Aged Care Australia
Print Post Approved PP324494/0065
Spring 2011
AGED CARE ASSOCIATION AUSTRALIA 30TH ANNUAL CONGRESS 6-8 NOVEMBER 2011 GOLD COAST CONVENTION & EXHIBITION CENTRE QUEENSLAND
Productivity Commission Final Report | industry reviews Keeping Watch looking after those with dementia The Staffing Conundrum: matching care staff time to resident needs Clinical Partnerships Pilot Program partnerships create increased productivity!
Aged Care Australia – ANNUAL CONGRESS –
OFFICIAL PUBLICATION
Aged Care Australia Spring 2011 2011 Winter
Voice of the aged care industry
contents 3 5 6 16
16 23 27 30 33 41
National Update CEO’s Report President’s Report State Reports Congress 2011 Productivity Commission Report Cam Ansell James Underwood Bill Bourne Rachel Lane Hynes Lawyers David Sinclaire
Profiles 43 Patrick McClure
49 50 53 54 57 61 63
Technology ACIVA Update eHealth in Aged Care ITAC Awards Peter Fleming, CEO of NEHTA Aged Care IT in a National Context Face Your Fears and Do It Anyway Keeping Watch
Workforce 66 Announcing the New Presidential Card Dining Program 67 Taking a World View – Working with a Culturally Diverse Workforce 69 Staffing Conundrum: Matching care staff time to resident needs
ACAA OFFICE HOLDERS
ACAA - NSW
ACAA - WA
PRESIDENT VICE PRESIDENT DIRECTORS
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
Bryan Dorman Francis Cook Tony Smith Mary Anne Edwards Viv Padman Geoff Taylor Kevin O’Sullivan Rod Young Jane Murray
Sponsor Articles 72 Energy Contract Discount Offer 75 Contractor Management Online Editorial Partnerships Create Increased Productivity Sage Success Beginning of a Sage Adventure NSW Aged Care Manager awarded $35,000 Scholarship 81 Turned off the stove today? It’s been done 82 Aged Care, Who Cares? 76 78 79 80
84 Calendar of Events 85 Product News
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is the official quarterly journal for the Aged Care Association Australia
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Aged Care Australia
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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.
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national update
CEO’s Report Rod Young CEO, ACAA
Aged Care Reform – A Time For Delivery It is unlikely that the aged care industry will ever be in a better position to deliver on major reform than it is currently.
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ith consumers, unions, professional bodies, providers, government and opposition seemingly in accord with the need for reform to be delivered, it is essential that aged care recognises this significant opportunity and grabs it with both hands. Simply put, if we, the aged care industry do not take this unique opportunity, then it is likely that the opportunity for reform may well be another decade in the making. We do need to recognise that all that the Productivity Commission has done is deliver to the Government a blueprint from which the Government must develop a response and determine a significant reform package for the future. Minister Butler has convened an expert advisory group which will meet regularly over coming months to advise the Government on the implications of the reform package and what components need to be included and what a timetable for change may look like. ACAA along with the other major stakeholder groups who form the sponsor group of the National Aged Care Alliance (NACA) is a member of this expert advisory group. However, there is risk in the reform agenda for Government and for providers and ultimately for consumers if we fail to deliver on a package which does not hang together as an integrated package of reform. The Prime Minister and Minister have both repeated on a number of occasions their overarching objectives of: • • • •
Choice Sustainability Access Quality
The PM has also stated on a number of occasions that aged care reform will be a second term priority. These are laudable objectives and provide a starting point from within which all future decisions regarding the reform agenda must meld to ensure a seamless and integrated package of reforms which will deliver on these objectives and timeframes. The risks to providers are that in a new market environment some providers may not survive. There are further risks regarding the bond pool as to what is to likely happen when consumers can choose between bonds and charges and whether consumers will opt out of a lump sum contributions in favour of a charge contribution and whether this will dilute the existing $12B bond pool and impact severely on individual providers capital sustainability. These are issues that need to be acknowledged and addressed because the last thing the industry and Government would want to see is a number of providers fail with the consequent political and social upheaval that we would all face with older Australians being forced out of their residential care homes. ACAA supports this package but recognises there are considerable risks for providers, government and consumers. However, the PC has provided some lateral thinking that will, if adopted, expand the overall funding available to the industry and open up choice and access for consumers. If all of these objectives are delivered over time, this review should be considered a major success for the industry. ■
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national update
President’s Report Bryan Dorman, President, ACAA
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he introduction of the Aged Care Funding Instrument (ACFI) in 2008 was viewed by the Industry with considerable trepidation at the time as we were all uncertain of the outcomes of a critical financial issue for the Industry. Any major reform to the payments system for providing care would naturally be viewed so. A failure of the ACFI system would ultimately be a severe threat to Industry viability, notwithstanding that the RCS system had failed to acknowledge the escalating frailty and acuity of our aged care clients. A further problem with the RCS was the level of subjectivity that this tool created, which inevitably lead to Department of Mental Health and Ageing (DMHA) validations downgrading up to 50% of RCS assessments. Aged Care Providers were suddenly suffering financial losses while still having to meet fixed operational costs, such as staff and hotel services. This unsatisfactory state of affairs also had an unforeseen impact, when a deteriorating relationship began to develop between the Industry and the DMHA. At the time of structuring the ACFI, industry negotiators had spent five years developing the ACFI with DMHA, planning that the new scheme would be electronically enabled from the start. The intent was to ensure that aged care providers could lodge their claims on Medicare through the internet immediately. During the ensuing 2 years following the implementation of ACFI many providers had failed to adequately train staff in how to complete the ACFI assessment pack, including supporting the clinical assessment tools or had moved to electronic processing. Prior to adopting the ACFI, the ACAA had undertaken an evaluation of the level of claiming that was occurring among
Providers, and established that under claiming amounted to some $300M per annum. That is, providers were failing to claim at least $300M for care that the Resident had received. Since the introduction of ACFI we have a much more objective tool with Departmental Validators and Industry using the more objective ACFI tool in a consistent manner. Consequently, validations to date have clearly shown a substantial decline in downgrades. The electronic enablement of the ACFI has also lead to many providers taking up electronic clinical care software thus ensuring that the ACFI documentation is complete, additions are accurate and that all supporting documentation evidencing a particular claim is included. On the ACAA’s latest review, approximately 110,000 residents now have some form of electronic clinical software being deployed to assist nursing and care staff in the day to day provision of quality care for residents. This number is growing daily but not fast enough. The changing profile, frailty and dependency of residents continues to have a considerable impact on the Industry’s capacity for meeting care needs, and thus the level of subsidy being claimed by care providers. With 73% of care recipients now assessed as high care there is little wonder that the volume of subsidy payments have been rising rapidly. Notwithstanding these challenges, and on a number of counts, the ACFI has been successful in its objectives. It has provided adequate funds to resource the increasing acuity and ageing of our clients. It is a more objective and practical tool than RCS. Its introduction alleviated the declining Industry to Department relationships, and it better recognises the rapid growth in frailty and dependency among our clients.
Though it was not stated as an objective at the time; ACAA believes that much of the $300M previously unclaimed for care that is provided is now being claimed under the ACFI arrangements. This ACAA believes is a positive outcome and a success of its implementation. However, ACAA understands DHMA and Government are concerned that the scheme has been too successful and that the average increase in subsidy funding is running at 7% per annum, a rate which was not provided for in budget allocations and the forward estimates. Whilst this is primarily a matter for Government, increased activity is expected from DHMA in reviews of Provider ACFI claims. There is no doubt DMHA will increase their surveillance processes over coming months. ACAA is not aware of any inappropriate claiming practises occurring. Nor has DMHA brought to our attention any conduct they consider to be inappropriate. In discussions, ACAA has assured Government that we do not support any Provider using the ACFI scheme in an inappropriate manner. If however, Providers are unsure if they have been doing so, ACAA strongly recommends they consider reviewing their claims methodology. We also encourage Providers to consider moving to electronic processes soon. Having spent a lot of time and energy to achieve a funding tool that more accurately funds the care our clients needs, ACAA is anxious that this improved outcome be sustained. We therefore call on all Providers to review their ACFI claiming practises and ensure that your current processes are accurate and can be verified at any time if DMHA comes knocking. ■
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national update
ACAA – SA
committee ensures that the event is up-market as well as fun – we use quality venues, with great food and service, and with entertainment people talk about and remember. The $100 includes lots of free raffles, with one person in five winning a prize.
Paul Carberry, CEO ACAA - SA
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n Friday 26th August we held our annual dinner and awards night at the Adelaide Wine Centre, one of Adelaide’s most pleasant function venues.
This was our fifth such event and it was very pleasing to see that the support from members and corporate sponsors has remained strong. In these times of tightening industry budgets and general economic uncertainty, dinners are not always winners, especially at $100 per head. However, we think we strike the right chord with our event by focusing on that most important group – the dedicated and hardworking people who work in aged care. Many of our providers use the event to reward staff for their efforts, by fully or partially covering their cost for the dinner. Our organizing
Overall, we keep the formalities to a minimum, however we do ensure that sufficient time is allowed for the presentation of staff awards. The awards are central to what this night is all about – recognizing staff for their efforts and their contribution. In the early part of each year facilities are asked to nominate a staff member who has made an outstanding contribution to the lives of residents and relatives, for having gone above and beyond the call of duty, or for having shown great initiative and innovation. A nomination can be initiated by a relative or resident, another staff member or by management, so long as management endorses and supports the nomination. Nominees can be people in any role at any level in the organization. We appoint independent judges who have expertise in aged care, for example, people who have had an eminent career and are now retired. The judges review each nomination against a set of criteria we provide and allocate points accordingly. Through this process, four finalists and a winner are determined; if the points do not determine four finalists and a clear winner, the judges meet to discuss the nominations and resolve any ties. When the finalists were announced, the pride on their faces as they received their certificates and prizes said it all! This year several of the finalists’ nominations included comments from relatives and residents, stating what a wonderful difference the person had made to them and to their loved ones. These were read out as the respective finalists were announced; they were heartfelt and very touching, and really demonstrated how good quality care makes such a difference to peoples’ lives. As always, these events are only possible with the support of sponsors and I want to thank the major sponsors – Bankwest, Guild Insurance, HESTA Super Fund and Zenith Insurance Services for their generousity. ■
“2011 Award winner, Fred Schenk from Gleneages Aged Care, receives his Award from Colleen Hogan-Manning from HESTA”
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ACAA – NSW Charles Wurf, CEO ACAA-NSW
Prudential Reform And Changes To The Aged Care Act
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n early September the Association held a briefing for aged care providers regarding the amendments to the Aged Care Act which came into effect on 1 October. The briefing addressed, in particular, changes for the permitted use of accommodation bonds. Prudential reform, and how we facilitate choices in aged care for consumers, and where necessary with oversight by Government, is essential to get right if we are to continue to build the capacity of the aged care system, and address future demand.
amendments was presented by Bill Bourne, ACAA-NSW’s Manager, Financial Services, with subjects discussed including: • Obligation to give information about ability to refund accommodation bond balances; • Permitted use of accommodation bonds; • Offences relating to non-permitted use of accommodation bonds; • Transitional provisions (applying to accommodation bonds charged prior to commencement); and • Application provisions (Applying to accommodation bonds charged after commencement). Representatives from respected financial services organisation, Global Treasury, also made a presentation on general governance principles and governance frameworks for aged care approved providers. The Aged Care Association Australia – NSW has recently partnered with Global Treasury, and we will be working with them to provide further options for members concerned about quality governance and compliance outcomes.
This is an especially engaging time for our industry, in addition to recent legislative changes, the Productivity Commission’s Final Report, Caring for Older Australians, provides reform mechanisms that will shape the future of our industry.
Some of the services Global Treasury will provide include template governance documents, ongoing support and advice for the unique requirements of providers, including representation to government departments, and support and advice to both unique and large aged care providers.
The briefing was attended by 84 representatives from a range of roles throughout the Association’s membership. An overview of the
I look forward to sharing this service with members in coming months. ■
national update
Aged & Community Care Victoria Gerard Mansour, CEO Aged & Community Care Victoria
Aged care reform – opportunities and risks It is important that the Productivity Commission (PC) final report confirmed the inadequacies and limitations of our current system in being able to meet the burgeoning growth from Australia’s ageing population over the next 20 years.
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he PC has in my view set out a package which, with refinement, can form the basis for a reform agenda blueprint. The PC should be commended for this. Key elements such as the move to an entitlement system, the creation of two independent bodies - the Gateway and Commission - to administer aged care have already been well received by many stakeholders. But there will also be many practical issues to be resolved when determining not only the final shape of a reform package, but the transition plan in moving from one system to another. Importantly, the Prime Minister, when releasing the Final Report, set out four principles (increased consumer choice, access, quality and sustainability) which she advised would guide the Government in its decisions – whenever they are announced – about the directions for aged care reform. But in my view our industry needs to step back for a moment, and reflect, so that we are clear about our own decision making criteria in how to respond to the PC reform blueprint. The dominant decision making principle is that any reform process must deliver a sustainable industry capable of providing choice and access to consumers in all settings. Sustainability as a core principle is paramount. It is enormously significant that the Prime Minister herself has named sustainability in her key principles. Yet this will be without doubt the most challenging concept of all. For, in moving from a system where Government controls supply, demand and price to a system dominated by a consumer entitlement to care, there is a very real threat of market failure. We must name this risk publicly and
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make sure real and robust plans are put in place to minimise such an outcome. After all, unless we have a viable industry, consumers will not receive either access or choice of services. Sustainability must recognise the different needs in metropolitan and rural locations. It must cater for all Australians irrespective of their wealth, must meet the needs of our indigenous communities, those from differing cultural backgrounds and those with special needs such as the homeless, mental health and disability. Our biggest challenge is to develop a model, based essentially around market forces, that has the capacity to deliver the right range of care and services for older people in the context of the community in which they live. While the Aged Care Approvals Round (ACAR) system clearly has its challenges, it does have at its heart a planning paradigm. And so, the biggest opportunity for our industry is also the biggest threat. This will not become a stumbling block if we carefully plan the reform process to make sure the practical policy settings are right. For example, there is a sufficient ongoing lump sum stream for residential accommodation, that the Gateway accurately assesses the care needs of older Australians, that there is timely access to care assessments, and the price for care is appropriate. The best chance of success is for Government to set in place a phased and long-term reform package in collaboration with our industry and key stakeholders. This is the right time to reform the system and build a sustainable industry for the long term that delivers an entitlement for all older Australians to receive care as and when needed. ■
national update
Aged Care Queensland Nick Ryan, CEO Aged Care Queensland
On the aged care landscape, Queensland members, along with the industry across Australia,
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t a state level, there are some major issues which will impact on many residential/community care providers and retirement village operators. These include:-
have been busy digesting and analysing the recommendations of the Productivity Commission. We are awaiting the Queensland visits as part of the Gillard Government’s “national conversation on healthy and positive ageing” and more details on the realities for the future when details are forthcoming from Government.
Fire Safety in Residential Care The State Government Electoral Bill 2011 went before Parliament in August. Fire safety regulation in residential care buildings under MP 2.3 is now a reality. After many submissions and discussions with the initial exposure, the public benefits test, through to the public exposure drafts and directly to Ministers, Directors and Departments responsible, we have not managed to convince Government that residential aged care should be treated differently because of the high level of compliance with Fire Safety Regulation already in place. The legislation came into affect on 1 September 2011. Members will need to have buildings assessed against MP 2.3 within 6 months of the commencement date and there will be a minimum of three years lead time. We will be working closely with Building Codes Queensland and the Department of Local Government and Planning around the inspection outcomes and requirements, and the extent of remaining non compliance. Once the quantum of cost for the industry generally and individual facilities in particular are understood, we will be in a better position to focus on risk of closures and advocate more effectively with state and federal government. We are continuing to work with the Opposition and State Government to achieve a fairer outcome for members affected by these regulations.
Community Care A recent Fair Work Australia decision gazetted by the Governor General has come as a surprise and represents a significant impost to some of the named employers. The Transitional Provisions and Consequential Amendments Regulations 2011 requires 316 named organisations to pay all staff in accordance with the rates of the Queensland Community Services Award 2008, despite this Award having been transitioned to the community services Modern Award. The new rates are effective from 1 October 2011 and back pay entitlements apply from 1 January 2010. This is a perplexing decision by Fair Work Australia when they stated in their initial Pay Equity determination that they saw no justification to simply adopt the Queensland rates (which are the highest) as the national rates for the Modern Award. Some of our members have indicated the inevitable impact on clients and staff by having to reduce service provision hours to fund the full cost of this decision.
Retirement Villages The Civil Proceedings Bill 2011 (Qld) was introduced in State Parliament on 24 August and included proposed amendments to the Retirement Villages Act in relation to the calculation of exit fees. An urgent meeting is being sought with the Deputy Premier in conjunction with the Retirement Village Association on behalf of village operators in Queensland. Although closure of villages both in Queensland and Australia is rare, the Office of Fair Trading has released a Discussion Paper on this issue. We are currently liaising closely with members to finalise an industry submission by the closing date of 9 October. So August has certainly been a busy month on the legislative front and our lobbying efforts on behalf of members continue. ■
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national update
ACAA - WA Anne-Marie Archer, CEO ACAA-WA
Community housing with care A change in supported housing in the West The August opening of the 96 apartment Bethanie Peel Community Housing project near Mandurah (South of Perth) has created a platform for what could be considered a future deregulated model for support aged care.
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he combination of Federal Stimulus funding, a proactive State Department of Housing and many negotiations later, Bethanie Housing was awarded Growth Provider Status with a charter to provide affordable and social housing for WA seniors. At the opening on 17 August the Bethanie Group Inc. CEO, Stephen Becsi, explained that it was their aim to provide high quality affordable accommodation to seniors, even for those on an aged pension, whilst also providing home care services to eligible residents. It was also highlighted that the added benefits of have residents in need of care living in close proximity of each other will greatly enhance the efficiency and cost effectiveness of care delivery. Given the enormous demand for affordable housing for seniors in WA, it is not too surprising that the entire one and two bedroom apartments were occupied literally within weeks, accommodating the oldest and frailest seniors on the State’s waiting list. The sentiments expressed from the new residents at the opening were both heartfelt and moving, but all in appreciation for the high standard of accommodation they had not been able to access in the past.
The Bethanie Group’s Chief Development Officer, Rob Spencer, ensured the apartments exceeded the Adaptable Housing Standard Class B and Bethanie went to the level of detail of having towel rails designed and fabricated so they had the appearance of the latest in contemporary style, whilst providing the practical use of a grab rail. Each apartment building has a lift, intercom system for guest access, security access control system on external doors and a CCTV system for surveillance. The buildings have been provisioned for the NBN fibre rollout. Other design features included door widths and light switches are larger than the standard types, bathrooms are more spacious and showers that are ‘hobless’ for ease of access. From an environmental perspective, ongoing affordability principles have been considered, with the development achieving a 6-star+ energy rating, including instantaneous gas hot water systems, providing the most economical solution for single residents. In addition to the apartment design, the project also incorporates many of the features that are traditionally seen in a village
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national update
environment with a fully equipped clubhouse, outdoor recreation options such as bocce courts, BBQs, vegetable gardens and a workshop for manual arts and crafts. The Bethanie Group has a team of staff to maintain the grounds and buildings as well as a care manager to ensure the physical and social wellbeing of the residents is supported. Whilst visiting the apartments prior to the official opening it was evident that the project’s managers are actively integrating additional support such as Bethanie Community’s meal services and providing access to other community services for pensioners such as local transport and hospital transfers. This will ensure the residents’ independence is maintained as they become frailer. However, if the need arises for full time care, there is residential care within close proximity for respite or placement if required.
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This development has been achieved through the co-operation between the Federal, State and Local Governments and clearly demonstrates what can be achieved if all levels of government work collectively toward a common goal. In regards to future developments, the Government requires approved ‘Growth Providers’ to reinvest profits in further affordable housing projects. As such, the Bethanie Peel site is just the first of many. Bethanie Housing reinvests surplus from rent directly into growth and the Bethanie Dalyellup estate is next on the agenda and is set to launch in September 2011.
