed through bond payments in low care.

There are also issues of financial adequacy in community care. Transport costs have a major impact on the costs of providing community care; so also do staff costs. Both of these have been rising more rapidly than the community care payments and are likely to continue doing so. While there is some potential for new technology to reduce costs in community care (for instance, through improved remote monitoring), those reductions are not likely to be sufficient to offset other sources of cost increase, including rising levels of acuity in the population being served. As those cost

aca Aged Care Australia | Spring 2010 | 55

editorial

“

The primary financial

role of the Commonwealth should be to finance care for those elderly Australians who are not in a position to themselves cover its costs

”

pressures play themselves out, providers will have little choice but to reduce the hours of care they provide for each package.

Possible models to ensure sufficient savings are available to fund future aged care needs:

Further difficulties with the financing of community care are likely to arise from the move to consumer-directed care. This involves shifting some or all of budget control into the hands of the consumer, which can have many benefits. However, it also means that providers can no longer subsidise high cost to serve cases from low cost. The result will be to erode the ability of providers to bridge the acuity gap noted above through cross-subsidisation within the pool of consumers.

The options below are not mutually exclusive and a combination of these ideas could be considered:

Many elderly Australians have limited assets and income, and a substantial share of what assets they own involve the family home.

While that home can be sold at the time of entry into residential care, it may not be so readily sold if only one member of a couple is going into care. Moreover, domiciliary care provided in the family home obviously cannot be funded through the sale of that home, though there may be ways other than selling or unlocking the consumer’s equity in his or her home.

We note that many Australians who retire in the future will also have pools of superannuation available to them built up through the compulsory superannuation levy. There are however, concerns that the amounts of super available to retirees will not fund their retirement needs, let alone their aged care needs.

Combined, these factors mean that meeting the growing demand for care will require a significant increase in the flow of funding to the sector. The issue is determining the appropriate balance that is needed in that increased funding as between consumer contributions and payments from the Commonwealth.

In principle, the primary financial role of the Commonwealth should be to finance care for those elderly Australians who are not in a position to themselves cover its costs. In that sense, the Commonwealth has, and must retain, a primary responsibility to ensure an adequate social safety net is in place.

Conversely, those consumers who are in a position to cover their own care costs should do so, thus minimising the call on public expenditure and hence also minimising the need to impose distorting taxes so as to fund that expenditure.

1) Use of Superannuation or other long-term saving products Our first conceptual idea is to open up superannuation or other long-term saving products e.g. savings account, long-term care insurance. This would require a system whereby care and services would be separated from accommodation and each funded differently which would provide flexibility for both the provider and the resident.

Residents’ individual superannuation funds would be used to pay for care and services, whereas the cost of capital would be funded by the superannuation industry as a whole.

We believe that incentives would be required for this to occur (possibly tax incentives) or government legislation to ensure minimum investment of the funds into the industry.

At a particular age (e.g. 40–45) a portion of superannuation contributions would be set aside for aged care needs.

If these funds were not all used to provide for a person’s aged care needs, then either the entire balance would be forfeited to the larger fund or alternatively, the employer portion would remain in the fund and the voluntary contributions would be released to the family.

The aged care operator would benefit through user pays for care and services and should benefit from gaining access to capital. The model would be similar to a private hospital, with options based care and services, therefore the operator would be able to fund debt from loans out of superannuation funds.

This model could potentially lead to a reduction in the government burden for care cost if used as an incentive for younger ageing and wellness. It also moves the burden of funding to the consumer through superannuation payments during their working life, although the government would still be required to provide a safety net level of funding and would still have a vital role in ensuring that quality of service was maintained. This model could also

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editorial have further benefits if the superannuation system was opened up to allow children to contribute for the aged care needs of their parents.

2) User pays system Our second conceptual idea is also based on separating the care and accommodation aspects of aged care and then allowing the resident to pay for the care and accommodation based on the quality of the service provided.

As opposed to the current system where the basic level of service is underpinned by the resident, under the resident pays system, the basic level of service would be underpinned by some level of government support.

The monthly retention of the accommodation bond would need to be changed from a cap to a floor arrangement and could be used by the resident to fund care and accommodation.

Removing regulatory burdens, which create inefficiencies in the industry, should allow

the operator to derive a reasonable rate of return and provide greater transparency in charging â&#x20AC;&#x201C; it would result in an increased ability to attract capital market funding.

This model would ensure that the government could focus regulation on the level and quality of care and would involve the provision of a safety net for basic care for those who cannot afford it and a guarantee in the case of â&#x20AC;&#x2DC;resident defaultâ&#x20AC;&#x2122;.

The system would operate under a similar funding model to that used to fund private medical insurance.

This would benefit the resident through greater transparency in charging and the ability to choose service and accommodation levels to their liking and their affordability. It would also result in access to better quality facilities and care given greater investment by the industry.

This model could result in the wealth and income of the family being used to fund the resident care and accommodation needs of their parents/grandparents, although we note

that the removal of the government funded place may create some initial uncertainty in funding and prompt a pull back on bank lending guidelines which would need to be addressed.

3) Use of insurance products Our third conceptual model involves the use of different forms of insurance to fund aged care e.g. public (e.g. Medicare), private, and/ or social.

In our view, insurance would not be for base level aged care needs. This is a method whereby the costs of care above base level would be prepaid for users of the aged care system.

The system would be deregulated and the Government would provide a minimum underwritten level of accommodation (e.g. four-bed ward services) and services/care with existing co-payment arrangements. On top of that insurance would provide funds for levels of accommodation and food above base levels (and possibly care above base levels).

This model would encourage a deregulated environment with opportunities for product differentiation. Government would still be responsible for base care.

Insurance products could be acquired by individuals and used either by the individual or their carers/relatives. The method is cheaper for individuals than the alternative of pure savings schemes where everyone has to save enough to meet the costs even if they end up not using the system.

In order to ensure that the pool of funds was sufficiently large, the government could make the scheme mandatory or make it an opt out scheme or incentivise individuals in a way akin to the current private health insurance arrangements.

4) Use of capital markets for funding requirements Our fourth conceptual idea involves the wider use of capital markets for funding requirements. Current bonding and debt arrangements lack flexibility and are a limited

source of capital, so aged care businesses will need to attract other sources of capital.

Capital market funding would include: • Superannuation funds • Stock markets • Private capital • Private health funds.

The funding of accommodation costs (capital markets/ superannuation/private capital) should be separated from the funding of care costs (supported by government) to allow a greater diversity in the mix of the accommodation.

The current level of regulations would need to be reduced to make the industry more attractive for investment. The cap on the rate of return would need to be lifted to make it appealing to the capital markets. The rate of return could be assisted by reducing the tax burden on aged care businesses – i.e. state/ federal, direct and indirect taxes. Owners could also get relief through a ‘negative gearing’ type model.

The Government would still need to provide a safety net for base levels of accommodation and base this on individual or family means tests. However as the levels of investment and return increased over time this might reduce.

Residents would benefit through access to more diverse accommodation as well as more choice.

Strategies for effective funds dispersal 1) The current position The key components of funding for care recipients are: • Care and personal services • Accommodation and hotel services.

Currently Government provides approximately 80% of aged care funding.

Means tests and regulations discriminate for and against many care recipients in accessing their care and accommodation needs. Numerous anomalies, inconsistencies

editorial

“

A better mix of acute

and long-term services can help make expenditure more effective and sustainable

”

and imbalances have grown out of a system focused on management of demand for aged care, services and accommodation within the government appropriation system. This is entirely understandable as good Government must be held accountable for its expenditure.

However, what we now have is a system where Government is the price setter, price taker and price controller with complex regulation and controls to protect its interest in the process.

The current rigid and inflexible system exists in a changing environment and where higher and more complex levels of care will be required by many and where Care Recipients will seek more choice over their care needs than the current one size fits all model.

2) A suitable pricing mechanism It is vital that an independent mechanism for calculating an appropriate economic cost of care and personal services and levels of hotel and accommodation services is established.

The task of undertaking this cost assessment should be allocated to an independent authority or commission (i.e. consider the possibility that that function be undertaken by the new Hospital Pricing Authority) for the ongoing evaluation, calculation and administration of this cost mechanism.

This can then serve to be the price setter, whereby Government as purchaser, can determine the level of services it will fund and to who it will fund into the aged care system. It can also be the price setting mechanism for care recipients in choosing the services they wish to access and the type or quality of accommodation and hotel services they procure.