Awards for Excellence The Bethanie Peel Community Housing project received State recognition at the 2011 WA UDIA Awards ceremony held Saturday 3 September as the overall Winner for excellence for Seniors Living and the Runner-up for the Affordable Development category. These Awards have been specifically developed by and for the development industry to recognise excellence and innovation in one of the State’s critical industry groups.
Congratulations must be extended to the Bethanie Group for these awards! ■
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Productivity Commission Report
Caring For Older Australians
Implications for Residential Aged Care The Sector Cam Ansell Grant Thornton
What Does It Mean For The Sector? In August 2011, the Productivity Commission publically released its final report entitled Caring for Older Australians. This research represents the most comprehensive review of the aged care sector since the Review of Pricing Arrangements in Residential Aged Care 2004 (The Hogan Review). The Productivity Commission has consulted extensively and made use of over 700 submissions to the initial Inquiry and draft report to produce a well-balanced report proposing a major overhaul of Australia’s aged care system.
Our predictions relating to the major market changes are based on our experiences in Australia and in less regulated operating environments overseas (http://www.grantthornton.co.nz/ aged-residential-care-service-review. html). Assuming that an appropriate implementation strategy is adopted for future resident/subsidy contributions, the following critical changes can be expected in Australia:
The report has been released at a time when Australia’s rapidly ageing population faces a dramatic slowdown in investment in the aged care industry (http://www. grantthornton.com.au/files/aged_care_ survey_2008-final.pdf). The Productivity Commission has acknowledged most of the issues raised by Grant Thornton Australia in our research submitted to the Inquiry. The majority of our recommendations made in relation to the draft report have been adopted (http://www.grantthornton.com.au/files/ grant_thornton_interim_review_of_draft_ pc_report_110131.pdf)
1. Substantial growth in investment in high quality aged care services and infrastructure underpinned by commercially viable business models; 2. Greater levels of competition between providers, driving service innovation, consumer choice and efficiency. Strong service integration driven by entitlement models; 3. Accelerated redundancy of older residential aged care facilities and the rationalisation of existing services; 4. Downward pressure on very high individual accommodation bonds (super-bonds) and competitive pressure on some extra service facilities; and 5. New foreign and domestic entrants into the market and consolidation among existing providers.
The most substantial changes impacting upon operators in the residential aged care sector would result from the establishment of entitlement models and the relaxation of regulatory restrictions over supply (approved places) and price (resident capital and recurrent contributions).
The Productivity Commission’s report states that the creation of a responsive and competitive market will require providers to change their business models and will test the management skills of some. The extent to which these changes represent a threat to existing operators
will depend largely on their capacity to adapt and capitalise on their existing strengths. From the provider’s perspective, the challenge and opportunity is to address the three critical factors that will be paramount in this new environment: 1. Resident co-contributions and pricing; 2. Increased competition; and 3. Capital funding
1. Co-Contribution and Pricing The Productivity Commission has recommended that the users of aged care services should make a greater contribution to the cost of their care, which is similar to the approach proposed in the UK Dilnot Report “Commission on Funding of Care and Support - July 2011” (https://www.wp.dh.gov.uk/ carecommission/files/2011/07/FairerCare-Funding-Report.pdf) It is proposed that prices would be established through a combination of market forces and the provision of subsidies reflecting the real cost of delivering care and related services. The figure on the following page summarises the funding streams. These initiatives open the door to a more viable sector in which consumers are able to exercise choice in relation to accommodation and services. The burden for doing so will drive higher expectations for value and quality.
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Productivity Commission Report
demand. The resulting impact on occupancy levels and the workforce can result in service closure. While many operators have voiced their concerns at this threat, the Productivity Commission’s priority has been for the sustainable improvement of service levels for consumers and not the protection of established operators. To prevail in this new world, providers must leverage their superior knowledge of the communities in which they operate, their established care service models and workforce and their reputation. The current over-regulated system limits choice and the capacity for consumers to influence service standards. Prices for accommodation charges and hotel services (catering, laundry, entertainment, etc) are capped in the majority of cases and this inhibits service innovation. Under the proposed reforms, consumers will be expected to contribute to the full cost of these services, where they can afford to pay, as well as a limited proportion of personal care costs. The price would be set by providers and will be subject to negotiations with those receiving services. Grant Thornton research confirms the Productivity Commission’s conclusion that the provision of aged care services in modern facilities is not financially viable. This is largely because of the regulations over price under the Aged Care Act 1997. In the absence of such restrictions, providers would be able to charge a commercial price for their services and can expect Government subsidies that are adequate to cover care costs. Establishing appropriate pricing will require more than just an assessment of current operating costs. In a competitive environment, price will be determined more directly by the value perceived by residents and their families than provider resource inputs. Providers will have to capitalise on their knowledge of resident priorities and preferences to design innovative services that are both valued and affordable. Their capacity to let go of redundant aspects of their current service models and adapt to increased competition will be paramount in a less regulated pricing environment.
2. Increased Competition Grant Thornton anticipates that the proposed reforms would result in increased levels of investment and greater levels of service innovation. However, the level of competition for business in a more commercial and dynamic market will be a new paradigm for most operators. We are already observing fresh investment in the Australian aged care sector from foreign interests, drawn to our relatively affluent and rapidly ageing population. Some of these investors are currently operating in countries more accustomed to competing in less regulated conditions. The proposed relaxation of supply constraints will remove the protection afforded to current facilities under our existing managed bed policy. Our experience in New Zealand indicates that heightened consumer expectations, particularly in affluent areas, can result in aggressive competitive behaviour. Operators with strong service models and access to capital are able to establish themselves in the catchment areas of existing operators who do not meet market
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Based on their understanding of their community, providers can determine whether their service models are likely to remain competitive in a more dynamic environment and develop strategies for their adaptation and the upgrade or redevelopment of their building stock.
3. Capital Funding The Productivity Commission has recommended the removal of restrictions on the payment of accommodation bonds in standard high care which would dramatically increase the proportion of consumers that could pay refundable entry contributions in residential aged care. At the same time, providers would be required to offer periodic accommodation charges as an alternative (and set at a commensurate value) to accommodation bonds. The move has raised concerns about the potential decrease in bond receipts across all forms of residential care if residents prefer to pay periodic accommodation charges. Although future preferences are difficult to predict, we do not share the same level of concern. There are several reasons why the number of accommodation bonds might actually increase over the short to medium term. 3.1 Investment stimulus requirement Although we anticipate the entrance of new market participants in the future, it will be established Australian operators that will drive the initial development and the redevelopment of the country’s aged care building stock. Grant Thornton estimates that an investment of approximately $21 billion will be required in the short and medium term. Few existing providers have the cash reserves to undertake new developments or redevelopments at a cost of over $180,000 per bed (excluding the cost of land) without resident capital contributions (http://www.grantthornton.com.au/files/aged_ care_survey_2008_2nd%20report.pdf). Lending horizons for Australian financial institutions are relatively short and the use of accommodation bonds is a well established mechanism for the repayment of bridging finance. The success of the Productivity Commission’s vision for a rejuvenated sector is dependent upon new investment by providers. Future reform implementation strategies will need to facilitate access to resident capital contributions. In the longer term, operators and their financiers will develop alternative capital financing models on the back of the more profitable operating models. This will help reduce dependence on accommodation bonds for new developments.
Productivity Commission Report
3.2 Resident Preferences Residents currently paying accommodation bonds have been assessed as requiring low care services (or extra service high care). The average length of stay for low care residents is approximately 36 months compared to high care entrants of 15 months (Department of Health & Ageing 2011). The introduction of accommodations bonds for standard high care may not appear attractive given the likely duration of stay. However, many high care extra service facility operators have been successfully operating under this model for many years. Feedback from the Productivity Commission indicates that the proposed Australian Aged Care Home Credit Scheme can be used to draw down accommodation bonds against the value of the resident’s home. This means that the resident can retain their home, and often their pension, while incurring a servicing cost to the Government limited by charges based on the Consumer Price Index. Alternatively, the Aged Pensioners Savings Account scheme can be used to deposit the surplus from the sale of the home after paying an accommodation bond and the pension would be preserved.
Conversely, a resident paying periodic accommodation charge instead of a bond must meet the providers’ cost of capital. This would be substantially greater than CPI charges from the Home Credit Scheme (or no charges from funds from the sale of the home) and represents a disincentive for consumers to pay accommodation charges in lieu of a bond. 3.3 Alternative Capital Contribution Models With the establishment of entitlement models, the resident’s capacity to influence the setting in which they receive care will drive the creation of a broader spectrum of service environments and innovative building designs. International experience demonstrates that seniors’ housing models adapt to consumer expectations where entitlement models are effective. This is reflected in their options for accommodation payments. In the future environment proposed by the Productivity Commission, recipients of residential aged care services will be able to receive care services in apartments or units and should be able to make contributions based on their personal circumstances and preferences, including the strata purchases, loan licenses and rental alternatives currently provided at retirement villages. In a less regulated pricing environment providers will develop alternative
capital funding models that meet consumer demand and support the development of accommodation that their clients value. In the longer term, we believe that the emergence of entrepreneurial financing alternatives and consumer preferences are likely to reduce the sector’s dependence on accommodation bonds in their current form. However, if the reforms are successful in creating a more viable sector, providers will have greater capacity to service borrowings and banks will be able to develop products to help support this transition.
Opportunities and Challenges Below we consider some alternative approaches to planning for change in a more dynamic and responsive market. The following are examples of opportunities and challenges for consideration during the strategic planning process. i) Service Integration As discussed above, the proposed entitlement models will afford consumers greater choice in the setting in which they receive care. Our overseas experience demonstrates that such models can open the door for greater levels of service integration between retirement living, residential aged care and community care services (http:// www.grantthornton.com.au/files/retirement_living_report_1012. pdf). Residential aged care facilities can operate as an effective and efficient service hub for the community. This provides valuable and affordable benefits to consumers while generating revenue and referral opportunities. In a village context, the potential for serviced apartments, rehabilitation and transitional care and home care services would be greatly enhanced. Conversely, operators of retirement villages without care services may find it difficult to meet the needs of residents that have received an entitlement for care. This will create opportunities for service expansion within villages or partnerships with established care providers. ii) Redevelopment/Renovations Improved access to capital funding and more commercial accommodation charges will prompt many operators to upgrade their facilities. Developing viable operating models (and securing bank finance) in a dynamic market will require careful planning and consultation. Operators must think beyond current services to adapt to future priorities, preferences and competitor activity. Input from the care team members closest to residents and families will be instrumental in this regard. The ability to leverage established experience and resources is a major competitive advantage not available to new entrants to the market. Considerations for development planning are provided in the Grant Thornton Aged Care Review – Second Report (http://www. grantthornton.com.au/files/aged_care_survey_2008_2nd%20 report.pdf )
iii) Service Expansion Many operators may wait until the reform recommendations are formally adopted (or even implemented) by Government before actively seeking expansion opportunities. While caution is always wise when making investment decisions, we believe that the relaxation of aged care price and supply constraints in Australia is inevitable. With a rapidly ageing population and growing dismissal for service innovations, strategically minded organisations will plan to leverage their strengths to adapt now rather than waiting for them to become liabilities in a changing market.
“It’s not the strongest of the species that survives…it’s the one that is the most adaptable to change” – Charles Darwin As described above, residential aged care activities share synergies with retirement living, community care and other seniors’ care and accommodation services that will be enhanced under a formal entitlement based aged care systems. Providers should not limit their expansion possibilities to residential aged care, but consider how they might benefit from the development of a broader service offering to better meet customer needs and preferences, which may include a range of accommodation types and standards. ■
Food safety programs (tailor made) Kitchen and laundry processes Cleaning/infection control audits and methodology redesign Laundry and kitchen design
• Food Safety Programs which are both manageable and sustainable • Laundry assessment to provide savings in both utility and labour costs • Providing expertise and knowledge to assist organisations to retain in-house support service
creeksolutions pty ltd hotel, health and aged care consultants
PO Box 60, Croydon, NSW, 2132 M. 0425 356 134 E. paulcreek@creeksolutions.net
www.cr www www.creeksolutions.net .creeksolutions.net eeksolutions.net
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Productivity Commission Report
Productivity Commission Creates Opportunities Retirement Villages and astute Residential Care Operators may be the Big Winners under the proposed PC Changes
James Underwood James Underwood & Associates Pty Ltd
The Productivity Commission (PC) Report has recommended many changes to the landscape of aged care. The government now has to consider which of these changes will be implemented. In this article, we look at the possible impacts of two of the key recommendations and of one large omission. In addition, some of the initiatives are a little bit hard to fathom or look difficult to implement. For example: The proposed co-payment maximum of $12,000pa is about half of the current maximum income-tested fee (ITF) of $23,612pa. It is hard to see why an enhanced user-pay initiative like this would actually propose that some new residents pay substantially less than now. Possible very large increases in community care fees for some people through the start of the co-payments. (Most EACH recipients currently pay only $59/wk. With a maximum co-payment, this could increase to $289/wk.)
Alternatively, very high occupancy rates would be expected in residential care, if there were insufficient places. This also is not the case as residential care occupancy rates have never been lower:
Government-sponsored reverse mortgages on the family home to fund co-payments even if a spouse/dependent child is still in residence. Running an annual ACAR process concurrently with releasing places through a non-ACAR “liberalisation” method for a five year transition period (Vol 2, Page 507).
1. “Crisis in Aged Care” A key item in the language of the PC Report is that it is addressing a “crisis in aged care”. The PC recommends a major increase to the number of community care packages as “soon as practicable” to “provide a pressure valve to the system and address...unmet demand” (Vol 2, Page 499). This is proposed because increases in numbers of residential care places are subject to “exigencies and timing of construction”. The PC’s proposed 20% or thereabouts increase would lift community care by over 11,500 new packages. The urgency demanding such a major increase would presumably be a failure to build new residential care places, but the numbers being built nationally do not appear to have fallen off:
Source: AIHW
Similarly, occupancy rates for community care are hardly startling. In 2009/10, they were 93.2% for CACPs; 90.3% for EACHs; and 85.6% for EACHDs (Source: DoHA Occupancy Cubes). Accordingly, a major immediate increase in community care availability may simply auger a further reduction in already historically low residental care occupancy levels, rather than meet any urgent crisis in need.
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2. The “Persons Aged 70+” Benchmark is now a Very Inaccurate Guideline
has occurred through interstate migration of (younger) retirees – the movement of “sea changers” to Qld.
The PC Report recommends de-regulating the system of allocation of new aged care places. Certainly, getting rid of the “1,000 persons aged 70+” benchmark is a good idea as it is leading to some fairly inaccurate outcomes. Why? Let’s look at the example of Queensland vs South Australia. At 30 June 2010, there were proportionally far more residential care places for persons aged 70+ in S.A. than in Qld. There were 92.4 places in S.A. compared to just 84.8 in Qld. This should have meant that S.A. services would have poor occupancy. But no, South Australia had the highest occupancy in the country at 96% and Qld had lowest occupancy of any state at just 91%. Why, again? One key reason is demographics. South Australia has far more “old old” persons as a proportion of its 70+ population. In 2011, for every 1,000 persons aged 70+ in Qld, there were 387 of them who were aged 80+. In South Australia, there were 425 persons aged 80+ for every 1,000 aged 70+. This means there were 10% more 80+ persons in S.A in the same benchmark group! In the 85+ group, the percentages are even more divergent. Of every 1,000 persons aged 70+ in Qld, some 187 are aged 85+. In S.A., this figure is 211 persons, or nearly 13% more! Partly, this dichotomy
Why is this important? Because the majority of persons aged 70+ entering permanent residential care are not aged 70yrs to 80yrs. (Only 20.8% of all new admissions come from that group, huge as it is.) Nationally, some 79.2% of all admissions of persons aged 70+ are actually aged 80+. Indeed, over 53.0% of all new admissions aged 70+ are actually aged 85+ at point of admission (AIHW 2010). So, use of the “over 70+” benchmark has resulted in insufficient new places being allocated to South Australia and, probably, too many
being allocated to Queensland. Qld has a little over twice the aged population of S.A. but has been allocated over 6 times the number of places as S.A. for many years! Beds/1,000 aged 70+
QLD 84.8
S.A. 92.4
Residential Care Occupancy
91%
96%
402,326 155,677 75,286
188,201 80,040 39,622
Persons Aged 70+ Persons Aged 80+ Persons Aged 85+ No. of new places Allocated: 2007 2008 2009/10
1,622 1,603 1,583
375 123 237
3. What about Retirement Villages? The PC Report recommended that the regulation of retirement villages remain with state and territory governments and not be aligned with regulation of aged care services (Vol 2, Page 315). However, the retirement village sector is noted to have around as many residents as the residential care sector (Vol 2, Page 308) and appears ideally suited to deliver de-regulated community care products as a strong marketing edge. Few places appear better than retirement villages for the economic delivery of home care
into an environment that is both secure and devoid of mobility and other hazards. Plus, retirement villages can still make places more affordable to new residents through offering retentions (called deferred management fees – DMFs – or exit fees). The PC has expressly recommended abolishing retentions in residential care. So, has the PC missed an opportunity to make recommendations for a key aged care area of the future – retirement villages?
Conclusion The PC proposals for de-regulation and simplification of the aged care system are very desirable. The elimination of planning ratios and the careful introduction of free market forces are good ideas. These will give providers the opportunity to plan for and commence services where they are needed and where they are likely to be successful. We are seeing key providers “land-banking” now to have the sites available in the right areas for when de-regulation occurs. Similarly, the liberalisation of availability of home care packages could lead to retirement village operators strongly increasing their involvement with – and marketing of – care in aggregated living environments. Service integrated housing (SIH) is beginning to blossom in anticipation. There are many potential challenges – some major – and we’ll all need to be very involved in helping the government frame its implementation plans in the months ahead. ■
Productivity Commission Report
Framework for the future? Review by Bill Bourne, ACAA-NSW
T
he draft report of the Productivity Commission report (“The Report”) has been widely accepted by all industry stakeholders, but it needs to be seen as simply a framework or “white-paper” for the future. There is a long way to go before we see the end of this Jig-saw puzzle and the following needs to be taken into account: • The government’s response expected in late October or early November; • The agreed timeframe for discussion and implementation (if any); • Inclusions in the 2012 Federal Budget which would need to be cash neutral to Government; • The drawn out negotiation and consultation process where the detail will be revealed; and • The inclusion of any other matters seen as relevant by the industry stakeholders. The report makes a number of recommendations and my analysis will concentrate on the contentious areas of “Paying for Aged Care” and will raise more questions than answers. This is simply a process in the negotiation, because as I have repeated advised members “the devil will be in the detail” and it is that detail, which is yet to be revealed, that must be closely analyzed. Recommendation 7.2 seeks, among other things, to abolish retentions on bonds, to require aged care providers to offer and publish periodic accommodation charges and bonds, and to abolish interest on bonds. In relation to the abolition of the retention, the industry sees this as taking away a right of the provider but also taking away a negotiating point for consumers who wish to negotiate bond payments. If the government wishes to abolish this right will the “no requirement for payment in the first six months” rule also be abolished? Will periodic accommodation charges be able to increase during the consumer’s stay in line with reviewed published charges?