Government will then have a much simpler task ahead of it, deciding which services/ accommodation it purchases and which is left to the care recipient to fund.

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3) Effective disbursement of aged care funding It is important we address the issue of dispersing aged care funding effectively. We need to consider how we convert the savings of care recipients to disbursements on to the care providers and how does Government facilitate a disbursement structure efficiently?

Currently recipients are converting their savings, mainly from the family home, to buy their aged care accommodation through payment of bonds/charges.

A few options could be considered to disperse aged care funding; • Savings options An introduction of a supplementary national aged savings scheme could be made through the extension of the superannuation guarantee scheme.

This would generate a pool of funds which can be preserved for procuring health and aged care services for citizens older than 75 • Insurance Health savings accounts which are Government approved tax effective savings accounts that are preserved for health and aged care service funding • Long-term care insurance This involves Government approving a tax effective long-term care insurance product that could be offered through the Private Insurance Industry or general insurers • Private Health Insurance Private health insurance providers are either obligated or provided with incentives to expand their product offering to include a range of aged care specific services and products that can be delivered in either the home or residential care • Public Insurance This involves Medicare being required to extend the range of options that it would offer customers to cover longterm care and home based service provision.

These options above mean that recipients can access their savings to fund the balance of care, services and accommodation or access another long-term funding option.

Conclusion Rigorous debate will continue around sustainability of financing long-term care services ensuring more responsive aged care services, increased consumer choice and better quality services. The current government inquiry provides an opportunity for the industry to work with government in ensuring the future of aged care funding is more effective and sustainable. n

For further information Helen Hamilton-James Partner National leader – Senior Living Tel: +61 (0) 2 9322 7880 hhamiltonjames@deloitte.com.au Henry Ergas Senior Economic Adviser Tel: +61 (0) 2 6263 7188 hergas@deloitte.com.au Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee, and its network of member firms, each of which is a legally separate and independent entity.

Please see www.deloitte.com/about for a detailed description of the legal structure of Deloitte Touche Tohmatsu Limited and its member firms.

Deloitte provides audit, tax, consulting, and financial advisory services to public and private clients spanning multiple industries. With a globally connected network of member firms in more than 140 countries, Deloitte brings world-class capabilities and deep local expertise to help clients succeed wherever they operate. Deloitte’s approximately 169,000 professionals are committed to becoming the standard of excellence.

This publication contains general information only, and none of Deloitte Touche Tohmatsu Limited, Deloitte Global Services Limited, Deloitte Global Services Holdings Limited, the Deloitte Touche Tohmatsu Verein, any of their member firms, or any of the foregoing’s affiliates (collectively the “Deloitte Network”) are, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your finances or your business. Before making any decision or taking any action that may affect your finances or your business, you should consult a qualified professional adviser. No entity in the Deloitte Network shall be responsible for any loss whatsoever sustained by any person who relies on this publication.

Liability limited by a scheme approved under Professional Standards Legislation. © August 2010, Deloitte Touche Tohmatsu.

All rights reserved.

editorial

SAGE visits China and Hong Kong SAGE study tour leader Judy Martin recently returned from SAGEâ&#x20AC;&#x2122;s latest successful tour to Asia. It was a great success where delegates reported the biggest learning was the Asian approach to active aging, Judy claims.

Louise Watters CEO of Port Stephens Veterans and Citizens Aged Care gives her overview of the trip and provides this reportâ&#x20AC;Ś

W

hat is becoming obvious is that the world is ageing and that need is going to far outstrip resources.

The policy framework of supporting ageing in place is strong in both Hong Kong and China although both are approaching it differently.

Hong Kong are building big day centres with innovative designs and hours of operation.

This includes Mon-Friday and the elderly person goes home to the family on the weekend. There is also discussion about utilizing the 60+ volunteer workforce to look after the 80+ people. Hong Kong is very land locked and there is very little government assistance for the elderly. One major university in Hong Kong is undertaking

research into the breakdown of the family relationships in Hong Kong.

Finding staff wishing to work in Aged Care in Hong Kong is very problematic which is similar in Australia.

China was very different again and clearly regulated by the state. The China National Council of Ageing is an interesting Government department especially with a representative from every government department involved in decisions effecting seniors in China. The number of social welfare institutions, government run urban areas is 39,000. The number of aged care beds 2,754,000; the number of residents 2,088,000. There are bed vacancies within the aged care facilities. This reflects the Chinese culture of communal living other issues include affordability and location of the facilities. The financial data showed that 51% of these institutions are at a break even balance, 40% are running at a deficit, 9% made a small profit.

The facilities visited demonstrated a more holistic approach across retirement living and aged care facilities with the strongest focus being on lifestyle. The number of residents attending a form of activity whether it is mahjong, tai chi, calligraphy outside in small groups chatting, and singing was evident in all of the places visited on this tour. The elderly people around the streets of Shanghai and Beijing more often than not are seen pushing their wheel chairs than being pushed. We visited Beihai Park and saw the older people at the park at 6am to do their exercise. We saw people doing tai chi, fencing, choir singing, one group invited us to join in and a lot of fun was had by all.

There are only 10 Hospices in China, end of life care is not regulated by the Council but comes under the Department of Civil affairs.

Every facility/complex had access to dental services; medical services many with an in built small hospital, foot therapy. All had

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outside Tai Chi equipment. The majority of the workforce is care staff but there is also a very large component of registered nurses.

Standards for RNS have been developed but not enforced.

However like the rest of the world China by 2050 will have nearly tripled its population over 60 and its workforce will reduce from 9 to 2.8 for every elderly person. The Government has responded and is releasing land to build retirement villages with collocated residential care and encourage the local community to visit and utilize the facilities.

The elderly in China still have respect and are treated with dignity at all levels. The tour was very rewarding, and I certainly received a lesson in healthy ageing.

My name is Louise Watters and I am the CEO of Port Stephens Veterans and Citizens Aged Care. Our company heard about the SAGE tours through the web and through

editorial SAGE visits China and Hong Kong (continued)

SAGE is a joint alliance between peak Industry associations ACAA, ACSA, RVA and architectural company ThomsonAdsett.

The SAGE Tour programs offer delegates an educative, professional and culturally appropriate study experience in another country looking at Seniors Living Models and delivery of care.

SAGE delegates have the opportunity to evaluate the advancement of Eldercare from a global perspective and receive insights from some of the world’s most highly respected industry professionals.

the peak body. I chose to go on a SAGE tour to learn about international approaches to ageing and to bring back ideas on how we can further improve the services we provide to our local community. The other huge beneficial side to this tour I discovered was the networking among the delegates and sharing of information. There was much discussion on the bus as we went to the

facilities. The tour was well organized and we saw both ends of the ageing spectrum from the very wealthy to the very poor. I would recommend anyone looking to find innovative ways to grow their businesses to go on a SAGE tour and I would like to thank the Board of Port Stephens Veterans and Citizens Aged care for sponsoring me on this tour. n

Successful study tours have been run since 2006 across four continents for hundreds of delegates. SAGE continues to grow and support its mission and its name; Studying and Advancing Global Eldercare. For further SAGE and future tour information visit www.sagetours.com

events

2010 Calendar of Events 6 – 9 October

27 & 28 October

GP10 RACGP Conference

Aged Care Nurse Managers Conference Kardinia Centre, Geelong, VIC

Shaping our future T: 03 9417 0888 E: gp10@arinex.com.au http://www.gp10.com.au

Enquiries: Wayne Woff T: 03 9571 5606 www.totalagedservices.com.au

ACAA 2011 Diary Dates NSW Congress 2011 19 & 20 May Sheraton on the Park, Sydney Contact: ACAA NSW T: 02-9212 6922 E: admin@acaansw.com.au www.acaansw.com.au

ACQ State Conference 2011 23 – 25 March

26-28 October

14 – 16 November

Advantage’10 Sofitel Brisbane Central, Brisbane

ACAA 29th Annual Congress

Contact: OzAccom Conference Services T: 07 3854 1611 E: advantage10@ozaccom.com.au www.rvadvantage10.com.au

Ageing in Australia – evolution or revolution?

Adelaide Convention Centre Contact: Conference Solutions T: 02 6285 3000 E: acaa@con-sol.com or enquiry@acaacongress2010.com.au www.acaacongress2010.com.au

Jupiters Gold Coast E: events@acqi.org.au www.acqui.org.au

ACAA 30th Annual Congress 2011 6-8 November Gold Coast Convention Centre T: 08-9405 7171 jane@acaa.com.au

If you don’t understand this now, you will in a few years…

When asked by a young patrol officer, “Do you know you were speeding “?

This 83-year-old woman talked herself out of a ticket by stating . . .

“Yes , but I had to get there before I forgot where I was going.”

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editorial

Australian scientists achieve major Alzheimer’s breakthrough Australian scientists have achieved a major breakthrough by finding the causes of Alzheimer’s disease at a cellular level.

T

his ground-breaking new study paves the way for identifying a potential therapy for the disease.

The findings have been published in the prestigious US scientific journal Cell.

The research team, from the University of Sydney’s Brain and Mind Research Institute (BMRI), was led by Professor Jürgen Götz and Dr Lars Ittner.

Their work shows how two key proteins interact to trigger the brain degeneration known as Alzheimer’s. A protein called TAU affects and mediates the toxicity of amyloid-b, which together with TAU causes the symptoms of Alzheimer’s disease.

Professor Götz said that this significant breakthrough by Dr Ittner and their team has implications for how the disease develops and how it may be treated.

In 2001, Professor Götz published a milestone work in Science, which showed that the two hallmark proteins, amyloid-b and TAU, act together in disease. Their exact connection remained unexplained however.

“It was always clear to me that finding this link could be the key to understanding the disease,” Professor Götz said.

Alzheimer’s is the most prevalent of all diseases which involve memory loss, with one person in 85 around the world expected to be affected by Alzheimer’s by the year 2050.

The main clinical feature of Alzheimer’s disease is a progressive loss of cognition, accompanied by aggression and mood disturbance, leading eventually to patients being institutionalized. At the present time, the disease is incurable. n

No time like the present: the importance of timely diagnosis Over 90% of Australians say that they would be likely to visit their general practitioner if they have concerns about their memories. At the same time, there is evidence that many GPs have difficulty in identifying and/or addressing dementia through appropriate referral to specialists or support services.

A

s a consequence obtaining a diagnosis can be difficult, lengthy and an intensive process for both the person with the concerns and their carers and family. But timely diagnosis is important and essential to the ongoing treatment and care of the person with dementia.

Interviews with carers and people with dementia suggest that the barriers to a diagnosis may include: • • • • • • • •

stigma and negative attitudes to dementia care difficulties in differentiating normal ageing from dementia GPs lack of confidence or training and risk of misdiagnosis the difficulty of accessing specialist diagnostic services, especially in rural areas limited time and lack of a recognized, time-efficient screening tool a perceived lack of need to determine a specific diagnosis perception that the patient cannot comprehend/cope with the diagnosis risk of damaging the doctor-patient relationship.

This is why Alzheimer’s Australia asked Professor Dimity Pond and her colleagues to write No time like the present: the importance of timely diagnosis for GPs. Alzheimer’s Australia through reports, studies and conversations with their clients recognise the need for more support and education for GPs through the diagnosis and ongoing management of the disease.

It is important to remember that many different health conditions affect memory and are often treatable or reversible. Once other conditions have been ruled out a timely diagnosis of dementia will ensure the person can commence treatment as soon as possible.

Evidence shows that medications for dementia are most beneficial in the early stages of dementia and may stabilise the symptoms of dementia for a period of time in some people.

Timely diagnosis makes it possible to plan future health care while the person with the diagnosis still has capacity to communicate in advance decisions about health care though advance care planning.

Equally, it is important that the person has the opportunity to put their financial affairs in order by appointing a person to manage their financial affairs.

No time like the present is aimed at all medical health professionals.

It offers a comprehensive coverage of important topics such as different types of dementia, signs and symptoms, the process of diagnosis, referral to services post diagnosis and firsthand accounts from carers. n The publication is available for free download from www.alzheimers.org.au Hard copies can also be purchased for $7.50 each by calling (02) 6254 4233, emailing admin@alzheimers. org.au or downloading an order form from the website.

editorial

Fragile Facilities: Serious Risk Professor Tracey McDonald [1] Ms Wendy Smallwood [2] Affiliations: [1] RSL LifeCare Chair of Ageing, Australian Catholic University (ACU) [2] Commonwealth Nurse Advisor and Aged Care Standards and Accreditation Agency Auditor

Background

S

ince 2007 a significant increase has occurred in the number of aged care facilities that have been found non-compliant with regulations under the Aged Care Act 1997 (the Act). Increased activity by the Australian Standards and Accreditation Agency (the Agency) could be a factor with around 7,000 unannounced visits during 2008-09, exceeded the 3,000 planned unannounced visit schedule. In May 2010 the then Minister for Ageing, Justine Elliot announced further steps being taken to increase accountability through even more unannounced visits with a focus on staff police checks among other compliance elements.

Since February 2009 service compliance and applied sanctions arising from this intense scrutiny of the residential aged care industry has been openly displayed on the Department of Health and Aged Care (DoHA) website. Information includes homes sanctioned during the previous year; those currently sanctioned; and those under a notice of non-compliance (NNC).

The authors use the term ‘fragile facilities’ to describe residential aged care organisations that have been found to be non-compliant with regulatory requirements. Fragility of this

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type is not a permanent situation. Facility problems in dealing effectively with demands made by government, the general public or clients are temporary and can be improved.

However, among these fragile facilities the situation can deteriorate to a point where a service can be judged by The Agency and DoHA as posing a serious risk to residents.

When this occurs, urgent and expert action is needed if the organisation is to ensure the safety of residents and staff and continue as an approved service.

Information on providing aged care services that comply with legislation and standards is available on the Department of Health and Ageing website: http://www.health.gov. au/ as well as on the Australian Aged Care Standards and Accreditation website http:// www.accreditation.org.au/. Information on what constitutes ‘serious risk’ is also provided on the site and approved providers (AP) should ensure they understand what this entails even if they believe it will never apply to their service.

What follows is an account of what may occur when a fragile facility is declared a ‘serious risk’; and a discussion of aged care management and clinical issues that could have led to this decision. Aged care managers should not rely on this information in the event of their facility becoming involved in dealing with a serious risk situation. In such an event they should immediately seek advice from their peak industry body.

SERIOUS RISK There are many different routes that can lead to serious risk being declared and as circumstances and situations change, so do the response strategies necessary to resolve these situations. In this brief overview we present information based on relatively recent situations of serious risk and the challenges faced by APs and others involved in the response.

In situations where the Agency believes that there is a serious and impending risk of harm to the wellbeing and safety of residents, ‘serious risk’ will be declared. Serious risk is called when there is immediate or severe risk to the health and wellbeing of one or more residents. When serious risk is identified by the Agency their decision-makers inform DoHA of the findings. DoHA assesses the evidence provided and makes a decision regarding any immediate and severe risk and may impose sanctions on the AP. At this point the AP will be asked to provide a list of residents and/or their representatives so that contact can be made with them about the situation. It is crucial that this list be kept up-to-date at all times as an inaccurate list is further evidence of information systems failure.

Following the decision to declare serious risk, all residents will receive a letter from DoHA stating that the facility has been identified as posing a risk to their safety and wellbeing. If follow-up interviews with residents occur, the purpose is to ensure that they are fully aware of what has happened within the facility. Predictably, this process can be very distressing for residents, families and staff.

The AP needs to contact the peak industry association for advice as soon as they are informed of their serious risk status.

Immediate and constructive action to remedy any significant non compliance identified during an audit, may improve the outcome for the AP regarding DoHA’s decision. Whatever the outcome, it is advisable that the AP appoints an external consultant (either from their corporate office or an external source) who has both the clinical and managerial skills necessary for an immediate and effective response. If the consultant is already a member of the Commonwealth panel of Advisors/ Administrators there are distinct benefits in terms of the ongoing response process where the sanction of appointing a nurse advisor (NA) will be imposed. The list

of possible sanctions is at s.66-1 and s.66-2 of the Aged Care Act 1997 and can include non-payment of government subsidy for new admissions or the engagement of a registered training organisation (RTO) for staff education and training.

The following description of the response process is based on many years’ experience of assisting facilities to respond effectively following declaration of serious risk status.

There is no standard response and the issues will vary between fragile facilities, but we have outlined what could occur.

• Immediately (within the first 12 hours of serious risk being declared) At this point any delay by the AP in responding can result in disaster. Approved providers have to realise that their compliance responsibilities must be met by whatever means necessary. After notifying the peak industry association the AP will engage an appropriate consultant to help with the response to DoHA and the Agency, and introduce remedial clinical and service activities in the facility.