The prohibition of interest on bonds is not supported in its current form. If the provider is to be prohibited from charging interest to the resident for unpaid bonds then the provider should not be required to meet any interest payments on the repayment of bonds when the resident leaves the facility. This also needs to be read in conjunction with recommendation 7.4 where the commission recommends that the Government charge a fee to providers (interest) for providing a guarantee on the bonds. Is the government guaranteeing the bond from the date of entry? Recommendation 7.3 seeks to introduce the AUSTRALIAN AGE PENSIONERS SAVINGS ACCOUNT. This account will be controlled by the government or its agent and pensioners can invest the proceeds of the sale of their principal home and subsequent principal home(s). This is simply an income grab by the government from providers where residents’ previously paid higher bonds to ensure that they maintained their pension status and the fringe benefits that are attached to the pension. The AUSTRALIAN AGE PENSIONERS SAVINGS ACCOUNT would pay interest to the pensioners at a rate equal to the prevailing CPI. This begs the question what CPI and is the government going to be up front with this as they currently are with the COPO arrangements? The account and the interest (CPI) earned from AUSTRALIAN AGE PENSIONERS SAVINGS ACCOUNT will be exempt from the Age Pension assets and income tests. It will not be exempt from the proposed co-contributions test nor will it be exempt from income tax and this should be read in conjunction with recommendation 7.10. No amounts other than the proceeds of the sale of the principal residence(s) can be deposited into the account and the account holders can flexibly draw down on the
balance of the account. There should also be an allowance for payment of outstanding amounts owed to aged care providers. Recommendation seeks to charge residential providers a fee to reflect the cost of the government guarantee on bonds. One questions why providers should have to pay when the government will collect $billions through the AUSTRALIAN AGE PENSIONERS SAVINGS ACCOUNT? Will the government guarantee payment of the bond on day 1? If not will they pay the interest on the bond equal to the General Interest Charge? What if providers do not want bonds, will they be charged? This recommendation needs to be discussed in full. Recommendation 7.5 recommends the abolition of the tiered structure of payments for concessional/supported residents (the 40% rule). In its place the Commission has recommended the reversion to the ratios by planning region with fines for those facilities that do not achieve those ratios. This is similar to the non-compliance deductions under the Residential Care Subsidy Principles 1997 which were never invoked but despite many requests from the industry it has never been revoked. The ratios currently set on a regional basis and are available on the DoHA website will have to alter due to the change to the “protected persons” definition and less people will qualify as protected persons. One questions the need for a regulated ratio and for a requirement that each provider in the planning region meet that ratio, especially with the current vacancy factors and the recommendation to remove the regulatory restrictions on residential bed licences. Fines are draconian and would depend on: • The ratios being 100% correct and no government can guarantee that;
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• The availability of supported residents • The non-migration of aged people and • The admissions policies of all facilities in the region. Fines would also severely affect facilities that are currently extra service facilities as those facilities are not required, nor are they funded, to admit supported residents. Again we state that Part 3 of the Residential Care Subsidy Principles 1997 should be deleted. This recommendation seeks to redefine the supported resident by excluding the protection of the principal home from the assets test in instances where there is a “protected person” residing in the house at the time of admission to aged care. A “protected person” is defined as: a) A partner or dependent child of the resident; b) A carer of the person who has been residing with the person for a period of 2 years or more prior to entry to aged care and who is eligible for income support; c) A close relation of the person who has been residing with the person for a period of 5 years or more prior to entry to aged care and who is eligible for income support. The recommendation seeks to allow those “protected persons” to continue to reside in the home by introducing a system of deferred payments through the Australian Aged Care Home Credit Scheme. This raises a number of questions: a) Is the “deferred payment” actually paid to the provider on an ongoing basis and the deferral is relating to the government’s recoupment of those funds from the Estate? b) If it is payment to the provider that is deferred is interest chargeable and is interest chargeable on interest? c) This will introduce a whole new level of accounting to account for the deferral – sales. d) How does this recommendation sit with legislation around tenants-incommon? e) As the accommodation is a form of rental, will rental assistance be re-introduced? f) Will the Australian Aged Care Home Credit Scheme act as estate agent to rent the home (or part thereof) to the “protected person”?
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This recommendation seeks to: a) Remove the restriction on supply of additional services; b) Discontinue the issue of extra service licences; c) Remove the distinction between ordinary and extra service licences Whilst this simply opens the market to “extra service” it must be handled with care as higher accommodation and services need to be charged. Would exclusion from regulation make charges subject to GST? The Specified Care and Services (Schedule 1 of the Quality of Care Principles 1997) needs to be critically examined and expressed in plain English. Without this there will be constant arguments as to what is and what is not covered by the fees paid to the facility. The discontinuation of the extra service licences needs to be closely grand-parented as both the resident and the facility could be affected if there was a straight cut-off to the licences. Recommendation 7.9 seeks to introduce a care recipient co-payment through the AUSTRALIAN SENIORS GATEWAY AGENCY which will be based on a comprehensive means test taking into account the Age Pension income test and an assets test. The asset test will include the resident’s share of those assets which are excluded from the pension means test such as the principal place of residence, accommodation bonds and the proposed AUSTRALIAN AGE PENSIONERS SAVINGS ACCOUNT This co-contribution will be assessed by Centrelink and will be regularly reviewed. The co-payment will be adjusted to take that review into account. The co-payments are a substitute for the current income testing arrangements. Currently this is based on income earned over certain thresholds (for the various types of resident) and these thresholds are set above the maximum pension level with a daily maximum payment. The income test currently excludes the principal place of residence and accommodation bonds. It also does not take into account as income rent received to assist in the payment of accommodation charges or an accommodation bond by periodic payments.
If the current Centrelink means test is adopted: a) The resident will be much worse off due to the amount payable; b) The government will “double dip” by using the same asset (the value of the house) to meet the accommodation payment and the co-contribution (which will consequently decrease government subsidies). c) If there is a protected person living in the home will the home come under the deeming provisions? d) The self funded retiree will be worse off as the 20 March 2008 income testing changes will be defunct. Recommendation 7.10 of the report recommends the implementation of a stoploss limit which is estimated to be $60,000 excluding accommodation and everyday living expenses. This is subject to further discussion. Once this limit has been reached no further co-contributions will be required. The commission also recommends that with a stop-loss limit in place the government should exclude aged care costs from the net medical expenses rebate. The introduction of the stop-loss limit is window-dressing. There is currently a daily maximum income test limit which is $64.69 per day and increases as the pension increases. The current amount equates to $47,225 over 2 years and if applied to the estimated $60,000 in the report would equate to 2.54 years. This is similar to the average length of stay in residential care. The Commission then recommends that because there is a stop-loss limit in place the aged care costs should be excluded from the medical expenses rebate under the Income Tax Assessment Act. About 12% of current residents are required to complete a tax return (estimate), however this figure will increase exponentially as the affects of compulsory superannuation come into play. These residents will be adversely affected as will providers who use the tax rebate as a marketing tool. The recommendation, if accepted, will be seen as a cash-grab by the government at the expense of the vulnerable aged Australians in need of care. ■
Productivity Commission Report
Final Recommendations Rachel Lane Executive Manager Aged Care Solutions Colonial First State
Care Co-contribution arrangement The current arrangements for cocontributions towards the cost of aged care vary significantly between HACC, CACP and EACH services and those paid toward the cost of residential aged care. This is largely due to the formal process of determining a resident’s income after moving into residential aged care versus the informal process and need for the care provider to determine a care package recipient’s capacity to contribute towards their cost of care. The Productivity Commission recommends replacing the current arrangements with a single national co-contribution regime that will apply equally across in-home care services and residential aged care. While the rate of co-contribution was not suggested, the commission has indicated that it would be dependent on the underlying cost of care and the recipient’s capacity to pay. An indicative range of between 0 (for those with the least means) and 25 percent (for those with the greatest means) of the cost of care has been proposed with a lifetime limit of $60,000. In determining the amount of care cocontribution a “comprehensive aged care means test” would be used. Unlike the current income tested fee arrangements the care recipient would have their capacity to pay based on an asset and income assessment. Assessable income would be determined as per the current social security assessment of income; however the assessment of assessable assets would include the care recipient’s share of assets that are exempt from pension assessment (the principal place of residence and accommodation bond). While these assets will be assessable for the purposes of calculating the co-contribution, the exemptions for pension purposes would be retained and pension entitlement would remain the same.
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The current exemptions that apply to the assessment of the former home where a partner or dependent child lives there, carer that is eligible to receive an Income Support Payment has been living in the home for the past two years or close relative that is eligible to receive an Income Support Payment and has been living in the home for the past 5 years would be replaced with an assessment based on legal ownership. For a couple who own the home jointly an assessment of 50 per cent of the value of the home would be made against each, while in the case of a dependent child (with no legal ownership) 100 per cent of the home would be assessable against the care recipient and used in determining the amount of their care co-contribution and the funds they can access through the Aged Care Home Credit Scheme. This obviously creates very different outcomes for couples than what we currently we see, particularly in the determination of supported resident status.
Aged Care Home Credit Scheme The assessment of assets that are currently exempt and/or produce no income in the proposed co-contribution arrangements means that many aged care recipients are likely to have insufficient income to meet their ongoing cost of living. The commission recognise that the majority of wealth held by older Australians is “locked” in their home, “Currently, the median household of those aged 65-74 holds around 79 per cent of their net worth in their principal residence, rising to 90 per cent for the median household of those aged 75 and over.” The commission recommends establishing an Aged Care Home Credit Scheme to enable care recipients to access the equity in their home to assist in meeting the cost of living without the need to sell the home. Putting the information provided by the Commission into a quick case study, we get:
Jack and Shirley *figures used are based on current Centrelink assets and income tests for pension purposes and current daily care fee. Jack and Shirley are full age pensioners with a home valued at $1million and $60,000 in financial assets. Their only income is the interest earned on bank accounts and their age pension entitlement. Jack has been assessed as requiring aged care. Jack’s cost of care under the proposed reforms (based on current rates and thresholds and productivity commission cameos at Report No. 52, Table C.4) would be; Accommodation payment Everyday Living Expenses Care Cocontribution Sub Total Plus chocolates, haircuts, Total Pension entitlement Interest on bank accounts Total
$50p.d $40.25p.d $14.71p.d $104.96p.d or $38,310.40p.a $2,600p.a outings, medication etc $40,910.40p.a $37,923.60p.a (combined) $ 3,000.00p.a (@5%) $40,923.60p.a
Jack’s cost of care would absorb all of the combined pension entitlement and interest from bank accounts under the daily charge model; however, he could use the Aged Care Home Credit Scheme to provide the necessary cash flow to assist in meeting this cost. Alternatively, he could elect to pay his accommodation payment as a lump sum. Due to the small amount of funds available outside the home it is likely he would need to fund the majority of the lump sum through the Aged Care Home Credit Scheme.
Of course under the current arrangements Jack would be a fully supported resident and the aged care facility would receive a supported resident supplement (up to $30.55p.d) for him. Jack wouldn’t pay an accommodation payment (bond or charge) or contribute to his cost of care through an income tested fee. His current cost of care would simply be $40.25p.d or $14,691.25p.a. Even after we add in chocolates haircuts and outings, Jack’s cost of living in aged care is only $17,291.25 which is less than half of the combined pension entitlement. ■ Having worked in financial services for 12 years and as a specialist in aged care for the past seven, Rachel Lane is well known and respected within these industries, particularly for providing advice on the structuring of assets and income for aged care residents. Prior to joining Colonial First State, Rachel held the position of Aged Care Specialist with St Andrews and Bankwest. She regularly facilitates workshops for Aged Care Association Australia (ACAA), and is highly sought after as a presenter at aged care conferences and seminars around the country. In addition to a full work schedule, Rachel has recently completed a Masters degree in Financial Planning.
UPCOMING ACAA EVENTS Rachel’s next half day finance workshop “Financial Advice: Ensure a Win:Win for Facilities & Residents” will be held at the ACAA NSW Office on Friday 21 October – please contact Sharlene Bracken on 02 9212 6922 to register. Rachel will also be one of the facilitators for the Productivity Commission Report Master Class at the ACAA National Conference on Wednesday 9 November – please contact the ACQ on 07 3725 5555 to register.
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Productivity Commission Report
Unpacking the productivity commission report Theresa McCormack & Julie McStay Hynes Lawyers
On 8th August 2011, the Productivity Commission (PC) released its final report ‘Caring for Older Australians’. If adopted by the Australian government the PC’s recommendations signal a long anticipated reform of aged care in Australia. We unpack a summary of some of the details of this comprehensive and thoroughly researched report.
The Report is a framework, yet to be interpreted and ‘fleshed out’ by politicians and policy makers. The framework has been designed to operate as a whole package, if the government ‘cherry picks’ only parts of it, the opportunity for functional reform may be lost.
components of the costs of aged care as follows:
Importantly the PC recommends some short term changes that if adopted and implemented by government would fit within the current legislative framework avoiding the otherwise inevitable delay of legislative change.
• Accommodation and everyday living expenses should be the responsibility of individuals, with a safety net for those of limited means. • Health services should attract a universal subsidy, consistent with Australia’s public health care funding policies. • Individuals should contribute to the cost of their personal care according to their capacity to pay, but should not be exposed to catastrophic costs of care.
The PC recommends reforms be transitioned in over a prolonged period consisting of three phases being:
Accommodation payments / capital funding
• Phase 1 (from 1 to 2 years post implementation); • Phase 2 (from 2 to 5 years post implementation); and • Phase 3 (5 years post implementation and beyond).
The PC proposes removing the distinction between residential low care and high care places and between ordinary and extra service places. It also proposes the gradual removal of regulatory restrictions on the number of residential bed licences.
Funding
Providers should charge ‘accommodation payments’ for their residential place to all permanent residents (with the ability to pay) regardless of the level of care required.
The Report proposes reinventing the current supply restricted funding model to a more flexible, future proofed model driven by consumer demand for care. The new model will be responsive to the needs and numbers of seniors eligible to receive community and residential care. The PC proposes providing care recipients with an entitlement to care rather than allocating direct subsidies to providers stating that this has the “potential to improve productivity and the quality of services to care recipients”. The PC has approached its review of aged care funding by ‘separating out’ the different
Providers would be required to offer a periodic accommodation charge (e.g. daily, weekly or monthly) and may offer a lump sum accommodation bond, equivalent to or lower than the periodic accommodation charge. A combination of both may be offered. The accommodation payments, should be determined by the provider, but must always reflect the cost of supply of that particular residential place in that location. The price charged by providers for accommodation in
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Productivity Commission Report
residential facilities should reflect the actual value of the accommodation according to prevailing market conditions and should reflect the different quality and features (such as building and room amenity). Providers will be required to publish their accommodation charges and accommodation bonds. A form of bond retention amount (linked to published charge and bond amount) might be a part of a payment option offered to seniors, assuming seniors are fully informed, however current regulated bond retentions will be abolished. The government will continue to guarantee accommodation bonds but will charge residential providers a fee to reflect the cost of doing so. The distinctions between residential low care and high care places would drop away in Phase 1. Accordingly, if the government adopts and implements the reforms, providers could ask all residents to pay lump sum accommodation payments (subject to ability to pay) as soon as the reforms are adopted. As such lump sum accommodation payments in the first two years after implementation of the recommendations would likely increase in number. The value of bonds is likely to decrease however, because accommodation payments must reflect the cost of supply.
New financial products In Phase 2, the PC recommends the introduction of two new financial products to provide seniors with the flexibility to pay for accommodation payments and care. • Australian Age Pensioners Savings Account scheme Seniors will be able to deposit some or all proceeds of the sale of their principal residence into a government backed savings account, which should pay interest equal to the prevailing CPI. The funds held in the account would not impact the pension and could be drawn down to pay for accommodation and care. • An Australian Aged Care Home Credit scheme A government-backed line of credit would be secured against a senior’s principal residence, or their share of that residence. The drawdown would be subject to interest charged at the CPI. If the outstanding
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balance and accumulated interest reach a limit set by the Australian Seniors Gateway Agency (Gateway) (discussed later in this paper), the interest rate would fall to zero with no further drawdown permitted. Repayment would be on sale of the residence (upon the death of the individual), except where there is a spouse or dependent permanently residing in the home. In this case, the balance would be repayable when that person ceases to permanently reside in the residence or ceases to be a protected person. There is a perception that these products will serve as a disincentive for seniors to pay lump sum accommodation payments. If the pension is not at risk, why pay a lump sum (which also pays no interest) over a periodic accommodation charge? Making lump sum accommodation payments seem attractive might take some restructuring of payment options, not to mention, creative marketing. Providers will be planning ahead to afford themselves the flexibility to adjust business models if necessary, in anticipation of fewer bonds. Many however anticipate a commensurately greater ongoing cash flow, given that accommodation charges will reflect costs of supply and that subsidies are likely to increase substantially. Some recent indications from the banking sector suggest that financiers are less negative than initially anticipated about the recommended changes with the consensus being that the sector needs the changes to survive. Supported residents The PC recommends that the supported resident payment be sufficient to meet the cost of providing an approved basic standard of accommodation. The PC suggests the subsidy be based on 1.5 beds per room. The draft report suggested a two-bed room with shared ensuite. Providers objected to this proposal, as this form of accommodation is not what providers are building or what consumers want. The issue said the PC, is “striking the appropriate balance between the needs of people unable to pay for accommodation, community views about ‘acceptable’ standards of accommodation and the burden on taxpayers”. The PC recommends that providers continue to be obliged to make available a proportion of accommodation to supported residents at
least in the transition period (Phases 1 and 2). The level of obligation should be set on a regional basis with a sliding scale of penalties dependent on the level of non-compliance. Current pricing arrangements, which discount the full rate of supplement when facilities do not meet the supported resident ratio, should be abolished. The PC suggested in Phase 1 a pilot scheme for trading up to 50% of a facility’s supported resident obligation with other providers in the same region to be assessed in Phase 2 with a view to allowing more general trading in supported resident places. At the end of Phase 2 competitive tendering for ongoing provision of accommodation to supported residents could be considered.
Recurrent funding To establish the adequacy of current government subsidies the PC recommends that an independent body determine the cost of providing aged care services. This role would be analogous to the proposed Independent Hospital Pricing Authority for the National Health and Hospitals Network. It suggested a new body, the Australian Aged Care Commission (AACC) (discussed in more detail later in this paper) review and replace the Commonwealth Own Purpose
Outlays (COPO), with a more appropriate indexation method to enable recurrent funding to keep pace with actual care costs.
Opportunities for increased funding Importantly, the PC supports additional grants and recurrent care subsidies for the provision of specific commonwealth funded scheduled services. By way of example, we consider proposed new funding associated with the following: • palliative and end-of-life care; • culturally and linguistically diverse services (CALD); • reablement; • respite; and • medicare rebates for doctors and associated expenses. Palliative and end-of-life care The PC said there is a strong case for a greater role for residential and community care providers to deliver palliative and endof-life care. It recommends that payments
for palliative and end-of-life care services be aligned with those provided in other health care settings to ensure that those people receiving palliative care in residential facilities or the community do not receive a lower standard of palliative care than someone in an alternative setting. Palliative seniors generally have high care needs. It is likely that if the costs of providing palliative care are appropriately benchmarked, significant extra funding will be available to residential and community providers. This may in turn incentivise providers to expand service provision to include dedicated palliative care services.
warranted separate subsidies and where appropriate capital grants: • language specific services e.g. translation services; • culturally specific aged care and community services such as appropriate food, physical environment and social activities; and • ensuring staff undertake appropriate professional development activities to increase their ability to deliver CALD appropriate care. There may also be opportunities for extra funding for providers catering for special needs seniors or those in rural or remote areas.
Catering for Diversity The PC acknowledges the need for particular services for particular needs groups. The proposed relaxation of supply constraints on residential and community care services has the potential to provide opportunities for providers who elect to specialise in delivering care to specific CALD communities; or may allow existing service providers where demand exists, to expand their service offerings to meet the needs of these groups. This care may be provided in mainstream or in dedicated facilities or services. For instance, the PC recommends that costs in providing services such as the following
Reablement The PC recommends intensive reablement (rehabilitation) services with greater focus on independence, rehabilitation and restorative care. Eligibility and entitlement for reablement services should be highly subsidised, if not provided to recipients free of charge with eligibility assessed by the Gateway. Although some funding for rehabilitation is currently available, the proposed changes represent an opportunity for providers (if the recommendations are adopted) to increase funding to a level well beyond current arrangements.
Respite The PC recommends that for those services more closely aligned to health care, such as respite, the costs of accommodation could be included in a total care package of costs that are largely publicly funded drawing on the policy adopted for acute care in public hospitals. This would mean that for residential respite, daily or weekly subsidised accommodation charges could apply. The PC also suggested that a trial of more flexible arrangements for respite care, such as cashing out for respite services and extending the range of registered individuals who may be approved to provide respite care be conducted. Residential aged care providers may consider possible opportunities in meeting the ongoing demand for respite care. Medicare rebates for doctors and associated expenses paid by providers. The PC has said that the Medicare rebate for medical services provided by general practitioners (GPs) visiting residential aged care facilities and people in their homes should be independently reviewed to ensure that it covers the cost of providing the service.
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The PC says that costs associated with GP support services currently incurred by aged care providers, including e.g. visiting rooms, administration costs, dedicated equipment and IT support should be taken into account by the AACC when recommending subsidies for costs of delivering care. This is an opportunity for providers to gain funding for a service that to date they have borne the cost of providing.
Deregulation and expansion of community care The PC recommends that the number of community care places should increase as follows: Phase 1 • by 20% above the Aged Care Approval Round baseline (as soon as practicable on adoption and implementation of the recommendations); and • with another intermediate level of packaged community care temporarily added between Community Aged Care Packages (CACPS) and Extended Aged Care at Home (EACH)); Phase 2 - by a further 20%; and Phase 3 – be unlimited (but subject to assessment of need).
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Not having to apply for community care packages (coupled with the consumer driven care approach) presents opportunities for community care providers to expand services. Residential care providers may consider expanding into the provision of community care. Existing providers might expand into community aged care with very little capital outlay, coordinating provision of services from existing back office support. Retirement village operators may consider opportunities to provide more community care to residents and to the community outside their facilities. Greater scope and flexibility for provision of community care (and being asked to contribute more to residential high care) may increase the trend for seniors to stay in their homes longer rather than entering residential care, further increasing demand.
Structure of the wider system of support The model is for a consumer directed Aged Care System to be accessed via the Gateway (a one stop shop) at which the senior sources a schedule of Commonwealth subsidised aged care services and carer support services. Also available via the Gateway should be lower intensity, community support services such as maintenance and meal preparation
(as an entitlement, where assessed as essential to care). Seniors might also access these services directly. The PC acknowledges that a service provider centred approach and special purpose service models are required for some seniors (such as homeless people and some Indigenous people). These services could be accessed directly by the senior with assessment by the Gateway occurring within a three month period. The PC recommends that some base level of block funding be provided to ensure certain services are available such as in small regional communities, including those which may be co-located with health services. Opportunities exist for community support services to gain government funding (including block funding for infrastructure and overheads) as well as user charges and financial and in-kind support from state, territory and local governments and the community.
Australian Seniors Gateway Agency - a simplified gateway The Gateway, a single agency responsible for the provision of information about the aged care system, needs assessments and care coordination would help seniors make
informed choices.The aim would be to make access to services easier, reduce current gaps in service and provide for a person driven, more efficient continuum of care. (See Figure 1). Means test On first contact with the Gateway (and periodically), Centrelink on behalf of the Gateway would conduct a comprehensive aged care means test whereby a senior’s income and assets (including the family home) would be assessed to determine capacity to pay co-contributions. The one means test would be applied whether accessing community or residential aged care services. A lifetime stop-loss limit would apply to co-contributions (excluding everyday living expenses and accommodation). Seniors with less complex needs should be able to access some community support services directly or via a referral or an entitlement from the Gateway. Direct access would obviate the need for Gateway assessment and Centrelink financial capacity test. Information Information provided to seniors should be consistent but region specific and be two fold, including information about:
Figure 1 Australian Seniors Gateway Agency
• the system as a whole; and • each senior’s specific personal care options, access to services, entitlements, costs, cocontributions and available providers. Assessment The Gateway should consolidate the current needs assessment processes replacing: • low level home-based services assessments (by individual providers, including councils, charities, community organisations or others funded under the Home and Community Care (HACC) program); and • higher level assessments (by Aged Care Assessment Teams (ACAT)). Commonwealth Respite and Carelink Centres should be disbanded (with some
elements reconfigured into new specialist carer support services). Consistent assessment tool The PC recommends nationally consistent assessment of care needs (with a common suite of standardised and validated tools) applied in a consistent manner by those with appropriate skills. Consultants engaged by the PC suggested Gateway assessors use the Aged Care Financial Instrument (ACFI) for residential care with a similar instrument to be developed for community care. The aim being more timely and consistent assessments, improved access to services and similar outcomes irrespective of location. An initial assessment (or screening) by the Gateway would produce a preliminary care plan; a record of the person’s preference
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for care delivery and direct referrals to some community supports. It would also determine need for a further more comprehensive assessment. The needs assessment is translated into a quantifiable entitlement to a range of care and support needs. The Gateway should “draw on a range of services covering basic support, personal care, specialised care and carer support that best meet the assessed needs of the older person”. Various triggers would be in place for reassessments as and when required, to be performed by a senior’s provider (residential or community).The Gateway should have a comprehensive and robust audit function to prevent unnecessary reassessments by providers. The PC also supported carer assessment to determine the care circumstances of the senior and their carer’s needs. Records of all assessments should be kept electronically. Central to the proposal is an expanded system of electronic care records, to include information on assessment, eligibility, services used and payments made to recipients and referrals. Care coordination The Gateway should provide initial care coordination services where appropriate and as requested. A senior’s residential or community care service provider would provide any ongoing care coordination and case management. Review of decisions The Gateway will have a separate arm to hear complaints and conduct reviews of decisions of the Gateway at first instance. Appeals would lie to the Administrative Appeals Tribunal.
Workforce issues The PC recommends the independent development of a comprehensive aged care workforce strategy to identify and address ongoing and future workforce issues; and to make aged care a more attractive employment option. Current working conditions and pay rates cannot compete with those in the acute care sector. The PC recommends that the National Hospital Pricing Authority benchmark appropriate levels for fair and competitive wage rates.
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The PC recommendations also include: • Skills development through expansion of accredited courses including vocational, tertiary nursing places, advanced clinical courses for nurses and management courses for health care workers entering aged care roles. • An independent and comprehensive review Figure 2 Proposed functions of the Australian Aged Care Commission of aged care related vocational education and training and the delivery of these by Commission for care quality registered training organisations. The Commission for Care Quality would The PC considered but did not recommend be an independent body under the Financial mandatory staffing ratios or licences for Management and Accountability Act 1997 personal carers. (Cth), responsible for quality regulation in residential and community care. It would Australian Aged Care be a part of the AACC. However, new key performance and quality indicators will Commission (AACC) be applied in a consistent and transparent The PC acknowledges the relationship manner. and divisions of responsibility between Department of Health and Ageing (DoHA), The PC recommends the introduction of Aged Care Standards and Accreditation an electronic data set (Data Set) which Agency (Agency); and the Complaints establishes a minimum set of indicators Investigation Scheme (CIS) need to be for meeting the Accreditation Standards. redesigned. It acknowledges that basic The Data Set will be extended to include principles of good governance mean there the more general quality and regulatory should be: compliance data required under the Aged Care Act 1997 (Cth) (Act). Of concern • A separation of regulatory responsibility however, to some community care providers, from policy responsibilities; and the PC recommends the Data Set be applied • ‘Arm’s length’ separation of appeals about consistently across residential aged care the actions of the regulator from the facilities and community care providers. regulatory body itself. The PC acknowledges the current An appropriate separation of regulatory duplication and overlapping in regulatory responsibility from policy is lacking in the requirements (particularly in relation to current system and recommended in the new. matters such as infectious disease outbreaks, The current regulatory functions should be occupational health and safety, food consolidated in the AACC, an independent safety, building requirements and nursing regulatory commission and a Prescribed scopes of practice) resulting in higher Agency under the Financial Management and costs and unnecessary complexity. The PC Accountability Act 1997 (Cth). It should have recommends the review of accreditation three full time, statutory Commissioners processes and standards to identify and being: a Chairperson; a Commissioner remove onerous duplicate and inconsistent for Care Quality; and a Commissioner for regulations. Complaints and Reviews. (See figure 2) DoHA should cease all regulatory activities except policy advice on regulatory matters and advice on the setting of quality standards.
Prudential regulation of accommodation bonds The AACC should be responsible for the prudential regulation of accommodation
bonds. Residential aged care providers should be required to disclose (to care recipients or prospective care recipients) whether they have met prudential regulations in current and previous financial years. Providers should also be required to indicate that on request (rather than automatically) the following be disclosed: • An audit opinion as to whether the provider has complied with prudential standards. • The provider’s most recent audited accounts. These recommendations are less onerous than originally proposed in the draft PC Report. Pricing The AACC should transparently recommend the level of prices and subsidies. It should develop an appropriate formula for indexation. The AACC should also be responsible for monitoring prices and assessing costs for example, monitoring whether accommodation charges set by providers are equivalent to the cost of supply.
licences and extra service places) the range of enforcement tools available to the regulator will need to be expanded.
Community visitor program
It acknowledges that putting into practice ‘responsive’ regulation involves adhering to the principles of:
The PC proposes the implementation of an independent statutory Community Visitors Program for residential aged care facilities, akin to the operation of other types of statutory visitor programs operating in other residential settings (e.g. disability and children’s residential services) the aim being to promote and protect the rights and wellbeing of residents. The program should be in addition to and intended to operate alongside the existing National Aged Care Advocacy Program.
• consistency (same event same result); • proportionality (enforcement action proportionate to seriousness of noncompliance); and • transparency (impartiality and balance in decision making).
Although this sounds positive, in practice, given the current highly regulated framework including mechanisms for internal and external complaints, it would seem unnecessary. Providers may consider objecting to this aspect of the report.
Further as the AACC takes over the dayto-day administration of the quality of community care (via Community Care Common Standards), there will be a need to develop a wide range of enforcement tools for community aged care.
Commission for complaints and reviews The PC adopted the vast majority of the Walton review recommendations about the Complaints Investigation Scheme. The Commission for Complaints and Reviews should be responsible for complaint handling and should consist of three arms being: • assessment, early resolution and conciliation; • investigations and referrals; and • communications, stakeholder management and outreach. Review of decisions The Office of review should review decisions of the Commission for Complaints and Reviews. It should also be empowered to conduct its own investigations. Appeal would then lie to the Administrative Appeals Tribunal. Enforcement The PC notes that as the aged care system transitions away from its heavy reliance on quantity restrictions in residential aged care (for example, through removing bed
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Productivity Commission Report
Regulation of retirement villages
the opportunity for functional reform will be hindered and may be lost.
The PC considered regulation for retirement villages, but concluded that as these were more accommodation based than aged care service based, regulation was not appropriate under the Act. Retirement villages remain within the realm of the State and Territory governments. The PC has however, encouraged the Council of Australian Governments to consider the national harmonization of retirement village legislation.
The Hon Julia Gillard in a media release on 8th August 2011 said “The Government is determined to begin to make the necessary reforms to our aged care system in this term of government as part of a broader ageing agenda”.
Moving forward As stated at the beginning of this paper, the Report is a framework, yet to be interpreted and ‘fleshed out’ by politicians and policy makers. The framework has been designed to operate as a whole package, if the government ‘cherry picks’ only parts of it,
The Federal Opposition Leader Tony Abbott said the Report demonstrates the aged care sector is “in crisis because it’s been neglected for far too long…”. He said that the Coalition “will study the report closely”. The government is yet to provide a formal response to the report. It is yet to adopt it or come up with a plan for implementation. It is hoped that this preliminary work will be done in time to make an allocation in the May 2012 budget. Assuming all this occurs the legislation will still have to progress through parliament.
Representatives from the aged care sector must continue to engage directly and through their peak bodies with the government, its ministers and local members to ensure the momentum for reform is not lost. The aged care sector has unpacked and poured over the recommendations and now holds its collective breath. The aged care sector and the PC itself are in no doubt reform is imperative and that the PC recommendations need to be applied in their entirety. Residential aged care and community care providers await the definitive and practical response of the incumbent Australian government to the PC Report. For further information on the Productivity Commission’s final report ‘Caring for Older Australians’; or to find out how Hynes Lawyers may assist you, please contact Julie McStay or Theresa McCormack (07) 3828 5555. ■
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Response to PC Report – David Sinclair, Stewart Brown & Co
T
he final report from the Productivity Commission has largely confirmed what was included in the draft report released back in January 2011. The final report does contain a lot of the detail that was missing from the draft report which allows a more detailed analysis of the recommendations. The report contains many financial positives including a higher level of income for accommodation services. The recommended changes to the sources of funding will certainly help to ensure that the industry is put on a more sustainable footing. The report also contains a number of areas of concern. In relation to financial issues I would like to concentrate on two areas. The first is to look at everyday living expenses and see how the current financial data stacks up against the Commission’s recommendation for funding these costs and whether there is much left over for administration costs. The second area is the proposed structure for funding accommodation services and whether this provides the long awaited cure for the lack of capital for construction of high care facilities. Firstly, to summarise, the report divided costs into four main components: • accommodation services (the equivalent of rent, mortgage payments and related expenses such as gardening and home maintenance) • everyday living expenses (such as food, clothing, laundry, heating and cooling and social activities) Everyday living expenses Catering Cleaning Laundry Utilities Resident daily care fees Surplus available to operator
High care average 21.80 7.80 3.60 5.09 38.29 39.50 1.21
• health care (such as nursing, allied therapies and palliative care) • personal care (the additional costs of being looked after due to frailty or disability). These costs are likely to funded from three different income streams: • Accommodation payments • Everyday living • Health and personal care
Everyday living expenses The report points out that there will be some blurring of certain elements of care. In a community setting, assistance in preparing meals might be classified as part of personal care. In a residential care setting this element is likely to be included as part of the everyday living expenses. These ambiguities will need to be considered when the proposed Australian Aged Care Commission (AACC) undertakes to determine the costs of care upon which the care subsidies will be based.
One element of cost that has not been included with those listed by the Commission is the cost of administration. This is now a major element of the overall cost structure of a typical residential care facility or community care service. In the latest Stewart Brown financial performance survey, administration costs accounted for 14.9% of total expenditure in a residential aged care setting and 16.7% of total expenditure for a service provided under a community aged care package. Let’s examine the current cost structure of a typical aged Low care All facility care facility for everyday average Average living expenses and see 20.69 21.19 how these costs compare 5.78 6.70 to the income stream recommended in the 2.73 3.13 report. We can then assess 4.65 4.85 if there is anything spare 33.85 35.87 for administration costs. 39.50 39.50 Typically the costs associated with everyday living expenses will vary 5.65 3.63 depending on the average
acuity level of the residents. The table below provides three comparatives being facilities catering predominantly for high care residents; facilities that cater predominantly for low care residents; and the third comparative averages the costs for all the facilities in the March 2011 Stewart Brown financial performance survey. All amounts are displayed as dollars per resident per day. These costs are averages, so the more efficient operators will be achieving a greater margin on these services. Even in the case of a higher margin, any surplus achieved in providing these services will not meet the full costs associated with administration. The March 2011 Survey showed that administration costs averaged $25.47 per resident per day across 468 residential facilities in the survey. So the question is where is the money going to come from? When discussing the cost of care the Commission does not mention administrative costs. Nor is it included in the discussion surrounding accommodation costs. So the report does not appear to address this important cost element directly. Currently the cost of administration is built into the ACFI subsidies along with the various supplements, including the 8.75% conditional adjustment payment. It will be extremely important that the AACC takes administration costs into account when determining the cost of care and the base amounts for the other income streams. However, if we put this issue aside for a moment, it does appear that everyday living expenses should be adequately met by the daily care fee contributed by the resident.
Accommodation services For many years operators have argued that there is a lack of capital funding available for the construction of high care places. Many operators cross subsidise the construction of a high care facility by using funds obtained from bonds in low care, or in many cases, funds generated from other parts of the business such as retirement villages. Even if external borrowing from a financial institution was undertaken, it was generally on the understanding that accommodation
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bonds would be used to repay this loan. Any loan was usually short term. Bank borrowings has generally been used as bridging finance and was replaced by finance from accommodation bonds as soon as possible after construction has been completed. The increased base level of accommodation payments will be welcomed by the industry and will certainly assist operators of existing high care facilities. However, I am not sure that it is the panacea that the industry is looking for. The report indicates that, as a result of a number of recommendations, there is likely to be a change in the mix of accommodation bonds compared to persons paying for their accommodation with a periodic payment. In low care facilities, the current mix is highly biased towards residents paying for their accommodation through accommodation bonds. This bias is expected to shift in the other direction. This poses two risks:
$250,000 a bed to construct. The Commission appears to have applied a rate of return on the value of accommodation of 8.65% per annum to calculate its average daily accommodation payment of $50. Using the same formula the relative accommodation payment based on the cost of accommodation being $250,000 would be roughly $60 per day or $840 per fortnight. If the organisation borrowed to construct the facility then this payment would only meet the interest burden on those borrowings. It would not contribute at all to repaying any of the principal. This is made worse as the accommodation payment also needs to meet the costs of maintaining the facility in good order. Excluding building depreciation, the average property maintenance cost across the facilities in the Stewart Brown March 2011 survey was $11.82 per resident per day.
There may be a liquidity risk during the transition period from relying on accommodation bonds to then rely on periodic payments. As old bonds are paid out they may not be replaced by a new bond. These payouts may have to be financed externally. The Commission has recommended that the Government may have to provide some assistance to smaller providers to help then navigate this transition.
The Commission noted in its report that the risk profile of residential facilities will increase as a result of increased competition, the reduction in the values of bed licences and a possible drain on cash as old accommodation bonds are paid out. Unfortunately, this increase in risk profile in combination with fewer accommodation bonds available to repay loans quickly is unlikely to make operators an attractive target for financial institutions.
It may be very difficult to obtain finance for the construction of a new facility. In fact, if accommodation bonds do not remain the primary method of paying for accommodation then it may be prohibitive for new entrants to enter the industry. I would like to illustrate this conundrum. A typical residential aged care facility might cost say
The transition period will need to be monitored very closely to ensure that the shift away from bonds does not create a dearth of funds available for the construction of new facilities. The ability of new entrants to enter the market will also have to be assessed once the trends in the new regulatory environment become clearer. â–
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profile
Aged and Community Services Australia appoints new CEO Mike Swinson talks to Patrick McClure, AO, the new CEO of ACSA about his new role and the influences in his life.
P
atrick McClure, AO, likes a challenge and this will be a good quality to have while aged care in Australia is undergoing a “once in a generation reform opportunity”.
“I consider becoming the CEO of ACSA at this point in time is a wonderful opportunity; I am very interested in contributing to social policy having chaired the Reference Group on Welfare Reform under the previous government. The PC Report offers a blueprint for critical reform the sector urgently needs,” Patrick says. “There are a number of challenges facing the sector, particularly in terms of funding. We are analysing the Productivity Commission recommendations to understand the potential impact on provider funding, future development pipelines and sustainability of the sector.” “It is a once in a generation reform opportunity to make the system more sustainable, to provide better access for older people and to continue to provide quality services.” Before we get into more detail about the challenges facing the aged care sector and Patrick McClure in his new role, now is as good a time as any to look back and see what influences helped form this remarkable man. Family was a strong influence on Patrick. He recalls a happy childhood, his father being a good role model. “Life for me as a kid was happy. We were a large family of seven children. I have six sisters! My father was Managing Director of Warner Brothers in New Zealand and then when he was promoted when I was a teenager the family moved to Sydney where I grew up,” Patrick said. He was educated in Sydney by the Christian Brothers at Waverley College. He played rugby, cricket, was adjutant of the cadet unit and enjoyed public speaking and debating. “A theme in my life has been about empowering people. It is about encouraging people to be the best that they can be. I studied to be a Franciscan priest and was with them for 10 years, and that experience and values of social justice influenced me. It also provided me with a good classical education ,” Patrick says. “It helped me develop skills in leadership and strategic thinking as well as giving me a very broad education, including the arts. During those years as a Franciscan I also developed a strong social conscience.”
That social conscience came to the fore during his time as CEO of Mission Australia developing innovative programs for homeless people and youth at risk as well as major involvement in the privatised Job Network, as well as involvement in advocacy and policy development. During his tenure Mission Australia grew from a small state based organisation to an international company with 3,000 staff, revenue of $250 million and services in 300 locations. Mission Australia was a major player in the privatised Job Network, which has many similarities to the proposed reforms in aged care.