The consultant needs to arrive at the facility ASAP and identify the residents for whom serious risk has been called. Any of the expected outcomes may have been involved as non-compliant however the highest risk areas are in Standard Two “Health and Personal Care”. Some of the common issues arising under this standard are examined in detail later in this article.

If, by the time the nurse consultant arrives on site, the facility has not already sanctioned, the AP will be advised to voluntarily cease admissions in order to reduce pressure on staff and enable the situation to stabilise around caring for existing residents. If sanctioned, the AP has 5 days to identify a Nurse Advisor, but it would be a mistake to not act immediately. A list of Advisors from which the AP can choose will be provided by DoHA. By giving written approval to the Agency and DoHA for the consultant to act as the APs representative, prior to the Nurse Advisor being approved and appointed, lines of communication essential to the management of serious risk can be opened up.

• Day one of Serious Risk For the purposes of clarity in relation to the following information, ‘consultant’ refers to

an aged care consultant who is a member of the Commonwealth Panel of Advisors/ Administrators.

Agency auditors will arrive at the facility and begin assessing and monitoring resident care and services as well as the facility response to the situation. Commonwealth officers may also visit the facility depending on the nature of the risk and why the Audit was initiated. Interviews with residents and families will commence and staff should assist where necessary to enable interviews to be conducted sensitively and, as far as possible, in private. A residents and representatives meeting and a staff meeting should be called by the AP within 5 days to inform all stakeholders of the situation.

It should be anticipated that both DoHA and the Agency will attend as observers to the residents and representatives meeting.

Mini staff meetings will be convened on a daily basis by the consultant to keep the staff informed of actions and the processes involved. During this period the staff are the APs greatest asset, a fact that must be recognised and supported by the AP and consultant.

The consultant will review specific residents who have been identified by the Auditors as being at risk of harm. The consultant will review these residents’ clinical health status and care needs and if necessary they will be transferred to hospital if the consultant believes the facility is unable to provide the level of care required. The AP must support the consultants’ decision to relocate the residents. DoHA and the peak industry association can provide assistance in identifying suitable aged care alternatives and also make contact with area health services to open channels needed for resident transfers. Once these specific residents have been safely provided for, the consultant will undertake clinical outcomes assessments related to non-compliant areas for all other residents. In this way he or she will make sure that there are no additional areas of risk that have not yet been identified. It is possible that over the following days more residents could fall into serious risk as well.

The primary focus of DoHA at this point is on complaints handling processes as well as negotiating care and compliance issues related to residents being transferred and those remaining in the facility.

Clinical assessment of each resident will include consultation with their general practitioner (GP) if further assessment and treatment is required. Mini case conferences on all residents at risk will be completed and documented by staff (as directed by the consultant) in their clinical records.

From the first contact, the consultant must treat all staff with respect and provide support, as this group is generally unaware of deficits in their skills and knowledge about providing care and services. Staff can quickly become alienated from the process. Their ability to perform their duties can rapidly decline due to stress and anxiety, further compromising resident care and safety.

As the clinical situation becomes clear, APs must approve the consultant’s requests to call in additional people who have the skills necessary to deal with areas of care and service deficiencies. Depending on the nature of the identified risks the specialists involved could include: Supply pharmacist, mental health services, behaviour management specialist, continence advisor, dietician, speech pathologist, physiotherapist, specialist clinicians for resident’s specialised nursing care needs, OH&S advisor, fire safety advisor, infection control advisor and an equipment service group to check serviceability and appropriateness of care and service equipment. The consultant has to be the acknowledged leader and coordinator of such a team and all visiting professionals must be fully briefed on the process of serious risk and the need for sensitivity towards the staff group and acknowledge their concerns.

• Day two - Unfolding of serious risk response Despite the highly stressed environment and any organisational chaos that can ensue, the consultant must be an oasis of calm amidst this turbulence. Management will take their lead from the consultant’s behaviour which should inspire confidence that the situation can be safely and efficiently resolved.

Once all clinical assessments and transfers have been completed, the next few days will be punctuated by daily visits by Agency and in some instances, DoHA officers. The facility will be microscopically examined for any further non-compliance and a very real possibility exists that further areas of non compliance will be identified and referred to

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Agency decision-makers. Daily monitoring by government officers will continue until serious risk is mitigated.

The development of an action plan must commence immediately which identifies the strategies to be implemented to mitigate risks to residents identified by the auditors.

This action plan will be presented to DoHA throughout the period of serious risk as evidence of progress with the addition of daily phone contact to the designated DoHA Officer assigned to the facility. During this contact the consultant (appointed nurse advisor) will be required to indicate the level of AP involvement and intention to remedy the situation.

• Days three to seven – towards mitigating serious risk Within seven days of receiving a notice of serious risk the AP must respond. At this time the AP may query the audit findings and provide supporting documentation arguing that the risk is less than claimed at audit; and provide evidence that facility systems and care are effective and appropriate. A comprehensive continuous improvement plan will be required for presentation to DoHA which addresses all aspects of the Agency audit findings. In serious risk situations this may be separate to the action plan.

As the process unfolds, the focus turns to systems underpinning care and services, for instance, documentation, information systems, quality systems, staff training, etc. The consultant, whom by this time is identified as the Nurse Advisor (NA) will make daily reports to the AP and management board regarding how to address the sanctions imposed and the discovery of other areas of risk.

Naturally, these activities will place staff, residents and family under emotional stress and if all senior people in the organisation spend time supporting and counselling those involved, the situation is more likely to stabilise and reduce the emergence of shame, blame and other consequences of receiving a damning report. Without this level of support absenteeism, sick leave, resignations and unauthorised contact with media and other groups can occur, further jeopardising the potential for adequately meeting standards for care and services. Staff should be counselled rather than disciplined during this period. Disciplinary action

should only be taken to address serious breaches in professional practice or employee performance as advised by the peak industry association industrial relations advisors.

Complainants should be identified and managed in confidence by the consultant.

Tip on speedy response There is an industry expectation that serious risk will be managed within a 7 to 10 day time frame, to a level where the Agency can assign auditors to review the expected outcomes where serious risk has been identified for individual residents.

The risk to the AP of delaying action on managing serious risk quickly and to the satisfaction of the Agency decision makers is that their accreditation may be revoked.

AREAS OF IDENTIFIED RISK The following sections draw upon announcements to the media between 28 July 2009 and 9 July 2010 by the Hon Justine Elliot in relation to sanctions imposed and the areas of risk identified. An analysis of the main issues and some tips for APs to consider are also included.

SERIOUS RISK - NURSING CARE AND TREATMENT During the period 2008 to 2010 issues commonly leading to serious risk and sanctions were clinical care; nutrition and hydration; medication management and pain management which are key issues in nursing care.

Serious risk announcements are publicised on the websites mentioned earlier and

when generally known, could deter nurses and other professionals from seeking employment or being associated with homes identified as posing a serious risk to residents.

An examination of some of the issues identified and justifying sanctions being imposed during this period reveals a significant lack of suitably qualified and skilled staff, among other issues shown in Graph 1.

Aged care facilities are required under s.54-1(1) (b) of the Aged Care Act 1997 to provide suitably qualified and experienced staff to perform the duties required for safe and effective care and services to the people accepted by the facility for admission.

Admission policies need to relate to staff ability to manage resident care needs once they are admitted. When residents with complex care and behaviours are admitted despite many staff not having the skills or experience to provide appropriate care, undue risks are borne by these residents who are placed in harm’s way.

It is important to be in control of resident admissions by ensuring that whoever is admitting people has the skills to understand the care and services that will be required by that person. Part of the pre-admission assessment is to ascertain if the person could be suitably placed within the existing resident community. In our experience this is rarely ever done well or with accuracy as the primary goal. If carefully undertaken, competent assessment makes it possible to prevent future care issues and complaints arising from misplaced or mismatched residents.

The Aged Care Assessment Team (ACAT) documentation on its own does not provide a true picture of what care a person will need if admitted. A combination of ACAT assessment with the facility’s own assessment of the family; medical practitioner information; and contact with the previous facility or hospital

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manager will enable APs to establish the duty of care that may be required. Once this is known, the adequacy of staff skill and numbers to meet their care needs can be gauged.

Careful staff recruitment and retention is needed to build a positive, respectful work culture and to identify staff whose influence or competence level is less than optimal.

All managers and staff need to be held accountable through performance appraisal and management systems.

Safe management of wounds requires evidence of appropriate and timely treatment as well as a documentation system that makes it easy to track progress on wound healing outcomes. Where this is lacking, staff may not be aware of their responsibilities in relation to assessment and management of wounds or the need to record details of care and treatment. An investigation may reveal an ineffective system of clinical communication about wounds between GPs, family and hospitals, or that people in the communication chain are unaware of their responsibilities.