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profile
In his early working life Patrick established a business providing low cost food for people on limited incomes. He then worked in the Department of Social Security, later to become the CEO of the Society of St Vincent de Paul, Mission Australia and followed both those roles with two years as the CEO of the Retirement Villages Group. It’s a joint venture between FKP and Macquarie. As a Franciscan student, during the holidays he worked as a cook in a hostel for homeless men. The job entailed getting meals ready for over 100 men - with a menu dependent on food that was donated. “If the kitchen ran short of food at any time, someone would ring nearby Pentridge Jail and they would send over a truckload of fruit and veg,” Patrick said. “I still enjoy cooking, even though I’m a basic cook at best. Working with homeless people changes your life, because you recognise just how privileged you are and the life opportunities you have. That experience engendered in me a strong social conscience.” Another challenge facing Patrick is the recently announced plan for a national merger of ACSA with ACAA following 12 months of exploring a range of options for restructure and consulting widely with members. “The merger or restructure of ACSA has been an ongoing debate for many years. The Government’s commitment to aged care reform
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and the Productivity Commission inquiry provides an opportunity to bring the organisations together. There are negotiations at both state and national level taking place, and both ACAA and ACSA have established taskforces to take the process forward,” Patrick says. “The proposed Productivity Commission reform recommendations will require consensus and support from all stakeholders including consumers, providers, health professionals and government. “Aged care providers will be at the forefront of the reforms and a new national peak will help provide a stronger focus for the industry.” Apart from dealing with current aged care sector changes, Patrick has recently written a book about his life called “Seize the Day - From Priest to CEO”. This book contains a reflection on his life journey, from early family influences, to his work in the Third Sector. “As a leader I have learnt about balancing values and efficiency, achieving outcomes and profit, restructuring organisations, developing a national brand, the importance of emotional intelligence in effective teams, the role of advocacy and lobbying and building research and policy capacity in an organisation,” Patrick says. And it is these skills that Patrick brings to ACSA that will see the aged care sector through some of the biggest challenges it has experienced. ■
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ACIVA Update Caroline Lee, CEO Leecare, ACIVA President
The Aged Care IT Vendors Association has been busy for the last 18 months, contributing to the various National E-health Transition Authority (NEHTA)
On the National Compliance, Conformance, Accreditation Governance committee and the national e-health ICT Implementation Committee, representing Aged Care is: • Caroline Lee (Leecare) and • Geoffrey Bowker (Epicor)
the government and national
along with only two representatives from Medicare, DOHA, the Medical Software Industry Association (MSIA), the Australian Information Industry Association (AIIA), Standards Australia and the National Association of Testing Authorities (NATA).
agenda for the Personally
Other committee members include:
Controlled Electronic Health
• Brett Avery (Webstercare) has taken over the role now to attend all NEHTA Health Identifier committee meetings • Peter Staples (ManAd) attends any Medicare related meetings • Our nominated Aged and Community Care Accreditation representative is David Loiterton (Autumcare) • Caroline Lee (Leecare) is on the NEHTA Stakeholder Reference Forum • Gerard Stevens (Manrex Pty Ltd‐ Webstercare) represents aged care at the Medications Management Reference Group (MMRG) Tiger Team • Peter Young (DCA) is in charge of our Aged Care IT Vendors Panel initiative • John Perkins (Ethan Group) is managing our Total Cost Of Ownership committee • Joan Edgecumbe (ehealth education) and Sonja Bernhardt (eye on my care – Thoughtware) are managing our website initiatives • Joan Edgecumbe (ehealth education) and Bart Williams (Questek) represent ACIVA on the ITAC 2012 conference committee
forums and e-health initiatives, ensuring aged care remains on
Record.
Following our AGM on 8 August 2011, the following nominations were received and positions were confirmed: • President – Caroline Lee (Leecare) • Secretary – Joan Edgecumbe (ehealth education) • Treasurer – Chris Gray (icare)
• Public Officer / Vice President – Bart Williams (Questek) As you can see from the above, aged care is well represented by the industry vendors at various national forums regarding e-health. Our members represent not just aged and community care software vendors, industry benchmarking software, financial software but also call-bell, hardware, networking and infrastructure vendors and industry partners. All members are committed to furthering the interests of aged and community care in the national forum, and are committed to ensuring e-health and access to the personally controlled health record becomes a reality in this industry in the very near future. We are committed and will keep you posted on our progress.
Our members include: Aged Care Quality Association Inc AutumnCare Database Consultants EOS Technologies Epicor Software Ethan Group Goldcare iCare Solutions Inerva Pty Ltd iSoft Leecare Management Advantage Pty Ltd Manrex Pty Ltd NEC Australia Pty Ltd PeoplePoint - CDC Software QPS Benchmarking Questek Simavita Superior Management Solutions Telemedcare Thoughtware WeCare Australia ■
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E-HEALTH IN AGED CARE Aged Care Peak Bodies, through the Aged Care Industry Information Technology Council (ACIITC), establishes the framework on how Aged Care will develop E-Health.
Much has been stated by the Government and its Agencies about E-Health over recent years. ACIITC has been involved and contributing to the E-Health Agenda for the nation over the last three years. This involvement includes contribution to electronic transfer of prescriptions, discharge summaries, digital signatures and Personally Controlled Electronic Health Records. This involvement involves Aged Care Providers participating in various committees.
T
he ACIITC was formed by ACAA and ACSA three years ago for the express purpose of improving the quality outcomes for recipients of aged care services in residential and community care settings. ACIITC has during this period achieved a number of notable outcomes: • Raised the profile of aged care and eHealth across the health system • Provided regular advice to the National e Health Transition Authority (NeHTA) on aged specific service issues • Initiated the formation of ACIVA the aged care it vendors association • Accepted a priority action to reform the medication management service within residential aged care • Proposed an electronic medication chart that would support remote access for general practitioners, pharmacists and aged care staff • Received funding from DoHA to produce a fully developed medication management solution for aged care • Delivered the fully developed solution to DoHA in July 2010 • Submitted a tender for the delivery of a electronic medication chart to the PCeHR funding round • Entered into an agreement with NEC to provide a hosted data, telephony and technical support service (Cloud Computing) to the industry This has involved considerable work by the peak bodies and the members of the IT Council, all of whom give generously of their time on behalf of the industry.
Guiding Principles for E-Health in Aged Care E-Health has the potential to transform Aged Care, improve efficiency, and deliver improved health outcomes and to change the way we deliver community care by using assistive technologies to place the care recipient at the centre of the system and allow
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the care recipient to take much greater responsibility for their own care. Accordingly, we set the following principles to engage with E-Health: 1. Support National Health Reform Aged Care is part of the wider Health System. As such, E-Health is a lever in assisting in Health Reform for Australia. An aspect of Health Reform is to re-allocate resources to where they are needed and to use current resources effectively. Any activity in E-Health must pursue demonstrable and measurable health reform outcomes. Aged Care is integral to this. 2. Address Aged Care Workforce challenge by increasing productivity Any E-Health activity must be focused in delivering materially increased productivity, or increasing current workforce capacity as a clear and core outcome. 3. Facilitate Improved Care Current workflow practices often cause bottlenecks for health and care professionals in trying to deliver the best possible care. We must be able to demonstrate how E-Health will make an identifiable difference and demonstrate that improvement has been achieved. 4. It is Consumer Centric Consumers need to be enabled to make the ultimate choices about their care services and their service providers. E-Health must deliver consumer centric care outcomes that moves from the current paradigm. There is a growing emphasis by Consumers for “ageing in place� services. Telehealth will be an enabler, amongst other activities. How will the national programs in E-Health, Telehealth and National Broadband network assist older Australians? What is the difference that all these will make to the Care Provider and Care Recipient and wider stakeholders who part of team based care for the Older Australian? 5. Care cycle must involve authorized family and friends As we all know, volunteers, family and friends have an increasing role in completing the team based care of older Australians. E-Health will make a significant difference in the provision of better coordinated care. 6. Transform Aged Care With all of the above, we must realise a transformation, an evolution of Care delivery in Aged Care.
Delivery Framework for E-Health To realise the benefits of E-Health, there must also be in place a delivery framework that protects and enhances the quality service provided by the Aged Care Sector. They are: A. Industry wide The program needs to be scalable and deliver to the Industry as a whole. No more trials. B. Sector Driven Industry involvement has a history of delivering success. It also indicates a program is a serious one that is desirous of success.
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C. Enable what already exists and scale it Nationally This is fundamental to the National E-Health Strategy endorsed by the Australian Health Ministers Council in 2008. There are many electronic records in many sectors, in particular in Aged Care. The strategy is to take what is there, make it interoperable to overcome disparate islands of information with different Care Providers and then scale this capability nationally. Not to re-invent what already exists. D. Vendor Agnostic A National Program must support all current vendors, not just one or a few. Not only Software, Hardware but also Providers of Technology Services. We ensure a level playing field where all who want to risk their capital to provide goods and services to Aged Care are encouraged to do so in a playing field that is assured to be level so that success can be achieved, where choice reigns supreme, innovation can thrive to propel the Providers to deliver ever increasing and innovative Care. This could encourage new entrants. More importantly it will protect and encourage the current market. This is in the interest of the Aged Care Industry. Reduction of choice and increasing costs is not acceptable. E. Open Standards We support Open Standards. What is an Open Standard? An open standard is publicly available, and developed, approved and maintained via a collaborative and consensus driven process. That is, interoperability between software (such as Aged Care Clinical and GP Desktop, for example) is seamless and open. That is, a public road that all software adopt and use as a norm. To put it another way, if Open Standards are adopted for interoperability, one does not have to invest in locked-in processes that require Providers to spend more money to facilitate interoperability. Open Standards deliver better and reducing costs to Aged Care Operators so they can re-invest in IT that delivers productivity. If E-Health or professed players in the field do not deliver this, then consider your choices carefully. We must evaluate very carefully whether to invest in E-Health that fails to deliver Open Standards. We must future proof our investments to ensure access to the wider market in the future. F. Sustainable E-Health must be Sustainable, not a demonstration. It must be viable and must be able to be absorbed by the market and the customers who drive it. E. Equity of Access Equity of Access to Care is the foundation that our Industry and that of the wider Health System is built on. E-Health must be able to continue to enable this foundation and increase its reach in delivery of Care. After all, that is why we also support National Health Reform. Aged Care Industry Information Technology Council is an incorporated company with the two Peak Bodies of Aged Care Association Australia and Aged and Community Services Australia as its two shareholders. â–
technology
Mike Swinson profiles the man driving the e-Health train
Peter Fleming CEO of NEHTA Peter Fleming is a name that anyone in the e-health industry will know by now. It’s also a name that will become more widely recognised once the organisation he heads brings home the e-health bacon. If however NEHTA does not perform up to community and government expectations then Peter Fleming will probably disappear back into the world of finance, banking or industry, never to see the light of day in the world of e-health again.
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eter Fleming has become the CEO of NEHTA at a time when its critics (and there are a few) were clamouring for the organisation to start delivering real and sustainable advances in e-health technology.
He has a huge task in front of him and when I spoke to him for this article he was still an excited and focussed man. He tells me that he loves what he does, because he says ‘It can make a huge difference to many people’s lives, and that’s what drives me to make sure we do fulfil our charter.’ So where did this CEO come from? Well, you can Google him, check Wikipedia and there it is, his business background available for all to see. In a nutshell, Peter started work with Coles Myer, completed
“
The National E-Health Transition Authority has attracted a top technology executive from the National Australia Bank to be its new chief executive.
”
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a business degree while still employed fulltime, moved onto other companies like Vodaphone, then to the Mayne Health Group as its CIO, then into the National Australia Bank. When Peter was appointed as CEO of NEHTA I overheard mutterings while attending the annual HIC IT Conference that went along the lines of “why have they appointed a bloody banker as the CEO, we need a specialist IT person!” Others saw it differently. Obviously those individuals who criticised his appointment had not checked his credentials, because if they had they would have found an extensive IT background, together with broad business, finance and health sector experience. So who is the man who runs the organisation devoted to bringing massive change to the way the health system operates. Peter comes from a strong family background, growing up in Frankston in Victoria, one of six kids. He said he had a happy childhood, went to school at the local John Paul College. He developed a personal philosophy of focus and hard work, but behind it sits a driving ambition to make sure that the work he does ‘makes a difference in people’s lives.’ “I love working, and when you are working in the technology area, it gives you the opportunity to move from business type to business type and maintain your focus on technology. It was a great time to be involved in technology and obviously still is,” says Peter. “From a technical perspective there is nothing that we are doing now in e-health that is earth shattering or hasn’t been done before, but, and it’s a big BUT, the big challenge in healthcare is the size of the sector, and the change management that is involved. “Whenever you are doing a huge project that has a big element of change management in it, it’s the change management that is tough, that’s the challenging stuff and that’s the attraction to me. We have a huge number of very committed stakeholders involved in this and key areas of health care to deliver new technology, including aged care, Indigenous Australians, mothers with newborn babies and those suffering from chronic disease,” he said. Peter and his family are also living the aged care experience, his father is in his mid eighties and still active and living at home. His mother in law is also in her mid eighties but needs more community support,
even though she too, is still living in her home. Like them both Peter says his goal is to make sure that the technology is in place so that he can also stay at home for as long as is possible. Peter Fleming is acutely aware of the expectations he and his organisation are facing. “You said there is a huge expectation that surrounds NEHTA and what it is supposed to deliver. The reality is that there is also a huge amount of support for what we are doing. Consumer groups, medical groups and others, all getting in there and helping us. When we are successful it will be because of the hard work a lot of those groups have put in as well. “ In every interview I have read and researched that Peter Fleming has done, he stays on this message. “The first thing we must do, is to get the foundations rock solid, we need to make sure that we have secure messaging, our identifiers’ and security systems must work and be secure. Like the old phone system, this foundation is akin to building the poles and wires and underground cables, without it we would not have a reliable telephone network. The e-health sector is exactly the same. The infrastructure that surrounds e-health is vital and must be reliable and secure.” Another metaphor he rolls out is that unlike the rail system across Australia that is a hotch potch of different gauges, the e-health
hardware and infrastructure must be seamless, secure and able to cope with the huge demands that will be placed upon it. “We are moving forward, even if some of our critics say progress is slow, it’s better to be slow and accurate, secure, reliable and sustainable.” The first areas of action that will impact on us as health consumers will be in medication management and e-health records. For me, it cannot come soon enough, gone are the days such as a few weeks ago where I have to physically cart my X-Rays, scans and other bits n pieces from medical practitioner to hospital and specialist. “When did you have your last tetanus injection?” Do you remember? “What we want to put in place first,” says Peter, “is the e-medication or a medication management system that has been identified for a long time as a critical area of action, driven by the huge number of adverse drug events that happen every year.” Statistics reveal that many people die from adverse drug events, 138,000 people end up in hospital. “Once we get this medication management system in place and working effectively it will provide significant benefits to the
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community, it will also save lives. There is research that shows that at least 25% of clinicians time is spent trying to collate patient information, medical history and medical conditions. What a waste of time and money.” Back to statistics again, but they are compelling. One estimate of the benefit of this type of technology combined with electronic health records is that 5,000 lives will be saved every year once it is up and running. Peter says the upfront work that is being conducted now can go into operation with existing bandwidth technology. But he adds “You can’t ask clinicians, patients or hospitals to implement electronic systems unless the hardware delivery system is reliable particularly in remote areas; we need high speed, reliable bandwidth. When you start to move X-Rays and critical health records around, you must have reliable effective bandwidth and that’s still a couple of years down the track. “In any job I do, I want to know that it makes a difference, that what you do is worthwhile, and I know that when this work is done it is going to make a huge difference to everyone, it doesn’t come much better than that.”
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Postscript. On the 1st of March this year, IBM was awarded a $23.6M dollar contract to develop a nation-wide authentication system for our electronic health records. (Australia’s National Authentication Service for Health or ‘NASH’ ) According to IBM it will benefit over 600,000 Australian doctors, nurses and allied health providers and accelerate the delivery of smarter healthcare across the entire healthcare system. On the 12th of April this year, as part of the 2010/11 federal budget, the Government announced a $466.7 million investment over two years for a national Personally Controlled Electronic Health Record (PCEHR) system for all Australians who choose to register online, from 2012-13. What we don’t want happening here is what happened recently in the US. According to the AP news service, ‘medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see. There were insurance forms, Social Security numbers and doctors’ notes. Among the files were summaries that spelled out, in painstaking detail, a trucker’s crushed fingers, a maintenance worker’s broken ribs and one man’s bout with sexual dysfunction.’ ■
Aged Care Agenda
Aged Care IT in a National Context “...technology has a vital role in improving the quality and range of care available to older Australians, reducing the strain on care workers and improving labour and capital productivity for aged care providers. The Commission’s reforms will remove barriers in the aged care system to adopting costeffective technologies and will provide systemic incentives to improve technology use in aged care.” Productivity Commission 2011
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he Aged Care industry, like many others in Australia, is inexorably being drawn into increased technology investment due to four factors: • • • •
Government social policy Government investment policies Demographics Client and their relative’s expectations
then consideration of, the Productivity Commission’s terms of reference, draft and final reports, the willingness to examine new models such as the National Seniors Gateway Agency (NSGA). This systemic reevaluation is in parallel with the proposal of a new public facing tool of engagement - the Aged Care Gateway.
These factors are evident in the themes of investment being made by all industry participants, Government, the for-profit and the not-for-profit sectors, industry suppliers, the industry peak bodies and the Aged Care Industry IT Council (ACIITC).
This architecture of a new oversight and management approach at the Federal level for aged care is consistent and co-ordinated with the wider e-health initiatives, ensuring that the aged care sector can leverage the national infrastructure of e-health as it becomes available.
The Productivity Commission 2011, Caring for Older Australians, Final Inquiry Report signalled the productivity challenges aged care faces and proposed the change required to improve aged care in Australia, including the wider-adoption of information and communication technology (ICT).
Recently several key themes have emerged relating to ICT adoption and productivity gains not only within aged care but more widely in Australia, including;
At the governmental level, investment is occurring at the strategic/productivity level with the active funding of, and
• • • • •
Increased uptake of technology; Improving access to technology; Industry funding initiatives; Telehealth; and National Broadband Network (NBN) education initiatives.
These themes are linked to projects that are driving national change in the push for productivity gains through ICT (see table next page). As part of a consistent approach to the aging population and rising demand, government programs are also targeted at adding improvements in engagement. Examples include closing the digital divide through projects such as Broadband for Seniors, a Federal initiative to introduce exposure and basic training to seniors nationally via internet kiosks hosted by community groups. The Broadband for Seniors program, initially established as a three year project, was extended in the May 2011 budget with an additional four years of funding. Outcomes from this successful program have meant that many seniors are a little
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Increased Uptake of Technology
Improving Access to Technology
Industry Funding Initiatives
Telehealth
NBN Education Initiatives
Broadband for Seniors 2000 internet kiosks promotes social inclusion, connected communities and increased internet usage and understanding of technology in Seniors
Working with Industry Software vendors to host applications in the Cloud
Aged Care Industry ICT Infrastructure is a shared industry resource leveraging RDA Funding
Creating solutions to connect communities with health care – GP, Specialist, RACF and the home
Educating business and community about Digital Economy; Digital Enterprise Digital Communities
Aged Care Industry Cloud Portal helps industry members to make informed decisions about technology
Telehealth assists older Australians to age in place
In the Aged Care Cloud initiative (agedcarecloud.com.au), the ACIITC has been instrumental in establishing an environment that is a leading implementation of the new “Shared Services” model for ICT services. This shared service model is emerging across the economy as a way of achieving cost economies in the era of broadband communication services. Such paradigm shifts need to be recognised with-in the aged care industry as a valid alternative to previous on-premise, staff and energy intensive activities.
less intimidated by technology, and in addition to learning, skills and social inclusion outcomes, the program is also laying some foundations for technology as an aid in a community setting in the future - either in a “kiosk” setting or ultimately as some form of technology in the home. Broadband for Seniors has been well received in the community and has delivered outcomes across 2000 sites reaching about 94 000 seniors. According to the Government’s National Digital Economy Strategy, as a result of the Broadband for Seniors program, 84 per cent of kiosk participants now use the internet more frequently; 85 per cent of participants feel their computing skills have improved; and 60 per cent of participants agree that their level of social connectivity has improved. In parallel with the Government’s investment in the architecture of aged care in Australia through the Productivity Commission mechanism, the potential changes to public engagement via NSGA and the Aged Care Gateway, and the increased familiarity with technology via community programs such as Broadband for Seniors, the industry itself has invested considerably. ACIITC has spent considerable effort in engagement with key stakeholders to drive productivity and quality gains. These stakeholders include industry members and service providers but also industry suppliers such as key vertical market software suppliers who are central to enabling the interworking expectations of the nation’s e-health system, as well as government organisations responsible for various initiatives such as NBN, telehealth, e-medication and care-in-the-home.