Tips on safe staffing Always replace staff on care rosters. Using care and services vacancies to pad out budgets is false economy.

Use the quality systems you have in place to identify time and frequency data about accidents and incidents as well as infection control issues, to adjust staffing to prevent reoccurrence and reduce risk of harm to residents.

Tip on wound evidence On admission from home, hospital or another facility be sure to conduct a thorough physical assessment, including photographic evidence of any wounds, abrasions, rashes etc so that any improvement or deterioration of condition can be compared with baseline admission assessments.

Staffing of care and services must be adequate to accommodate resident preferences and not focused only on completing tasks and routine care.

Engage a clinical nurse specialist in wound management from the local area health service to advise and support staff on wound assessment and contemporary wound care treatments.

Manage your workplace culture and provide information and training about acceptable workplace behaviours BEFORE issues of bullying and harassment arise.

Documentation of wound care requires a simplified and dedicated reporting system that results in clear, concise information about wound treatment and healing.

The resident admission policy must have clearly defined entry and exit criteria to reduce the risk of inappropriate admissions especially where a special care unit is part of the facility.

Ensure that nutrition and hydration and manual handling are considered in wound management.

Issues of serious risk to residents shown in Graph 1 (previous page) include clinical nursing competence in wound care, medication management and pain management.

A high incidence of resident skin and wounds in the facility could indicate the use of out-of-date technologies or procedures, or a lack of staff skills as well as insufficient rostered hours to do the work. Skin integrity issues may be linked to unmet hydration and dietary needs; or faulty and inadequate equipment used to assist mobility and positioning; or a deficiency in staff manual handling skills.

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Regardless of who administers medication in the facility, the system of management of pain (when necessary) medications will reveal details of care quality. Shortcuts around responding to symptoms and signs of health problems, such as unwise delegation or lack of inter-professional collaboration, are easily found in resident records. Medication management issues provide assessors with an insight into local information systems, human resources management, quality management and collaborative communication.

Tips on safe medication management

Cheap but complicated medication management systems that are timeconsuming and physically unwieldy are error prone. Simplified modern systems of medication management and documentation can prevent unsafe practice and minimise serious risk.

All staff involved in medication administration should undergo regular competence testing. Registered nurses (RNs) need to be able and available to assess the therapeutic effects of medical treatment; respond to unstable conditions and consult with GPs where necessary.

Endorsed Enrolled nurses (EENs) and non-registered staff administering medications to people with stable conditions, need adequate training and appropriate supervision.

The frequency and intensity of pain experienced by residents in a facility is a good indicator of the culture of that service.

Pain in most cases can be quickly relieved with the right skills and using medical and non-medical interventions. Where a lot of pain is being experienced by the resident group it is likely that the organisational focus has shifted from resident wellbeing to staff needs. It could also indicate human resources deficiencies around workload, supervision, skills and resources needed to comfortably settle residents. Persistent pain in palliative care situations can be an indication of professional network failures. Palliative care services can be accessed through local hospitals however communication between the facility and area health services needs to be robust and able to be mapped through clear documentation.

Considered together, (i) pain among residents (ii) behaviours, and (iii) complaints, indicate the depth of problems within a facility in relation to staff skills, rostered hours, equipment and medical resources, network linkages with other care and treatment services.

SERIOUS RISK - CLINICAL GOVERNANCE Notices of serious risk during the period shown in Graph 2 indicate that the most dominant areas of non-compliance are

information systems that effectively support planning, assessment & evaluation of needs.

All staff should be able to use the organisationâ&#x20AC;&#x2122;s information and communication technology system with confidence and accuracy because their skills impact on the quality of evidence regarding clinical care compliance.

Too often compliance problems are exacerbated because the facility has no system that can provide documentary evidence of care and services that have

been delivered, or planned, based on assessments. Unfortunately, the presence of happy healthy residents does not replace documentary evidence of good care and services. What is needed is a system of information collection, storage and retrieval that will enable staff to identify issues around residentsâ&#x20AC;&#x2122; clinical outcomes, and enable these issues to be tracked back in the records to identify the origin of the problem and time-linked details of what has been done for them.

Tips on information systems Information and assessment systems that are too complex for the knowledge and skill levels of staff employed at the facility will cause system failure. Complexity increases when information technology systems require competent English when language skills are not a policy priority in staff hiring or training.

Obvious links are needed between information systems and quality auditing systems to enable effective translation of clinical indicators or environmental audits and the identification of issues in ways that lead to identification of risk areas and management action.

SERIOUS RISK - PERSONAL CARE Of all personal care outcomes the area most likely to lead to a serious risk situation is

editorial

that of nutrition and hydration. Assessment in this area of resident care is critically important especially in identifying behaviours, conditions and illnesses that may be causing malnutrition or dehydration. Any clinical reasons for weight loss including a recent long stay in hospital; palliative care medications; or wandering dementia, need to be clearly documented and incorporated into care planning and evaluation.

Assessment tools for judging weight need also be questioned in some cases. For instance, recent research on Body Mass Index (BMI) have shown the current tool for measuring body weight to be inappropriate for people aged 70+ years and even fatal if this group is maintained within the currently prescribed BMI parameters. On this evidence weight rather than BMI is a more reliable assessment approach for older people. (ref: Flicker, L., McCaul, K., Hankey, G., Jamrozik, K., Brown, W., Byles, J. and Almeida, O. “Body Mass Index and survival in men and women aged 70 to 75” Journal of American Geriatric Society, 58:234-241, 2010)

the resident’s body mass index etc. The Malnutrition Screening Tool should be incorporated into the care planning process for all residents identified as being at risk.

The screening tool can be found at: http://

www.health.qld.gov.au/patientsafety/ pupp/documents/malsc.pdf

The nutrition and hydration intake of residents who present with complex behaviours must be proportionate to their level of activity and agitation. Therefore when assessing the resident’s dietary needs and preferences the plan must be individualised and linked to the behaviour management plan.

Ensure the 24 hour availability of appropriate food and beverages for all residents and not just supply the standard plated sandwiches, deserts and biscuits.

If mass weight loss across the facility has been identified, check to see if staff are focused on schedules and tasks rather than a resident centred approach to nutrition and hydration and the overall appropriateness of the menu, portion control and plate wastage – and find out why.

SERIOUS RISK - ENVIRONMENT AND LIFESTYLE It is possible to gain an overview of how the facility menu has been servicing residents by looking at mass trends in resident weight change. Some facilities err on the side of caution about undiagnosed diabetes by having a total low calorie diet with the overall effect of unnecessarily reducing everyone’s weight. Alternatively, widespread weight loss could also indicate issues with staff time availability and their willingness to assist with feeding; adequacy and appropriateness of dietary supplements based on individual rather than resident group needs; or staff attitudes towards ensuring availability of adequate time and nutrition for residents.

Tips on nutrition and hydration A nutrition assessment involves analysis of clinical records in relation to preferences, culture, health status, body weight and

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Serious risk attached to con-compliance under Standard Four “Resident Lifestyle” is less frequent than issues under Standard Two (discussed above). However, when found together with failures of care and services they provide a good indication of where organisational systems have not effectively operated in tandem.

The graph below clearly identifies the major issues included in recent declarations of serious risk.

When assessing a fragile facility it is worthwhile to consider clusters of outcomes in order to uncover what has been happening to render a facility vulnerable to being seen as a serious risk to residents. The following examples of insights gained through this approach could be used by APs to follow up and confirm the accuracy and possible causes of such problems.

Call bells. In harmonious environments the resident call bell system is rarely an issue.

Delays in responding or malfunctions of equipment could prompt resident discontent and possibly indicate workload issues or staff attitudes. In such a case audits are needed to discover reasons for delays; the accuracy of call system data showing apparent neglect; and whether clinical outcomes are poor and staff policies and training are faulty.

Infection risk can sometimes indicate a conflict between lifestyle factors, infection control guidelines and resident or family choice. For instance, the regulation of lifestyle factors is now so constraining that food choices are limited to prevent any challenges to residents’ immune systems.

Ironically, this over-reaction by regulators could lead to the suppression of natural immunity due to lack of exposure to everyday immune system challenges.

Facilities should ensure the availability of appropriate equipment and staff skills to systematically prevent infection as well as the resources and a plan to respond to any future infection outbreak.

In the case of scabies outbreaks, management must be prepared to be proactive and include all staff, visiting professionals, resident and family who visit, and suppliers - all of whom may be the source of the infestation.

Lifestyle issues usually arise because of staff orientation to tasks and routines which restrict resident freedoms.

As well, lifestyle issues can include the activities program. It is wise to regularly audit activities programs in terms of ongoing suitability for the resident group and individuals involved.

Police checks are a compliance issue because they are simply not done.

Or, for staff who have lived and worked overseas after age 16, a statutory declaration to cover the gap in information regarding criminal activity has not been completed or signed.

Given the high number of students on visas that allow for 20 hours of paid employment it is important to monitor the legitimacy and appropriateness of visas and the hours worked.

Security issues intersect with most of the above issues but are particularly affected by organisational culture. Facilities that treat all residents as having the same level of need for protection and unnecessarily restrict physical risks to all residents will probably be noncompliant in this outcome. It is important to correctly assess resident safety needs so that people are not inappropriately confined.

Even those within secure units need continual reassessment for appropriateness of care type and location to see if it is still required – and if not, move them to more suitable care areas.

CONCLUSION Many and complex factors contribute to the successful running of a residential aged care facility and ongoing vigilance and continuous testing against professional and regulated standards is necessary to ensure that all who receive care, or work there, are safe. Where a facility fails to comply with regulations, or is unable to demonstrate compliance with key expected outcomes within the Standards, it can be declared as posing serious and impending risk of harm to the wellbeing and safety of residents.

In cases of serious risk, effective and immediate responses are needed if serious risk is to be mitigated. An expert team is required to identify to manage current and potential risk areas and it is anticipated that the workload will be intensive through this period. The AP must be fully briefed on the role and responsibility of the Nurse Advisor or Administrator and this person acknowledged as the team leader.

Situations where immediate or serious risk has been identified are often multi-faceted. The authors’ experiences as consultant and nurse advisor have been shared in the hope that approved providers, managers and staff might become more aware of the processes involved and some of the factors that impact a serious risk situation in aged care.

We have provided only a sample of the expected outcomes which may be highlighted when serious risk has been identified, for instance, palliative care, privacy and dignity or many other combinations across the 44 expected outcomes have not been canvassed here. Rather, we have focused attention on frequently identified areas which have serious risk and we suggest actions which may, in the first instance, prevent non-compliance and secondly, mitigate serious risk. On the basis of the insights provided here, facilities may choose to conduct local investigations to discover indicators known to be linked to notices of ‘serious risk’ being imposed on the approved provider, and initiate remedial strategies before issues arise at audit. n

editorial

Entrepeneur of the Year Award Leading South Australian aged care provider, Viv Padman, has won the Ernst & Young Entrepreneur of the Year Award, for SA & NT for 2010, in the Services category.

T

he award, which recognises the region’s top entrepreneurial talent, acknowledges the contribution entrepreneurs make to the economy and our broader community.

As long-standing member, past Chairman, current Board member and representative of ACAA-SA on the ACAA Federal Board, we congratulate Viv, Florence and the team at Padman Health Care which shares in this achievement.

Winners from each Australian State compete for the title of Australian Entrepreneur of the Year. The winner of the Australian competition then goes overseas to compete to be the World winner of the Entrepreneur of the Year.

In presenting the award, Mark Butcher, Ernst & Young’s South Australia Office Managing Partner said: “The Ernst & Young Entrepreneur of the Year is the world’s most prestigious business award for entrepreneurs. Entrepreneur of the Year celebrates those who are building and leading successful, growing and dynamic businesses here and in 135 cities in 50 countries around the world. Since the awards began in Australia in 2001 we have recognised more than 800 Australian entrepreneurs for their vision and achievements.” n

editorial

Exercising – Balance and Motor Coordination STUDY INTRODUCTION Physical performance is the ability to move, which enables a person to conduct his or her everyday person’s adjustment to a lower level of activity. Managing independently is made difficult by weakening agility, speed of movement, coordination, and balance.

To control balance is not the most simply duty for man. Changes in the regulation of balance, posture and movement are extremely individual. Moving in a slow and feeble manner visibly weakens motor coordination. Function of balance training for senior citizens is not so clear as for example strength training, though man have got good results with specific balance training and muscular strength training. It takes more time to train motor skills for senior citizens than adolescents, but at the same time it can have positive effects for senior citizens whole body control. Falling is by far the major cause of accidental death in the aged. As many as around 41% of aged people restrict their mobility for fear of falling, which prevents exercising the balancing systems. Therefore, the fear of falling itself can increase the risk of falling.

Balance exercise can be used to reduce the risk of falling and achieve savings in medical and rehabilitation costs.

METHODS The aim of the study was to assess the trainability and the training methods of balance and motor skills of elderly people.

The subjects carried out a guided exercise program in two groups for 90 minutes once a week from early September 2003 to late March 2004. The number of training sessions as 21 for each group. The training methods included motor and balance training, as well as strength and flexibility training with moveable balancing objects during the whole program and training in the playground environment built by Lappset Group Ltd. The program was designed and instructed by two sports instructors.

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The initial measurements of the test subjects included: • height, weight • body composition (Inbody) • the sensory organization test • hand compression force • a 10-metre walk using a photocell • standing with one leg • square jumping with one leg • the estimation of the subjects’ own balance skills with a subjective scale from 0-10 • score from a functional balance test and the time taken for the test. The functional balance test includes getting up from a chair, walking forwards for 3 metres, turning right, walking back, turning left and sitting back in the chair.

RESULTS The results show statistically significant improvements in postural body sway. The hand compression forces worsened especially during the winter. There were not any significant changes in the body composition, height or weight of the test subjects during the program. The gender differences were clear in the tests demanding strength and balance and the test improvements of the female participants were significantly greater in 10-metre walks.

When comparing the results of all the motor and balance tests with each other, the most surprising finding was the strong correlation in performance time on the Lappset Motor Track between the power, balance and functional tests. According to interviews with subjects, the most important factor explaining the meaning of this kind of physical training is the social aspect of the training.

CONCLUSION The results of the measurements are encouraging from the perspective of balance

and physical performance in the aged.

Balance exercise when line with muscle fitness and motor skill exercise would appear to produce the desired result and to slow down the inevitable deterioration in the physical performance of the body. Improving confidence in mobility is witnessed by the improvement in the results in the functional balance test and in the increased speed in walking.

The study indicates balance developed most of all in the vestibular system, the weakening of which is a large problem in the aged that results in very real problems in achieving and maintaining balance. The improvement in the personal assessment of balance among the test subjects also supports the abovementioned results.

What is the reason for worsening of hand compression especially during winter time?

We have had similar findings with children; the levels of isometric maximum forces for hand compression and leg extensors were higher in autumn than in next spring. Is the reason higher levels of activity in summer time, differences in hormone levels due to enormous amount of sunlight in summer time or mental differences due to changes of sun light in summer and winter time?

The most surprising finding is the strong correlation in performance time on the motor coordination track between the power, balance, and functional tests. A motor coordination track with versatile and different functions and requiring motor coordination and functional balance may indeed in the future serve as a so called test field for the characteristics in question and above all, as an exercise field where the aged can exercise and maintain their physical performance. n Case Study by Pahtaja Visa, Hämäläinen Pekka, Leppänen Tero Rovaniemi Polytechnic, School of Sports and Leisure, MOTO+ project, Hiihtomajantie 2, 96400 Rovaniemi, Finland

product news

VM3 introduces state of the art Purefier Products to the Aged Care Industry

container, pan rooms, toilet facilities and high dependency aged care rooms, or anywhere that malodour is present. In addition, the Body Fluid Control Compound can be used to effectively control and absorb body fluid spills and eliminate the malodour associated with such spills.

These include effective protection against:

ntroducing VM3 Purefier products to the market – the newest purefier products providing the solution to control moisture, malodour, volatile pollutants and microbial pathogens in air.

You can be assured that Vm3 Purefier products are safe to use in your facility as they are environmentally friendly (energy-free application), and the contents of the purefier products are naturally mineral based and non-toxic.

Vm3 Purefier products aim to provide a cleaner, safer and healthier environment for all residents, staff and visitors to your aged care facility. For further information on how your facility could benefit from Vm3 Purefier products, please contact Stuart Godwin for a consultation on 0438 764 505 or alternatively visit our website for more information, www.vm3international.com

I

Cost effective and easy to use Vm3 Purefier products have many effective applications. There are a range of products with different specialties including the Vm3 Purefier pads and the Vm3 Body Fluid Control Compound. The Purefier Pad can be applied to wheelie bins, industrial waste

NEAT AND CLEVER – Cleaning without chemicals

Extensive laboratory tests have been conducted to United States standards and results show the effectiveness of VM3’s products in preventing serious health risks to staff, visitors and fellow residents.