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One need only to look at the cloud based services already adopted within the wider business community for the potential opportunity for the aged care sector to facilitate the timing and method of technology implementation. The industry-based Aged Care Cloud provides hosted relevant vertical market software for residential and community care but it is much more. It delivers an industry resource in an accessible, easy to use way, that delivers information on all facets of this approach to ICT in aged care including social, ‘keep-me-informed’, twitter, LinkedIn and video media. The Aged Care Cloud covers subject areas including Productivity Commission report, Industry Peak Bodies and Aged Care Industry Vendor Association (ACIVA), vendor innovations, software applications such as clinical care, community care, and supportive technologies such as voice, data and communications. The building blocks of new approaches to ICT in aged care are becoming clear; the government is providing national platforms and broad directions, the industry through its peak bodies is providing support to members in relation to key initiatives, including computerisation, quality, and e-health initiatives. If the aged care industry is to benefit from these opportunities then investment in national information infrastructure could well make more sense, and accordingly the peak bodies have also invested in funding applications to the Regional Development Australia Fund (RDAF). Recognising the wide distribution of aged care facilities and service providers this industry-wide RDAF application sought to provide an industry owned and managed platform to establish a “Private
Aged Care Cloud� as the next step in enhancing the Cloud initiative to date; timed to deliver benefits to aged care residential and community service providers in the 2012 and beyond timeframe, when the building blocks of government NBN and e-health are well underway to being in place. In this same timeframe, the government’s telehealth initiative will be well defined and deliver remote consultations between medical specialists and patients in aged care facilities paid for via Medicare Item mechanism. This innovative use of ICT for defined consultation activities will likely grow into client/relative and client-in-the-home applications, especially as the broader communication infrastructure achieves its potential under the NBN initiative, delivering significant productivity gains to the economy as a whole. The building blocks are finally arriving for a leap forward in aged care service provision delivering a more agile, lower operational expenditure, engaging, higher quality, and transparent care. Remembering the most important goal is improving the quality of life for clients and ICT is one of the key ways of achieving this goal.
About NEC Australia NEC Australia is a leading systems integrator delivering ICT, communications and network solutions to enterprises, government, small businesses and carriers. Operating in Australia for over 40 years, NEC Australia designs, develops, integrates and deploys advanced solutions and systems leveraging best-of-breed technologies in multi-vendor environments. NEC Australia helps customers drive business value from their communications infrastructure and investments, providing services through a large network of consulting, engineering and support staff backed by over 200 dealer and partner organisations across the country. Our solutions include IP Communications Servers, PBX, Contact Centre Solutions, Unified Communications, Broadband Access Systems, Network Services, Systems Integration, Biometrics and Cloud Services along with Digital Signage and Display solutions. For more information, visit www.nec.com.au
For more information see www.agedcarecloud.com.au â–
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technology
Face your Fears and Do It Anyway! By Mike Swinson
“I’ve never used a computer in my life until we started this process. I was scared to death of them. I thought I would turn everything off if I did something wrong.” 93 years old, Bee Horwarth. “I have been asked to go to the aged care home and teach a 93 year old lady how to use a computer, I’m scared stiff Mum!” said 15 year old student, Lara. “I remember I did something on the computer and everything went haywire and I thought, I have broken this, it will never work again!” 93 year old Kath Thompson. This is a story of facing your fears, of trying something new, getting out of your comfort zone, of ‘having a go’ as we like to say in this country. It’s also a story of partnerships and volunteering, as teenagers partner with strangers old enough to be their great grandmothers.
applied and a short time later two large cardboard boxes arrived. They sat under Pat’s desk for a bit until she thought ‘I had better get someone in who knows about this stuff to install it!’ Then came the next challenge, how do we encourage the residents to use this new technology? Do you remember when you first started to use a computer? You need to be at least 40 years old to answer that, because most people younger than 40 started using a computer when they were knee high to a grasshopper and at that age nothing phased you, it was all brand new and exciting stuff. It’s not like that at all too many older Australians; to them it is unknown country, unchartered waters, to be avoided at all costs if at all possible. To many of them it is and will remain alien, scary and way beyond their ken.
Just how keen to ‘have a go’ at something brand new and scary will you be when you are in your early nineties? Would you welcome in a teenager you had never met to be your personal IT trainer? I’m not sure about that, but I might just summon the courage and put my hand up to say ‘count me in, I’ll have a go!’ Maybe that’s because my underlying philosophy in life is to do just that, I can put that attitude down to my Mother. Two ninety plus residents of the Westgarth aged care facility in Northcote in Melbourne, have a similar attitude. Kath Thompson and Bee Horwarth live in the ageing in place part of Westgarth Aged Care Facility, part of the Parkwood Group. There are 80 residents at Westgarth, 20 in High Care, 15 in a Dementia Specific Unit and 45 like Bee and Kath. Bee and Kath both have family and friends scattered across the globe and learning to use the computer has Bee now described as a ‘cool, hipped up Grandmother’ by her young grandson. The story began earlier this year when Facility Manager at Westgarth, Pat Glass became aware of the Broadband for Seniors Program. She
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Kath Thompson’s son said to her one day, “Why don’t you just have a go Mum,” and I said “Oh no, I might break it!” He laughed and said “the only way you could break this computer is by picking it up and throwing it on the floor!” Kath does remember that she did something when using the mouse or keyboard and the computer went haywire. She thought she had wrecked the whole thing and that it would never work again. “But no, it was easy to fix up, I didn’t loose the stuff I was doing at all and the computer didn’t blow up!” While Pat Glass says other residents have not been at all interested in using the new technology, Bee and Kath are the stand out performers, with the help and guidance of students from the nearby Santa Maria College. Pat said she was thinking about how she could help her residents learn to use the computers when she remembered that kids from Santa Maria had been involved in community work before. A quick phone call to the school followed, a number of students involved in the Duke of Edinburgh Program volunteered and hey presto it was all happening at Westgarth facility. 7 girls now visit regularly. “The girls are beautiful, they are really lovely. I have had so many staff, residents and family members say how wonderful it is to see the
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different generations working closely together. We had one girl on our piano the other day, playing it to a group; at the same time two girls were teaching computer skills it’s just wonderful.” Now the girls are saying “Can my Nan come here!” Bee says her computer skills are very limited, but she has a granddaughter living in Zambia and is keen to contact her using either email or MS Messenger! There’s no stopping this lady now. She said her great ambition when she started was to learn to send a surprise email to her great grandson. “Well when he received it he was so surprised and excited he took it to school and showed all his mates. He says he’s got a ‘cool, hipped up grandmother!’ It’s really happy, sad. You are so happy when you get connected on Skype or MS messenger, then sad when you have to end the connection.” “It’s so scary and so exciting.” Says Bee. Kath’s advice to all those who might be fearful of having a go at a computer to “try it, if you don’t try it you will never know if you can do it, or if you want to keep using it.” Bee on the other hand has set her sights on other things. “I haven’t learnt to hack yet. That’s something that awaits me!” ■
KEEPING WATCH The timely Carers Watch addresses a growing concern – looking after those with dementia.
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here are incidents in family life that many people don’t like to talk about. Frances Ingerson experienced one a few years ago after what should have been a pleasant meal with her husband Len, in a restaurant in Southport on the Gold Coast. She left the table for just a few minutes but, when she returned, her dining companion seemingly had vanished. Hours of anguish followed. The authorities were called in. Len, formerly a high-flying IT professional with a penchant for sports cars, was later found 15kms away sitting on a bench oblivious to the confusion he had caused. The 65-year-old, a sufferer from early onset dementia, had simply wandered off. It’s a common story. David Ingerson, 44, has heard many similarly poignant tales lately. He looked at what was happening to his parents – both the decline of his father and the plight of his mother as a round-theclock caregiver – and took action. After six months searching for ways to guarantee his father’s safety and give his mother peace of mind, the Brisbane-based technologist – who had created networks for pharmacies and medical practitioners – started tinkering. He developed the Carers Watch – a digital wristwatch that operates as a mobile emergency alert system. Using mobile phone geolocation technology, it allows carers to monitor and track their charges should they wander beyond set parameters, and it takes incoming calls. Globally, the incidence of dementia is growing. The ageing population in many advanced economics pose costly questions for governments, social service providers and families. Not surprisingly, Ingerson’s practical accessory is generating phenomenal interest
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from carers and health administrators in hospitals, aged-care homes and services. Technology-enabled e-health has become a sharp focus for governments seeking to manage costs and comfort through the trend for ‘ageing-in-place’ – at home. As requested by an overseas customer a specialised version of the Carers Watch is now available for care service providers. This version has all the basic functionality of the original carers watch but now the Alert button operates in a different way: Should the alarm be pressed the Carers Watch will advise up to 5 authorised individuals by SMS that an alert has been triggered. It also immediately rings your choice of nominated phone number (such as a ‘hotline’ in a call centre). The Carers Watch now works in a Mono-Directional mode, providing one way communication. Everything that is said near to the wearer will be broadcast to the nominated phone number. The watch itself remains silent and does not indicate an alarm has been activated.
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This new function does not affect the function of the standard Call A & Call B buttons on the watch but allows for a way of alerting a ‘base’ that a dangerous situation may be developing. The major advantage of this being that it is not seen as an obvious escalation of a situation that a person may class as threatening, such as a trying to get out a mobile phone and calling their office. ■
workforce
Announcing the New Presidential Card Dining Program You asked for it….we listened. We are very pleased to announce an expansion of our Dining Program. The best part is the ease of use…. • Up to 50% off • Present your Card when paying the Bill • Visit as many times in a year as you like • 450 additional restaurants across Australia and New Zealand For many Aged Care employees, this now means the difference between being able to dine out, and not. In addition to our restaurants, we have over 11,000 retailers offering discounts and in excess of 30,000 household products online, there is something in the Program for everyone. To make it more valuable to your employees, and hence your organisation, we have also made the Card usable by family members. I often meet resistance from organisations to implement an organisational funded Program, with the perception that “We don’t think our employees would use the Card”. I don’t know any Aged Care employee that could afford to pass
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up hundreds of dollars in savings annually, let alone thousands. So….how much can the average family of three save in a year by using the Program? Food & Fuel Insurance Dining Health Insurance Movie Tickets Clothing Holidays Household Items Car Servicing
$ 910 $ 720 $ 300 $ 280 $ 270 $ 200 $ 140 $ 100 $ 77 ====== $2,997
We also off a Hybrid Program, that allows you to fund the Program for full time and part time employees (for example), and offer the Program on an Opt-In basis for casual employees, who contribute to the Program themselves. This option still allows us to offer full implementation
support. From experience of this type of Program, we are finding that 85% of employees that attend information sessions do perceive the value and purchase a Card on the spot. At the equivalent cost of a 1 cent / hour pay rise, the ACAA Employee Benefits Program is a fantastic opportunity to offer a substantial benefit to your employees at a minimal cost. Whilst each website is co-branded 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: ACAA00000 PASSWORD: ACAA Brad King Manager Business Development Presidential Card 0413 839999 BKing@PresidentialCard.com.au
“Taking a world view – working with a culturally diverse workforce” by Sarah Tidey*
“Understanding what makes your employees tick is not just sound business practice – it also contributes to making your place of employment a richer and more interesting place to work.”
“Australians all let us rejoice…” Whilst Australia might have golden soil and wealth for toil, our other great asset is undoubtedly our cultural diversity. One in four of Australia’s 22 million people were born overseas. Australians speak over 260 languages and identify with more than 270 ancestries.1 The Aged Care sector attracts employees from a wide range of cultural backgrounds. As our population ages, the sector faces the dual challenge of responding to increased demand for their services whilst also coping with a shortage of labour. Smart employers will recognise the benefits of creating a work environment that attracts and retains staff from a variety of cultural backgrounds. Taking steps to support your employees’ needs reduces staff turnover, retaining skills and giving the organisation a reputation as an employer of choice. Happier, less stressed employees are more likely to work effectively as a team leading to increased productivity and a better service for residents. So how do employers best respond to the needs of a culturally diverse workforce? The process starts at the front door. Look at your organisation’s client base and at your
recruitment policies and evaluate whether your organisation attracts a broad range of candidates. Perhaps there are some local community groups that could be approached? Is the organisation advertising positions through a wide range of media? Does the application and interview process accommodate candidates from different backgrounds? For example for some cultures it is not appropriate for a woman to be interviewed by a man alone. Can interviews be conducted in pairs? Consider the set up of the interview room and whether it is a space that is comfortable for different nationalities. Make sure you discuss your new employee’s cultural and linguistic needs upfront and identify any training, education or organizational supports they need. During induction you should also provide new employees with an overview of the organisation and how it works. When organising any training you may need to give some thought to providing interpreters, or offering English language training. Keep in mind that not only are new migrants grappling with learning a new language but also with the Australian style of speaking – slang, colloquialisms and gestures are used on a regular basis. Organisations such as AMES offer courses in English for
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Make sure you discuss your new employee’s cultural and linguistic needs upfront and identify any training, education or organizational supports they need.
new migrants that also introduce participants to Australian business practices and cultural norms. Think about how accessible the organisation’s policies and procedures are to people for whom English is not their first language. Can these documents be translated or presented in plain English? New staff may also require facilities such as a prayer room for religious or spiritual observances or adaptations to a work uniform to accommodate cultural practices. The training and education process should not just be for new staff. Management and existing staff also need to be provided with opportunities to develop their knowledge and understanding of other cultures so they can encourage culturally inclusive practices.
“
There is no doubt that an
organisation’s best asset is its employees. Understanding
what makes those employees tick is not just sound business practice – it also contributes to making your place of employment a richer and more interesting place to work.
”
For employees who are new to Australia the workplace can be an intimidating place. It is important for managers to understand that some perceptions, emotions, behaviours and interpretations are the result of adapting to new cultures2 and to exercise patience and understanding in the workplace. Pairing new employees with experienced staff member “buddies” can be a good way for both parties to learn. Look for opportunities for staff to share knowledge of their culture through organized activities such as celebrations of cultural days3 and more casual interaction in the tea room or at social get togethers. Maintaining open lines of communication is very important. By chatting regularly with staff and obtaining their feedback and ideas managers can gauge how things are going for new employees and where problems or issues may arise. Remember that for many
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cultures giving feedback in a group situation or providing criticism may not be something that they feel comfortable with. This may be even more so if English is not their first language. Managers may need to identify with different employees what kind of communication they feel most comfortable with. This may mean setting aside time for one on one meetings with staff. Maintaining an open dialogue with employees is also an important part of the performance management process. Clearly set out to new employees what the process is for career development. In Australia it is common for employees to bear the onus of managing their careers, whereas in other cultures employees are not expected to “stake their claim”, and promotion will be in recognition of hard work or dedicated service. There is no doubt that an organisation’s best asset is its employees. Understanding what makes those employees tick is not just sound business practice – it also contributes to making your place of employment a richer and more interesting place to work.
References: Websites: ww w.culturaldiversity.com.au www.harmony.gov.au www.immi.gov.au (Australian Government – Dept of Immigration and Citizenship “Managing Cultural Diversity” Training Manual by Robert Bean Consulting Footnotes 1 Sources – www.immi.gov.au – Australian Government Department of Immigration and Citizenship 2 Managing Cultural Diversity” Training manual – Australian Multicultural foundation and Robert Bean consulting 3 Your organisation may like to get involved in Harmony Day – see www.harmony.gov.au ■ *Sarah Tidey is a consultant with Worklogic, a company that specialises in investigation of workplace complaints, resolution of workplace conflict, drafting and review of company policies, workplace reviews and audits, and training.
THE STAFFING CONUNDRUM:
Matching care staff time to resident needs Professor Tracey McDonald, RSL LifeCare Chair of Ageing, Australian Catholic University Ms Silvia Holcroft, Director, QPS Benchmarking
Acknowledgements Mr Adam Holcroft, General Manager, QPS Benchmarking Dr Doug Shaw, Statistical Consultant
Background: As a background to the central issue of whether decisions on staffing hours are related to meeting the assessed needs of residents or not, we need to understand the workforce engaged in aged care. Possibly the most comprehensive profile of the Australian aged care workforce is provided by the National Institute of Labour Studies (NILS)1 reporting on information collected from all aged care providers as part of their mandated agreement for receiving the Conditional Adjustment Payment (CAP) of 1.75% annual increase in government subsidy. The 2003/04 report2 and the second in 2007/083 contained information of particular interest to staffing.
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n the residential aged care occupational structure section it was noted that there had been a decline in registered nursing positions which accounted for 21% in 2003 but only 16% in 2007 – a decline of 1600 positions. At the same time the proportion of personal care workers rose from 59% in 2003 to 64% in 2007 – a rise of 17,500 positions. Registered nurse vacancy levels are rising with 26% of aged care homes reporting an RN shortage and 37% claim it takes at least one month to fill such a vacancy. While many explain the decline of RN participation in aged care as a feature of a global shortage of registered nurses, the reality is that RNs availability is influenced by the location and type of work and remuneration offered. In 2009 around 2,000 new RN graduates were not able to find suitable nursing work in Australia making the ‘RN shortage’ a myth. Providers unable to attract and retain RNs in clinical areas may need to review their approaches to employment of professional nurses who, after all, are key to the provision of safe, effective and regulatory compliant services. The anticipated third NILS report may provide further insights into work re-design decisions of approved providers. In particular we may see if providers’ attitude toward clinical professionals has resulted in a further change in RN workforce participation rates. In other staff categories allied health numbers remained stable across the two NILS reports but enrolled nurse numbers also fell. Agency shifts for nurses increased from 3.5% in 2003 to 5.7% in 2007. Personal care (PC) staff form a very small part of agency shifts and 60% of job vacancies are filled within 2 weeks.
Aged care career paths show that 50% of care staff had no prior aged care experience. Formal training and Aged Care Certificate III increased from 55% in 2003 to 65% in 2007. Most want work that fits with family life and personal commitments and see aged care work as an extension of domestic skills. Informal recruitment is the dominant mode of filling positions. Providers are required to employ people with appropriate skills to safely meet the needs of the residents admitted for care under the Aged Care Act (1997)4. There is broad understanding within the aged care industry as to what ‘appropriate’ might mean however at the time the clause was drafted, levels of resident frailty, morbidity and need for highly skilled nursing and medical care were much lower than they are in 2011. ‘Appropriate’ therefore needs to be understood in relation to the resident casemix (health and treatment needs profile) rather than simply the number of people in residence. Proposals to consider introducing staff to resident ratios generally focus on limiting staff workloads but fail to address the complexity of meeting needs of sicker, older and frailer residents. Staff rosters based on Staff/Patient ratios are no more than a ‘blunt instrument’ that regards all residents as having the same needs and all staff as having the same skills and experience. Still, work redesign across aged care may be further reducing RN participation and increasing the roles and scope of care staff work to substitute for RNs. Decisions on safe and effective staffing are complex and need to be driven by (1) Case-mix (patient/resident characteristics
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and need for care); (2) Intensity of care and size of care unit (individual dependency, number of individuals with high care needs, variability of care, admission and discharge frequency); (3) Context (geographic dispersion of residents, size and layout of the individual rooms, technology, equipment); and (4) Expertise (experience and qualifications of RNs, ENs and other staff, as well as management proficiency in resourcing clinical areas). The obvious outcomes of getting staffing and skill-mix right also address the general public’s perception that a quality chasm in residential aged care is increasing as RN clinical participation decreases or as RNS are diverted into management roles. Systematic reviews of research consistently find a strong relationship between clinical care staffing and specific adverse events, particularly in relation to vulnerable people. Acquired infections, urinary tract infections, blood stream infections, pneumonia, falls, medication errors, pressure ulcers, and increased mortality have been associated in more than one study5 with poorer staffing (more patients/residents per nurse or fewer hours of nursing care per patient/resident day). Competent management of work environments, type and quality of equipment, careful recruitment and staff support, clinical and organisational care processes and good communications between managers and clinicians may be able to mitigate some adverse outcomes. The ability to assess resident care needs, obtain funding and provide the amount of care hours required to residents is a core management function for residential care services. Monitoring and maintaining a balance between these three independent processes is crucial to the short and long term sustainability of the organisation. Australian aged care providers who subscribe to the QPS Quality Benchmarking System are able to take advantage of research undertaken to assist QPS clients to understand the relationship between funding and care hours provided to their residents. For example, an analysis of 3 months of benchmarking data on both funding derived from the Aged Care Funding Instrument (ACFI) and direct care staff work hours, submitted to QPS from 135 facilities (including high and low care; for-profit and not-for-profit; across a range of sizes from <50 to >150 beds), enabled an investigation of questions around whether labour intensity influences the cost of providing services in residential aged care.
Is there a standard ratio between staffing and funding? The ratio between CSWH and ACFI for these 135 facilities is shown below as a distribution which is approximately normal, with a mean of 0.0225 and a standard deviation of 0.004833. Among these facilities the ratios of CSWH to ACFI appear to be fairly widely spread.
Does facility size matter? The scatter plot (below) of CSWH against ACFI, with facilities differentiated by size, indicates that the number of beds does not appear to have an effect on the relationship between CSWH and ACFI. When regression lines are added for each group size there is a remarkable similarity between the regression lines.
Analysis In a correlation study using regression analysis associations between the variables mentioned above were identified. A regression line fitted to the data has an R-Sq of 58% (An R-Sq of around 20% is considered a good fit for this type of research).
Is ACFI funding being spent on care staff hours? The graph at the top of the next column illustrates the results of the correlation, with model showing a strong relationship between care staff work hours (CSWH) and ACFI.
Summary of findings
The fitted regression line shows that, on average, an increase of 1 in ACFI value results, on average with an increase of 0.02228 in CSWH. In other words, the higher the ACFI value for residents the higher the direct care staffing hours need to be and are shown to be in the sample tested.
The main study and analysis was more extensive than has been reported here, including for instance, the analysis of for-profit and not-for-profit differences in funding and staffing decisions. QPS members can access this information to assist them to maximise efficiency without compromising resident and staff safety.
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In terms of the issue raised as to whether funding and care staff hours are associated, the following findings are of interest: 1. A direct statistical relationship exists between care staff work hours and funding received. The results demonstrate that participating QPS clients monitor and adjust their care hours according to resident care needs. 2. There is no direct relationship between the size of the facility, funding and care staff work hours provided. This means that, for these facilities, care hours are provided according to resident needs rather than by the size of the facility.
Conclusions Through measuring, monitoring and responding to changes in resident care needs and care hours provided residential aged care facilities can gain efficiencies, or provide safer care. Access to reliable analysis of key elements in staffing decision-making can support providers in achieving efficiency without overloading staff or compromising resident safety. Clearly where resident dependency and need for skilled care and treatment is accurately assessed under ACFI, this funding is needed to access appropriately skilled staff in sufficient numbers to provide safe and effective care. Direct care staffing decisions need to be based on an appreciation of the clinical
and organisational complexities of each organisation rather than a simple, one-dimensional formula such as staff to resident ratios. Benchmarking information on push factors in staffing and funding can increase the certainty of good management decisions.
Endnotes 1 National Institute of Labour Studies - Website: http://www.flinders.edu. au/sabs/nils/ 2 Martin, B. & Richarsdon, S. (2004) The Care of Older Australians: a picture of the residential aged care workforce. Cwlth Dept. Health and Ageing, 2003/04 report. Retrieved August 30, 2011 from: http:// www.flinders.edu.au/sabs/nils/publications/reports/the-care-of-olderaustralians-a-picture-of-the-residential-aged-care-workforce.cfm 3 King, D. & Martin, B. (2007) A Picture of the residential and community based aged care workforce, Cwlth Dept. Health and Ageing, 2007 report. Retrieved on August 30, 2011 from: http://www.flinders.edu.au/sabs/ nils/publications/reports/a-picture-of-the-residential-and-communitybased-aged-care-workforce.cfm 4 Commonwealth of Australia Aged Care Act (1997) Retrieved on August 30, 2011 from: http://www.health.gov.au/internet/main/publishing. nsf/content/ageing-legislat-aca1997-acaindex.htm 5 Mitchell, P. & Mount, J. (2009) Nurse Staffing – A Summary of Current Research, Opinion, and Policy, Washington State University. Retrieved on August 30, 2011 from: http://www.ruckelshauscenter.wsu.edu/projects/ documents/NurseStaffingfinal.pdf
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sponsors
Energy Contract Discount Offer (ACAA Preferred Supplier) Energy Action have been appointed as the preferred supplier to all ACAA members and affiliates for energy contract procurement and management services. Who are Energy Action? Energy Action is Australia’s leading independent energy management company offering comprehensive buying and management services for both gas and electricity, aimed at reducing energy usage and saving your aged care facility money. The Australian Energy Exchange: Australia’s leading reverse auction platform for the procurement of energy. The company’s flagship service, the Australian Energy Exchange, allows energy suppliers to competitively bid against one another to supply your organisation’s energy – with a best fit contract secured in around 15 minutes. This unique service has secured energy contracts in excess of $5 billion and delivered millions of dollars worth of savings for Australian organisations. We are proud to have signed off over 5,000 contracts for some of the largest energy deals in Australia encompassing corporate, government and industrial business – including many aged care facilities. We look forward to bringing the benefits of our market and contract knowledge, experience, and the dynamics of the reverse auction, to the members and affiliates of ACAA.
Independent Energy Brokers = No Agendas An important consideration when dealing with an energy broker is that they are independent and deal with as many retailers as possible. The more retailers looking to
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secure your business, the more chance you have of securing a higher saving. Energy Action deals with all major retailers across Australia, such as; • • • • • • • • • • • • • • • •
ActewAGL, AGL, Alinta, Aurora Energy, Country Energy (now owned by Origin), COZero, Energy Australia (now owned by TRUenergy), ERM Power, Integral Energy (now owned by Origin) Momentum Energy, Origin, Perth Energy, QEnergy, Simply Energy, Synergy, and TRUenergy.
• • • • • • • •
Energy monitoring, Power factor correction, Site energy audits, Bill validation, Tariff analysis, Carbon pricing and impact reports Sustainability and energy efficiency team, …and much more!
Forward Thinking Secures Savings Although your electricity contract may not be immediately due for renewal, we could secure more attractive rates for you NOW than at a later date. This is part of the benefits of dealing with an experienced, and independent energy management company who is monitoring the energy marketplace on a daily basis – both retail and wholesale.
Energy Action – A Full Service Offering
The Wholesale Electricity Market As the wholesale electricity market can be highly volatile, it is difficult to forecast future prices of energy with certainty. However, wholesale electricity prices provide a very good indication and insight into market trends and movements.
Energy Action have experience not only in the procurement of energy for your site, but can also assist your business with a full service management of all your energy needs. This can encompass additional services such as;
The Wholesale Energy Price Index (WEPI) is a reportable index that reflects daily changes to contract and spot market conditions and their effect on the stability of the underlying wholesale price for electricity
Energy Action are always in discussions with new entrants to the retail energy marketplace.
in the NEM. The WEPI is a good indicator of retail price movements, as electricity retailers are one of the key players in the wholesale market. It was created by the Department of Industry Tourism and Resources (ITR) in conjunction with d-CyphaTrade and is published daily on the d-cyphaTrade website. The main driver of wholesale prices is demand peaks which are typically driven by extreme weather events. Compared to previous years, the past 12 months of wholesale market activity has been relatively stable across all states. The second half of 2010 saw steadily decreasing contract prices driving the WEPI down to record lows. The wholesale market reacted early in 2011 with the WEPI ticking up quite significantly as cyclones, floods and heatwaves hit Australia. Although uncertainty remains about the Federal Government’s proposed carbon price mechanism wholesale pricing still remains at
relatively low levels which indicates it may be a beneficial time for customers to consider securing their future electricity contracts.
What does the future hold? The electricity futures market gives an indication on the current perception of future pricing. One of the main participants in the
futures market is electricity retailers and hence the wholesale futures can be used as an indicator of future retail pricing. Below is a graph produced by the AER who publish wholesale electricity futures prices that are registered through the d-CyphaTrade futures market. The prices are for quarterly contracts out till the second quarter of 2015.
Figure 1 http://www.aer.gov.au/content/index.phtml/tag/MarketSnapshotLongTermAnalysis/ Data sourced: 8/9/2011
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sponsors
The vertical axis represents the $/MWh wholesale price of electricity – this can be divided by 10 to find a c/kWh equivalent. The wholesale price of electricity is traded in full day blocks i.e. it covers both peak and off peak periods. The current market climate is relatively stable (as shown in the WEPI) and ample supply has seen contract prices hitting relative lows. See the table below for settlement prices and current prices for calendar year implied wholesale futures.
How Do I Get Involved? The first step is to contact your Energy Action Corporate Sales Manager, Peter Naylor on 0415 103 707 or via email on peternaylor@energyaction.com.au. Peter will require you to send a copy of a recent electricity bill from all sites. ACAA members and affiliates will receive a free energy bill health check. If you then wish to proceed with Energy Action’s services, you can complete the Letter of Authority (LOA) and the Relationship Agreement (RA) if required. We take care of the rest for you! ■
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* Data sourced from http://d-cyphatrade.com.au/. Settlement date taken to be the last trading day of December for the year before contract period begins. Current Prices are as of 7/9/2011.
Contractor Management Online – Harmonisation 2012 Contractors on site in any
Benefits of a CMS:
Aged Care facility have more
• Meet your legal obligations and take charge of your contractors • Capture all information required to verify a contractor and their employees • Accurate reporting for all levels (including contractor approval status in real-time) • Consistent information for every contractor
occupational, moral and legal responsibilities than ever. Add to this the impending OH&S Harmonisation laws coming into effect from Jan 1st 2012 and some organisations are starting to get nervous. Are you ready for the new legislation? Given your legal obligations do you know enough about your contractors on site? Are they trained? Insured? Licensed? Under the new Model Work Health and Safety Act, the term ‘employees’ will be changed to ‘workers’ which now places contractors (amongst others like visitors, outworkers and students) on equal footing with other employees. This has significant implications for how organisations view contractors and visitors on site.
The new system has a range of features that are configurable based on implementation and we can also provide an existing contractor induction elearning package reviewed by the National Safety Council of Australia for compliance with the new legislation in 2012. Some of the key features include: • Self registration for contracting companies and their staff
• Payment gateway to enable a ‘contractor pays’ implementation • Document/evidence upload • All actions and communication are tracked through comments • Automatic status adjustment (e.g. previously approved contracting company and its employees will become ‘suspended’ if insurance or licenses expire) • Automatic email notifications • Option of e3’s professional help desk and verification services This brand new service is designed for organisation wide rollouts across geographic boundaries. Ensure you are prepared for the new Model Work Health and Safety Legislation; prioritise safety and compliance for your staff and contractors. Contact us at info@e3learning.com.au
e3Learning (ACAA’s elearning technology partner) have been providing online contractor induction services for over 5 years. To date, e3 have inducted over 60,000 contractors Australia wide across a range of industries. Our brand new Contractor Management System (CMS) is an ideal organisation wide solution to contractor management, verification, induction and compliance in line with the new legislation.
Best Safety Program Best Graphic Designer
Best Training Provider Best LMS/Hosted Best Compliance Training Program
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editorial
Partnerships Create Increased Productivity! Mike Swinson reviews the Clinical Partnerships Pilot Program.
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re you a registered nurse working in the aged care space? Are you a manager in the same sector? Are you a relative of an elderly resident living in aged care facility? If you answered ‘Yes’ to any of those questions, or if you are interested in how to make life for some of your residents happier and healthier then read on! This story began a while ago, by ‘a while’ I mean some years ago. Anne Moehead is the Nurse Practitioner Psychogeriatrics/ Dementia on the North Coast of NSW. Anne works in acute hospital settings where she assists in the treatment and management of older people with delirium, dementia and related behavioural problems. This story revolves around an idea that sprang from Anne’s productive and enquiring mind, because over the years she has led a number of innovative projects in an attempt to improve the services and outcomes for older people living in the Northern Rivers of NSW.
Anne had noticed that anyone who was admitted to the local hospitals Emergency Department from an aged care facility or from care provided at home often became very agitated, confused, upset, anxious and for many it marked a rapid deterioration in their health status. She noticed that when old and frail patients presented at the ED it was an unhappy experience and often marked a rapid downhill slide because: • They had no familiarity with the hospital environment • They were dealing with total strangers • There were constant staff changes, all were strangers. • They had no or little contact with friends from the facility • They almost all became agitated and their stress levels rose.
The pilot program identified 3 broad categories of people involved: 1. Those that present to ED who need to be admitted with broken bones or a serious illness. 2. Those who need x-rays, they see a doctor but could then return to the facility if the nurses had the skills to support them 3. Those who shouldn’t even arrive at ED but do because the aged care nurses do not have the necessary skills to know what to do and how to do it, within the facilities setting. Anne said “So even if the person needs to be admitted, we can try and get them back to the facility much earlier than we do now, hopefully before delirium sets in, before they get way too agitated, before they develop MRSA and get confused. That’s what we thought this pilot program could prove and it has!” It goes without saying that hospitals are where sick people are, it’s where infections happen and if you are old and frail then the chances of you getting another infection or a more serious health problem are much higher than for younger patients. The aim of the Clinical Partnership Program was to provide the opportunity for clinical registered nurses in aged care settings to update their clinical practice, skills and knowledge in more advanced specialised acute areas. The pilot program was designed, produced and implemented by a clinical nurse educator (CNE) from Lismore Base Hospital. Its goal was to reduce unplanned hospital admissions and reduce lengths of stay for residents of aged care facilities. (This in turn will produce significant cost savings to the acute sector and increase income to RACFs derived from a reassessment based on the Aged Care Funding Instrument.)
Anne said, “We wanted to see if we could change that for the better, that’s what was driving this project.”
But, and there always is a ‘but’ in order for this to succeed, nurses working in the aged care sector would need to lift their clinical skills.
Every hospital in Australia will tell you that the Emergency Departments are at or near capacity, some are stretched beyond capacity. A lot of the people who arrive at ED are aged or frail, some need to be in hospital with a fracture or a serious illness, but many don’t.
“We realised that we would have to lift the skills of nurses working in the aged care setting, so they were comfortable with providing care where needed, making a clinical assessment with the hospital if necessary, sorting out if a brief visit to ED
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was needed, checking with the doctor and the aged care facility where they would be looked after,” said Anne. The other members of the team involved in this remarkable pilot program included Natalie Carter who has spent the last eleven years with Uniting Care Ageing North Coast Region in various leadership roles including the newly formed position of Residential Group Manager, Nicola Scanlon a part time Acting Nurse Educator and Registered Nurse on the General Intensive Care unit at Lismore Base Hospital and Cheryl Munroe, a Clinical Nurse Educator at Lismore Base Hospital whose role is teaching and guiding registered and student nurses in both clinical and theoretical settings. The pilot was funded by a group called ‘The IDEAS Project’ because they believe it to be a visionary initiative. The Ideas Project brief is to increase the capability and expertise of the aged services sector on the NSW north coast, to raise and diversify the skills of the existing aged care workforce. Anne said “Often aged care nurses lose their acute care skills because it’s not needed; now this pilot shows it’s vital they re-activate them, it’s better for them, its way better for the residents and it saves the hospital a lot of time and money. Our next step is to see how we can extend this from a small regional pilot program to a much larger scale. We have built the skill base of 3 aged care nurses; we need to take that to 8 or 10 and more, then keep that process going so it becomes a regional approach first. After that it’s out of our hands.” “I am more than happy to share this with anyone as I want to see this work adopted elsewhere. In simple human terms this pilot program has shown that an old and frail lady who sits in the ED, where its brightly lit, surrounded by frenetic activity and total strangers, who has no idea of what is going on, gets so stressed, because it is a frightening place and if we can keep them out of there as much as possible that’s got to have huge benefits to our community.” And so say all of us! Anne Moehead can be contacted by phone on: 02 66202612, or by email at this address: anne.moehead@ncahs.health.nsw.gov.au
editorial
SAGE Success SAGE program leader Judy Martin announced that bookings for the SAGE USA 2011 tour are fully booked.
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which is combined with the USA national LeadingAge event. There are a number of networking events planned for the SAGE delegation when in Washington. Judy said.
This year there are 3 separate trips to Boston, Philadelphia, Chicago + New York and all tours will meet in Washington to attend the biannual IAHSA conference
In the current times of the ACAA/ACSA merger SAGE was at the forefront being an industry first collaboration that includes the three peak industry organisations ACSA, ACAA and RVA. SAGE offers innovative study tours to the Australian aged care and retirement living industries. Successful study
udy says “we are thrilled with the response. In October we have 45 Senior Executives of Australian industry heading off to the USA to take part in this year’s program”. Judy’s comments are supported by Rod Young, CEO, ACAA who is a delegate on this year’s trip.
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tours have been run since 2006 across four continents. ‘As a Foundation member of Sage, ACAA has recognized the importance of creating opportunities for Australian aged care providers to learn and experience the models of care and service being offered in other countries, said Rod Young, ACAA.’ Judy is currently preparing the SAGE program for both 2012 and 2013 and expressions of interest for the program are open on the website www.sagetours.com At the national conferences members will be alerted to the upcoming programs. ‘Members are encouraged to register their expression of interest on the website so we can monitor interest to progress planning’ says Judy. ACAA/ACSA/RVA will be following the SAGE group and reporting back to members post tour. ■
Beginning of a SAGE Adventure Colin McDonnell Starrett Lodge Care Service Manager UnitingCare Ageing Hunter, Central Coast and New England
I would like to share an exciting few months that I have just experienced commencing on the 2nd May.