A

ctiveion™ technology converts tap water into ionized water, a powerful dirt-removing and bacteria-killing agent.

It is an on-demand, onthe-go way to clean that works as well as, or better than, traditional methods.

Activeion effectively cleans and sanitizes many different surfaces without using chemicals. No airborne particulates. No surface residual.

It’s your safe and healthy choice for staff, visitors and residents which kills more than 99.9% of harmful germs when used as directed.

With just a tap and an Activeion ionator EXP™, cleaning professionals have a virtually endless supply of cleaner — with little-to-no ongoing cost. This amazing technology ticks the green boxes too – one device will make up to five thousand litres of broad spectrum cleaning fluid during its working life. It’s one of the only ways to clean that does not require a chemical-related healthwarning label.

The ionator EXP™ commercial use product is HACCP endorsed as a foodsafe product that reduces risk. For decades, a form of the technology has been used in special labs and large machines costing thousands of dollars.

Activeion Cleaning Solutions has simply adapted that technology specifically for on-demand cleaning, miniaturized it, and made it affordable for everyone, everywhere.

www.activeion.com.au

• • • • •

Aspergillus niger Candida albicans Pseudomonas aeruginosa Staphylococcus aureus (Golden Staph) Escherichia coli (E coli)

Aged Care Training At Your Fingertips!

I

n response to requests from aged care facilities and their clients, Wellness & Lifestyles Australia (W&L) has now made available a collection of their training resources for online access.

For over 6 years W&L has been providing services and training to organisations in South Australia, Victoria, and Northern Territory.

With close to 100 aged-care specific allied health and nursing staff, it gives an opportunity for nursing and care staff from across the country to gain access to their vast industry specific knowledge.

The W&L Education website has been specifically designed to cater for all learning styles, and as such users can easily access information either in the format of audio/video presentations, E-learning modules, E-books, downloadable posters, or short article pieces. Some of the topics include: • • • • •

Manual handling Wound dressings for the diabetic ulcer Falls prevention Feeding people with dementia ACFI complex health care education

Their regular ‘hot tips’ newsletters provide members with up-todate information relating to accreditation and ACFI validation feedback from around the country.

From the observation that it’s often difficult to get all care/nursing staff to attend training due to schedules and staffing requirements for residents, W&L sees this as an opportunity for facilities to provide training staff that can be done any time, on any internet computer. Not only that, but it can be viewed over and over again in the form of a presentation, assessed in the form of an e-learning module, then constantly reinforced via educational posters that can be put up around the facility.

There are a number of membership options available, from a monthly membership to only using the products that you want. To download a free manual handling materials e-book, and for a no obligation trial, visit www.wleducation.com.au or call W&L head office on (08) 8331 3000.

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product news

B

AXX is an advanced development discovered out of investigating methods of combating germ warfare by the British Ministry of Defence who had a remit to assess the risk of bacterial attack on the British Isles in the 60/70’s. This in turn had been initiated by observations over a hundred years prior by Louis Pasteur who had documented that the atmosphere in high altitudes and sunny days reduced the incidence of infection and effectively killed bacteria and viruses.

The answer lay in the natural occurrence of airborne Hydroxyl Clusters.

Modern technology and electronics allows the BAXX to achieve the aim of eliminating airborne pathogens by using cold plasma to strip a hydrogen atom from some of the natural water molecules (H20) contained in the air around us, leaving them as unbalanced hydroxyl clusters (-OH). These clusters seek and attach to airborne bacteria and virus cells and recover their missing hydrogen atom from the cells wall to return to a natural water molecule again (H2O).

In that instant, the bacteria/virus metabolism and cell wall is disrupted and the cell dies.

Thus nature’s way of eliminating airborne pathogens has been reproduced.

Hydroxyl clusters will also land on surfaces and kill surface contamination by the same method.

These same Hydroxyl Clusters can reduce and eliminate odours as well – particularly so on odours based on ammonia compounds or ethylene or waste decomposition.

The use of stripping away hydrogen atoms from airborne water molecules to form hydroxyl clusters is unique to the BAXX cold plasma technology which naturally kills all airborne pathogens including MRSA, C.Diff(Spore Form), Norovirus and Bacteria.

BAXX introduces technological breakthroughs and advantages such as– •

It doesn’t require any consumables other than electricity. No filters to clean, no chemicals or liquids to replenish, no service required.

Install it and leave it to do its work. Electrical consumption is a mere 120watts – the equivalent of two 60watt light-globes.

•

The case of the Baxx is in 316 stainless steel which makes it ideal for health care facilities, hospitals and any other moist environments where a germ free environment is paramount.

Baxx Australia www.baxx.com.au Ph: (02) 9939-4900 Fx: (02) 9939-4911 ssyme@baxx.com.au See ad on page 79 of this issue.

Ekotek Wireless Positional Duress System

E

kotek’s wireless positional duress product is a unique state of the art 2 way communications and duress system. Its flexible design can help to improve safety and response times in a multitude of industries and applications. Operating on a 2.4 GHz platform via Zigbee wireless protocol.

A completely wireless system allows Ekotek to have both flexibility and versatility in many areas. It is a cost effective solution for both new and existing facilities. Minimal disruption to business during installation means business as usual whilst the mesh network goes together. Self configuring and self healing the system is intelligent enough to be able to notify you of any abnormalities on the network.

Duress alarms, man down and dead man alerts, location based services, acknowledged paging, integration with other devices such as DECT cordless, Nurse call systems, Security and Fire panels are just some of the benefits of the Ekotek system.

Unlike a number of other systems currently in the market place Ekotek’s radio mesh network provides accurate positional location of all alarms raised on the network. Two way messaging allows acknowledgement of received messages.

The system is made up of the following components: The Hub: Is the device that creates the network. All communications on the system pass to and from the hub. The Hub can be located anywhere within the network. Alarm messages are displayed on the hub and can be responded to and cancelled from the Hub or a Paging device.

Repeater: There are 3 types of repeaters which go together to form the backbone of the mesh network.

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Internal repeaters (ceiling mountable), call point repeaters (wall mountable) and solar repeaters (externally mountable) mean that you are not restricted to building your network within the normal internal boundaries of a building.

Pager: Gives the user the ability to see a duress message and also respond to it.

Audible alert, Vibrate and Visual are 3 ways to receive a message. The Pager also has a snatch cord and man down / dead man facility built in.

Pendant: Allows for assistance calls to be raised using the location signal from repeaters to give accurate positional location. Audible, vibrate and illumination are all available methods for receiving a message. Man down / dead man feature are also available on the pendant.

See ad on page 13 of this issue.

For more information contact Multitone Australasia on 03 9888 1244 n

www.multitone.com.au

Fast, Hygienic and Saves You Money...

It’s a Hand Dryer

T

he Ultra High Speed Hand Dryer, JET DRYER is now available in Australia.

Currently sold all over Korea, UK, France, Vietnam, Russia and Israel, the JET DRYER is the latest hand dryer to upgrade to in your bathroom.

“Paper towels have become an expensive and environmentally unfriendly option for drying hands,” said Jeremy Kronk, Managing Director of JET DRYER. “Alternatively the older hand dryers are noisy and unhygienic i.e. they don’t filter the air they blow onto your hands, basically adding bacteria back onto your hands during the drying process”.

“There’s no better time for businesses to consider these issues and find a better solution, like JET DRYER.” The JET DRYER dries the hands fast, hygienically and saves money and the environment.

Fast – Because it dries your hands in less than 10 Seconds. Hygienic – The Jet Dryer uses antibacterial filters to clean the air for a healthier drying experience, plus the surfaces of the units are specially coated to eliminate bacteria build up.

Savings – Both the environment and costs savings of up to 90% compared to Paper Towels, or lower power usage than most of all the other hand dryers…

For the price of 1 paper towel, the JET DRYER can dry 10 pairs of hands.

Call 1 300 071 041 or visit www.jetdryer.com.au or email: info@jetdryer.com.au

BEDS OF THE FUTURE

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any people in the Healthcare Industry understand the advantages of electrically operated hospital and aged care beds in the conventional sense, the electrics provide simple and easy adjustment of the patient position by the nurses or the patient. What people are not yet aware of are the solutions now available using the latest generation of electric actuator control systems. Not only can these new systems directly communicate with the Nursing Desk and the Maintenance Department, but they will also provide a platform for advanced features which improve productivity, safety and quality of patient care. Features and benefits include: • Nurse Call buttons incorporated in the Patient Handset • Underbed lighting that the patient can switch On/Off at the Handset to help them safely exit the bed and be guided back to the bed in the dark.

• Illuminated Handsets for use at night; these glow dimly in the dark so people can easily locate and operate them. The illumination automatically increases when the handset is operated.

Floortec 480M Introducing new manual push sweeper

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he new NilfiskAlto Floortec 480M walk behind sweeper is the ideal solution for sweeping small amounts of dry dirt, sand, gravel, cigarettes, outdoor spaces as well as indoor floors.

Typical applications are warehouses, factories, car parks, retail stores, malls, schools, hotels, office buildings, bus/railway stations, convention centres, automative , garages and in private homes.

The very rugged non corrosive frame makes this manual sweeper very robust.

That combined with two main and side brooms, make this compact manual sweeper extremely efficient. The 840mm working path makes operating this sweeper 5 times faster than a traditional broom. Furthermore, the hopper is very light and strong and equipped with a carrying handle for easy emptying. For more information on the new Floortec 480M, visit www.nilfisk-alto.com.au or contact us on 1300 556 710 n

• Wet Bed sensors which inform the nurse the patient requires attention and a change of bedding; this could be indicated on the bed or communicated back to the nursing desk.

• Out of Bed sensors to indicate the patient has left the bed - have they just gone to the toilet? Are they wandering around disturbing other patients? Have they fallen and hurt themselves? Will they spend the night lying on the floor?

• Clean Me indicator showing the bed is due for its regular cleaning cycle.

• Check Me indicator to show when regular maintenance inspections are due.

• Service Data Tool that monitors and logs the service condition of the bed, providing quick fault finding - reducing downtime and service costs.

• Weighing Scales built into the bed that allow the patient to be weighed without moving them from the bed saving time for nursing staff and avoiding discomfort to the patient.

• A USB port connection providing power to a reading lamp or to charge an IPod or mobile phone.

• Wi-Fi positioning of the bed, improving identification and allowing the tracking of beds in large hospitals.

Many of these features and functions are economical and also provide real benefits to patients, carers and productivity and are either available today or in the near future. Choosing a bed without considering these features and benefits may well be costing you money over the longer term. The question you should consider is what value you place on improving your productivity, safety and quality of patient care. n The author Greg Pittard is the Managing Director of LINAK Australia. LINAK are well known specialist suppliers of electric actuator systems used in Healthcare, Furniture, Desk and Industrial applications. LINAK has recently released their new generation OPENBUSTM control systems for Healthcare equipment that allow these features and benefits to be realised.

• Motorised drives on the bed providing propulsion for transporting the bed and patient by one operator.

• Anti-entrapment sensors that stop the bed lowering function when an obstruction is detected - for improved safety.

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product news

The Roses vinyl offers the same industry James Richardson launches new commercial fabrics that More people in health community standardand attributes as Silk. But in contrast, it’s a more contemporary featuring ‘feel like silk and smell ofservices roses’ choose HESTA than any design other fund attractive metallic flecks and a stylish pattern

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ames Richardson is proud to unveil an exciting new range of commercial quality fabrics for the aged care industry in Australia.

The expert supplier of furniture and textiles understands that aged accommodation operators are bound by strict guidelines to ensure the safety and security of their residents. Even the seemingly simple task of furnishing a room must meet industry benchmarks.

This is where James Richardson can step in to help. It has exclusive distribution of ATN Vinyls from Germany. The textiles are of commercial quality and vigorously tested to the most stringent of performance standards. The latest fabrics to feature in the range are the Silk and Roses vinyls, which can be upholstered to any chair or sofa.

Silk, as its names suggests, feels as soft as natural silk while still retaining a high durability factor. It comes in a range of colours including pearl, chocolate, lavender and onyx. The fabric is UV resistant, flame retardant, and resistant to all fluids. And like other ATN Vinyls it has antimicrobial protection against bacteria, algae, fungi and mould.

of swirls throughout the fabric. It lends itself to an ambient texture of rich tones.

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With so many furniture and fabric options on offer, aged care facility operators are now empowered to create warm and inviting spaces for residents combined with the assurance that it is health and safety compliant.

The James Richardson collection of textiles also includes commercial grade wool, blends, natural fibres and Crypton with a guaranteed moisture barrier.

The fabrics are designed to meet the individual requirements of industries such as aged/health care, hospitality, corporate and education. The textiles are sourced from local and international mills and are stocked to ensure efficient delivery leadtimes for customers.

Since 2000, James Richardson has been the distributor of ATN Vinyls from Germany, Gabriel Fabrics from Denmark, Bute Fabrics from Scotland, Väveriet from Sweden and Crypton from the USA. For more information on James Richardson’s commercial quality textiles or high quality furniture visit www.jamesrichardson.com.au or call1800 812 440.

OCEAN HEALTHCARE WIPES THINKING ABOUT Your super fund can make a lifetime of difference Refreshingly clean... anywhere anytime RETIREMENT? 3 Run only to benefit members

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3 No commissions

cean Healthcare moist wipes are a hypoallergenic and offer a convenient and 3 Low fees as they avoid harsh soaps economical alternative to resident and patient showering and potentially irritant shower and bath additives.

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The Ocean Healthcare brand wipes contain Aloe Vera and are alcohol free, hypoallergenic and gentle enough for daily use.

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any people approaching retirement age are interested in accessing their super before retirement to either hesta.com.au/super reduce their working hours, or top up their super balance. This strategy is called Transition to Retirement (TTR).

Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL 235 249 regarding HESTA Super Fund ABN 64 971 749 321.

Consider our Product Disclosure Statement before making a decision about HESTA - call 1800 813 327 or visit our website for a copy.

The Hygienic Body Wipes 50 pack assists in giving a quick and easy general illness, disability or incontinence cleanup for patients. This handy pack has a resealable lid so the wipes do not dry out between uses.

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The Bed Bath Wipes 8 pack offers convenience and economy providing a WARM, all over cleanse without patient stress and discomfit - a perfect solution for patients in Palliative Care, Post Surgical and Dementia areas. The large, soft and thick wipes wipes are gently heated in the microwave and each wipe is then used for a specific area of the body.

Ocean Healthcare leaves patients feeling refreshingly clean.

Hygienic Adult Wipes Features: • Convenient 50 pack • Large 33cm x 23cm Wipe • Use anywhere anytime • No water needed • Contains Aloe Vera • Hypo - allergenic • Alcohol Free Bed Bath Wipes Features: • Microwavable 8 pack • Large 24cm x 20 cm Wipe • Warm for comfort • Contains Aloe Vera • Soft strong and thick • No water required • Alcohol free For further information please contact 1800 506 750 or email info@nicepak.com.au

Available from Clifford Hallam, Ostomy Association and Independence Australia.

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aca Aged Care Australia

If you’ve reached ‘preservation age’ (currently age 55 if you were born before July 1960) and have money in a super account, you can transfer part, or all, of your super into a TTR income stream.

This is subject to legislative requirements and fund rules. Your maximum yearly drawdown is 10% of your balance. The money is also non commutable which means lump sums cannot be withdrawn until you fully retire or reach age 65.

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Income received from the super income stream is concessionally taxed. This means, if you’re under 60, income is taxed at the marginal rate with a 15% tax offset. After age 60, the income is tax free! There is also no tax paid on the investment earnings.

This means you could have more cash available to either reduce your working hours by supplementing your income, or increase your super savings through salary sacrifice.

To find out more about how HESTA can help you transition to retirement, attend the next Transitioning to retirement presentation at your workplace, visit www.hesta.com.au for a copy of HESTA’s Transition To Retirement brochure and the HESTA Super Income Stream Product Disclosure Statement (PDS) or free call 1800 813 327 to arrange a consultation with a HESTA Superannuation Adviser.

Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249 regarding HESTA Super Fund ABN 64 971 749 321. Information provided is of a general nature. It does not take into account your objectives, financial situation or specific needs. You should look at your own financial position and requirements before making a decision and may wish to consult an adviser when doing this. The information represents HESTA’s interpretation of the law in some instances but should not be relied upon as legal advice. Our Product Disclosure Statement should be considered before making a decision about the Fund. Free call 1800 813 327 or visit www.hesta.com.au for a copy.