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s an employee of Unitingcare ageing NSW & ACT I was nominated for the inaugural Carol Penning memorial inspired leadership award and was very fortunate to win. This was a very humbling and honored experience as Carol was my mentor and started my journey on the road of person centred care for those people living with dementia. The award prize was quite a substantial amount of money to further my studies. This created a problem! - what, when, where and how would I devote my time and award money in a way that would best afford me further insight into the contemporized models of elder care and building design, a passion of mine which has been extenuated by my recent studies at Victoria University in the Masters of Health Science Aged Services. A friend of mine suggested that the IAHSA conference would be a good choice as it gathers leaders in the field from across the globe and she would be attending as representative of the Aged Care Channel. I gave it some thought and was goggled to find what this IAHSA was all about. Having no
luck in finding this conference, mainly because I had the spelling wrong, but fortunately I stumbled across SAGE tours and the wonderful adventure began. This has been the fastest moving rewarding, educational, networking association that I have ever come in contact with. Judy Martin SAGE program leader, from email address JM GlobalConnect “appropriately named” is like a conductor of an orchestra and can in one conversation work out how and who to connect you with like minded people from all around the globe. I signed up for the 2011 SAGE tour to Philadelphia and Washington and, guess what? it culminates in a fully organized IAHSA conference program in Washington - my goal was reached. The prospect of meeting leaders in the fields of design and programs for our ageing population is almost mouth watering. The SAGE tour to East Coast USA will visit a number of Aged Care and Retirement Living facilities in the Philadelphia region providing delegates with the opportunity to gain valuable insights in the delivery of care and services from key professionals. Study tour site visits are selected to highlight innovative programs, use of new technology, and advanced design features, and will include visits to institutional and community based settings offering the full continuum of care. I believe there are tours also going to Boston and to Chicago and New York at the same time. That’s a whole contingent in America as part of SAGE representing Australia. The excitement didn’t end with this discovery, Judy in her knowing way suggested I contact an industry colleague of hers based in the USA. She had met this
colleague through previous SAGE tours to San Fransisco. Dr Nader Shabahangi is CEO and Founder of Agesong a very progressive organisation for elderly in San Francisco. So in the momentum Judy had set within a 24hr period I had received an email from Nader inviting me, not only to stop and see their facilities, but to stay for 4 days and partake in an intern program to fully understand their strategies for helping people with memory loss. I could not believe my luck. Naomi from Flight Centre (the SAGE designated travel agent) organised everything from hotels, transport to and from Australia and to San Francisco then on to connect with the SAGE group in Philadelphia, all within the budget of the grant I had received for my award. To top off the excitement I met Professor Steven Sabat at the Alzheimer’s conference in Brisbane. Steven just happens to teach at Georgetown University Washington DC and has invited me to catch up with him and tour Georgetown Uni with him. This is the oldest Catholic and Jesuit University in America established in 1789 and will be an additional highlight of my SAGE experience. In closing, on embarking on this adventure I had no idea of where I was going and was unclear of how to best use my opportunity to advance my knowledge in a global way. Judy from SAGE has opened up my vision and connection to the world, she has also now connected me with leaders of aged care in London but that is for my next trip. It’s signing off now until my return from the SAGE adventure when I can tell you all how it went. If its anything like it has started, from my first contact with Judy, it is going to be amazing………………………. ■
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editorial
NSW Aged Care Manager awarded $35,000 Scholarship
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xecutive Care Manager with Baptist Community Services NSW & ACT Greg Price has won the first Provider Assist National Scholarship valued at $35,000. Greg’s scholarship includes: • $2,000 spending money • Registration, International airfares and accommodation for the 2 week SAGE Tour, October 2011 – Chicago, NY and Washington including registration and attendance at the international IAHSA conference • Education and training • Meeting with key international leaders in aged care • Registration, travel and accommodation for the 2011 ACSA National Conference • National Winner Trophy and plaque, and • His CEO will accompany him on the SAGE tour. (www.sagetours.com.au)
to reinforce the importance of developing relationships and ensuring older people feel valued as individuals. In his current role based in Alstonville, NSW, Greg has introduced three new projects: • A community network development initiative with a retired university professor, to develop links with a range of local identities and groups • A 12 month interactive change management program to develop and embed new care initiatives • A project to elicit and share clients’ life stories. Greg has a diploma in nursing administration and a degree in health administration. In 2001, he received the Commonwealth award for Professional Excellence in Residential Aged Care. He has presented 18 papers at Australian conferences and seminars and his work has been widely published.
Provider Assist congratulates Greg on his exceptional efforts and outstanding contribution to the industry and the lives of older people. Aged care funding specialists Provider Assist launched the scholarship program in 2010 to acknowledge and support the invaluable service provided by the aged care sector. The $56,000 program comprises six state scholarships and a national scholarship open to the winners from each state and territory. Nominations for the 2012 National Scholarship open on September 14, 2011. Information and registration details are available at www.providerassist.com.au. The scholarship program is open to anyone employed by an approved provider. Provider Assist hopes the Scholarship Program will change some of the lives of those that change so many every day. ■
SAGE is an industry initiative from the peak associations ACSA, ACCA and RVA & is one of the first programs that is a joint enterprise of these three associations. International exposure and the reputation of SAGE as a Australian initiative for industry members (like Provider Assist), made it an easy choice for their National Scholarship prize. Provider Assist are the first external SAGE sponsor and are absolutely delighted to have the winner on the upcoming tour where they will be part of a contingent of over 45 leading Australian industry representatives. With more than 20 years experience as a Director of Nursing in aged care in NSW and Queensland, Greg has remained passionate about enriching individuals’ lives through a holistic approach to their care. In 2004, Greg developed an “interaction based care” initiative to assist staff reassess how they engage with the older people in their care –
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Photo caption: From left to right, there is Peter Watson (Provider Assist), Greg Price (Scholarship winner) & Peter Morley. (Provider Assist)
Turned off the stove today? It’s been done! elping a person in the early stages of dementia can be difficult as they try to come to grips with memory impairment. Many may feel angry and isolated; however, the newly released iPhone application, It’s Done! could change this.
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to automatically generate a text message or email to send others when a task is done. For instance, within seconds of taking a daily medication and marking it as completed, a loved one or caregiver immediately receives a message that the medication was taken.
The smart phone application, or “app”, helps dementia sufferers confirm whether they remembered to turn off the stove, lock the door, or take their medication. The app also notifies loved ones and caregivers that a routine task has been completed.
For quick and easy set-up, the app comes pre-loaded with 40 routine everyday tasks. You can also create custom task names and list as many tasks for the day as desired. Tasks can quickly be set up as ‘one-time’, recurring, or scheduled for future dates; and tasks can also be prioritised and categorised for easy sorting and viewing.
People with early-onset Alzheimer’s, and who have an iPhone, can simply check-mark “done” on their routine everyday tasks after completion. One vital and potentially life-saving feature of the It’s Done! app is claimed to be its ability
When a task is completed and the check-box ticked, a bright green checkmark appears with a “click” sound and phone vibration. These visual, audible, and
tactile cues reinforce confirmation of each completed task. The app keeps track of how many times a task is completed and all completed tasks are stored in the app’s history for review at any time; and also has a task reminder to alert people of a task at an appointed time. The It’s Done! creator, Howard Lester, says the app provides a public service to everyone who forgets whether they did something; but particularly for folks who are memoryimpaired due to dementia, brain injury, or other medical conditions. “This simple and inexpensive, yet vital app, can certainly improve their quality of life,” Mr Lester says. He says the app can also create “peace of mind” for the caregivers and loved ones of those who suffer from memory-impairment. “It’s just one more tool for helping everyone rest easy.” Article reprinted with permission from DPS News www.AgedCareGuide.com.au July 28, 2011.
ACAA and ACSA were right!!! Their joint initiative and vision for collective action to support aged care providers nationally has worked! The National electronic Resident Agreement [NeRA] application is now the most trusted and successfully used resident agreement package in the aged care industry.
Here’s why: ✔ ✔ ✔ ✔
It’s fully compliant It’s easy to use It’s inexpensive Your support will support your Associations
NeRA software is a joint ACAA/ACSA initiative supporting the first national approach to resident agreements. Over 700 sites nationwide now use the software, and it has been great to see so many Association members - and the industry in general - taking an interest in this initiative and supporting a positive national approach to resident agreements.
Recognising the advantages of having a nationwide industry standard for resident agreements, (rather than individually maintained documentation) has meant the Associations have taken on the responsibility of monitoring legislative changes and maintaining the agreements via NeRA . NeRA automatically updates government data and the latest legal templates in relation to resident admission. This reduces the burden on providers to maintain accurate agreements and minimises errors made in generating agreements. Furthermore, the national standard embodied in the NeRA program is constantly being reviewed and revised based on feedback from providers. As part of a dynamic approach to both the content of the agreements and the development of the program, aged care software developer e-Tools is pleased to support both Associations by taking on board provider feedback and working with the Associations
to ensure a current national approach that reflects the industry’s interests. You can rely on NeRA for: • ease of creating and managing agreements • security of knowing that the agreements are current and accurate • potential to save on your most precious resources - time, labour and money These benefits explain the overwhelmingly positive response from the industry. For a very inexpensive investment you will have a reliable, effective, long term solution with costs recovered in less than 10 uses! So, purchase, subscribe and rest easy….the NeRA application has been designed to take all the work out of generating agreements while ensuring that they are legally up to date at all times. See NeRA in action for yourself, book an online demonstration by calling e-Tools on 03 9571 8611 or visit www.e-tools.com.au. ■
editorial
Aged Care, Who cares? Where, how and how much? ACAA asks the authors of Aged Care, Who Cares? some questions on the launch of this exciting book ABOUT THE AUTHORS Noel Whittaker’s financial advice has been helping Australians stay on the right track to a sound financial future for decades. Author of 19 books including the international best seller Making Money Made Simple, newspaper columnist, TV and radio commentator, Noel was made a member of the Order of Australia in 2011 for raising community awareness of personal responsibility in matters of superannuation, household budgeting and estate planning. Admired for his ability to demystify the most complex topics with wit and wisdom, he has now lent his winning approach to the expert knowledge of his new co-author, Rachel Lane. Rachel has worked in financial services for 12 years and as a specialist in aged care for the past 7 years. As Executive Manager – Aged Care Solutions for Colonial First State, she is highly respected for her advice in key areas such as the structuring of assets and income for aged care residents. Together Rachel and Noel have unraveled the complexities of aged care for the average reader.
Who do you see as the target market for this book? Right now, the eldest of the baby boomers find themselves between a rock and a hard place. Their superannuation has taken a blow because of the GFC and their parents are living much longer than they expected them
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to. Instead of being able to sit back and enjoy their retirement they are now forced to work longer to restore their own superannuation and at the same time try to care for one or more aged parents who are extremely resistant to the idea of moving out of their home to take advantage of better aged care. Children are often left with the dilemma of whether to try and care for their parent’s in their own home or move in with them to provide care and companionship or look at more formal care arrangements offered by retirement villages and aged care facilities. The choices can seem overwhelming and decisions are often clouded by emotions. The purpose of this book is to help the baby boomers and their parents understand their aged care choices.
What are the greatest challenges facing the aged care industry? Quite simply it is supply and demand. Medical advances mean that people are living much longer and yet despite much talk a succession of federal governments have done little to improve the number of places available in the aged care system. The latest initiative is the Productivity Commission Report which, if implemented, could cause aged care costs to skyrocket. To make matters worse the average Australian has a feeling of entitlement and expects
everything to be free, while the current adversarial nature of politics means that any initiative proposed by one party is likely to be vociferously opposed by the other. A particularly emotive issue is whether a person should be forced to sell their home to enter aged care. Given the parlous situation of many older Australians it is hard to envisage a situation where the average retiree could find the money for an accommodation bond without selling their home. The growing cost of construction is another factor. The developer has a challenge of providing modern accommodation at a profit while being limited by the amount they can charge.
What will the reader get out of the book? Obviously no book can provide all the answers and we strongly recommend that anybody who is going into aged care, or is assisting a relative or friend into aged care, seek expert advice. However, the book provides a simple overview of the way the system works, the kind of challenges that may be encountered and strategies to make the transition as painless as possible. For information about book launch events or to purchase a copy of “Aged Care, Who Cares – Where, How and How much?” contact Rachel Lane on 03 8618 5567 ■
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events
2011 Calendar of Events October
19 & 20 October
27 & 28 October
6 – 8 November
SAGE - USA (Including IAHSA)
Breaking Through the Barriers
Beyond the current NAHA: what next for national housing policy Crown Conference Centre, Southbank, Melbourne
ACAA 30th Annual Congress
T: (02) 9689 2088 E: j.okeefe@thomsonadsett.com www.sagetours.com.au
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Brisbane Convention and Exhibition Centre Lisa Woodward Conference Coordinator Tel: 02 9270 6626 lisa.woodward@cshisc.com.au www.cshisc.com.au/ conference2011
aca Aged Care Australia
AHURI Events T: 03-9660 2300 information@ahuri.edu.au
Magical Mystery Tour - The Long and Winding Road Contact: ACQ Conference + Event Management T: 07-3725 5555 E: acaa2011@acqi.org.au or enquiry@acaacongress2011. com.au www.acaacongress2011.com.au
product news
IT’S IN THE BAG
• Mix 10 - 10 gauge stone – rural roads, highways – larger potholes
“It’s in a bag , permanent and not afraid of water!”
“Asphalt in a bag is not designed to replace traditional hot mix for road building purposes, but to provide a quick and reliable means of effecting permanent repairs,” says Jackie based in South East Queensland. “The mixture works so well that many of the Asphalt contractors and local councils now use it for repairs and maintenance all around the country.”
• Mix 14 – 14 gauge stone – specialised use – extra large potholes.
That’s the message from Jackie Thew, owner of Sales Agency Australia and distributor of Asphalt in a Bag. Ready to use in all conditions, Asphalt in a Bag provides a pre-mixed product that offers a permanent repair solution for potholes, cracks, utility cuts, driveways, cycle ways, and car parks. We have been supplying many local Queensland Councils and Roadtek depots for a couple of years now. Due to recent changes to our internal structure and the addition of a 10 gauge and a 14 gauge mix on top of the already successful 7 gauge mix we are now in a position to expand our supply across Queensland and the rest of Australia. We currently supply three different grades of mix. • Mix 7 – 7 gauge stone – residential roads, car parks – cracks and small potholes
Manufactured from selective aggregates, bitumen and polymers, the bagged mixture is designed to suit the harshest of weather conditions. With an indefinite shelf life, the ready-mix is ideal for maintaining paths, driveways and roads and can be safely stockpiled awaiting future use. “Asphalt in a Bag expands and contracts with the surface and will bond to concrete, steel, asphalt and even wood,” explains Jackie. “The application of the product is five times faster than the average solution and can be exposed to traffic immediately.” Providing minimal disruption to traffic. With a lifetime performance guarantee, when applied according to the manufacturer’s specifications, Asphalt in a Bag will permanently adhere to the area which is being repaired. With the kind of wet weather we have been enduring this past few months, demand for our product has increased, we have a number of stockist’s throughout the country who can supply 1 or more bags, for quantities by the pallet load (50 bags) either contact one of our stockist’s/resellers or Jackie directly. Asphalt in a bag is a perfect and quick solution in the wet or dry for repair of those dangerous potholes. For more information, consult the website at www.asphaltinabag.com.au or give Jackie a call on 1300 789 967 for price and availability.
Fill that hole!
Building services experts switch on to help aged care sector Leading building services and energy management solutions company, AE Smith, has launched a new national initiative to support the unique needs of aged care building owners and managers. AE Smith was founded in 1898 and today is the largest privately owned building mechanical services contractor in Australia. It is a major solutions provider for a range of industries seeking to modernise and optimise how they manage heating, ventilation, air conditioning and other critical building infrastructure controls that consume energy. AE Smith General Manager of Energy Services, Mr. Doug Binns, said, “There
is a significant growing demand among aged care property owners to reduce energy and operating costs while being able to meet their accreditation requirements and make their assets attractive to tenants, staff and investors.” “Our unmatched experience and expertise can help owners overcome critical accreditation issues, improve the investment value of their assets, address rising costs while improving sustainability,” Mr Binns said. “We can help owners meet their funding assessment obligations while improving the attractiveness of their assets to residents and enhance workforce productivity through simplified control and reporting systems. Investors will understand the benefits of being able to significantly reduce energy costs without large capital investment,” Mr Binns said.
More information call Doug Binns on 1300 313 313 or visit www.aesmith.com.au
Next Gen Insulated Covers S.A. Diversified Products has just launched the first in its range of insulated products called Distinctive. The new insulated Dome and Base combines the latest in material technology and modern design to produce an innovative product that meets the ever changing demand of meal delivery. The efficient modern design provides excellent temperature stability, food clearance and the contours placed on the Dome allows for a superior handle giving greater finger room and comfortable grip as well as better drying when stacked. Distinctive Dome and Base unique design not only provides a great visual look to the presentation, its modern technology also provides efficient food delivery. S.A. Diversified Products has developed and manufactured the insulated Dome and Base in Australia which allows them the flexibility to work with organisations on corporate colours. For more information call Warren on 0419 990 200 or see www.sadiversified.com.au
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product news
Spring is on the Doorstep and Summer is around the corner – “Lets Get Rid of those Stubborn Fungal Infections”
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pring is just around the corner and this means those lovely summer clothes and open shoes come out of the closet. We want to look our best for the new season and so now is the time to get rid of those ugly and irritating fungal infections on our skin and nails we all suffer from, from time to time. Apart from preventing us from looking our best for the new season, fungal infections left untreated can become very severe and cause further complications. Athlete’s foot, Jock Itch, Fungal Nail (Onychomycosis), Ringworm, those itchy little infections found on the bra line, the torso and behind the ears, are all common fungal (Tinea) infections. They are caused by several common fungi found in soil and their spores floating around in the air, indoors and outdoors, and are especially common in the warm humid climates during our spring, summer and autumn seasons. The fungal spores are very prevalent in swimming pool areas, showers, locker rooms and other communal facilities. This also applies to the bathroom and other areas of the home where those with infections walk around with bare feet.
What to look out for • Intense itchiness in the affected areas • Cracked, blistered, peeling or blotchy areas of skin • Redness and scaling with an advancing edge • Discoloured, thickening and crumbling nails The diagnosis can be confirmed by your general practitioner with a scraping sent to a pathology laboratory. Generally if some simple rules are followed infections will be minimised. • After bathing ensure that areas predisposed to infection such as folds in the skin, between the toes, behind the ears, the groin, under the breasts etc are dried thoroughly.
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• Do not use other person’s towels. • Change underwear, socks/stockings daily especially in warm humid. • Wash underwear and socks/stockings in hot water at least 60°C. • When an infection is present take double care to dry carefully after bathing, and scrub the nails thoroughly to stop cross infection. • Use an antifungal powder in your shoes and/or on the body to kill live spores and to help keep the moisture level down on the skin. Fungi love moist warm places. • Ensure bathroom floors are washed thoroughly and regularly. • When gardening use gloves especially if abrasions or cuts are present. In the case of fungal nail, it can take some months to grow a clear nail after the fungi have been killed. Now is the time to act so you can wear those open shoes and have beautiful toe nails again. The same applies to finger nails and other fungal infections on the feet, legs face and torso. Until recently, there has never been a rapidly fungicidal, non toxic, truly effective antifungal available for the treatment of these infections. As a result there has been a tendency for hydrocortisone cream to be used as it stops the itching associated with fungal infections (Tinea). This is a not a good idea, as hydrocortisone thins the skin and being an immunosuppressive drug, suppresses the body’s immune defences against the fungal infection allowing the fungi to thrive. A Queensland company Biovite Australia Pty Ltd ( www.biovite.com.au ) has developed a range of topical antifungal treatments with a natural bioactive ingredient which is non toxic, nonsensitising, anti-inflammatory, truly effective and they are especially suitable for those suffering from compromised immune systems such as diabetics. The products are called Calmagen® SkinKALM® Dermaceutical Cream for fungal skin infections, Calmagen® NailKALM® Dermaceutical Lotion for the fungal nails and Calmagen® FootKALM® Dermaceutical Powder used to eradicate the live fungal spores form shoes and stopping re-infection while keeping the feet dry and fresh. The Calmagen® FootKALM® Dermaceutical Powder is also very effective for treating fungal infections on the torso, legs or feet. Dr Michael Freeman - Dermatologist
The Skin Centre Pindara Specialist Suites BENOWA QLD 4217
Does your client find it difficult to go to the toilet?
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he BIDET SHOP® is in the enviable position of having 100% of customers delighted by their products. Stephen from The BIDET SHOP® knows this first-hand because he hears client’s success stories daily. He says people are constantly calling him to let him know how happy they are. “People can’t wait to tell me what a difference the ‘paperless’ bidet toilet seat has made in their lives”, he says. “They are just so excited about all aspects of the bidet and are keen to share all the positives”. One Occupational Therapist, Renee Kelly says... “The bidet has revolutionised my approach to toilet hygiene for clients and carers of various ages, with physical and intellectual needs. The bidet facilitates independence instilling the client and carer with a sense of empowerment, dignity and confidence to attend to their own self care.” Another lady, who installed a bidet in her home, described it as a ‘life-changing’ event and couldn’t believe a toilet seat would make such a difference to her life. She had always wanted a bidet in her bathroom but had neither the room nor the money to install one. After she had read The BIDET SHOP® ad in the local newspaper... • • • • • • • •
Replaces your existing toilet seat Installs minutes Warm water wash Warm air dryer Heated seat Filtered water Twin nozzles No plumber required
...she felt it was ‘one of the things in life that was meant to be’. Her husband also suffers with incontinence and arthritis, and they found that the bidet had made it a lot easier for him to use the bathroom. Stephen says that the full range of bidets can be viewed and trialled at outlets throughout Australia. He also says, “We are the only company in Australia to supply the Hyundai and Coway range of bidets and, they are backed by one of the world’s largest companies and offer seven-day service if the customer has any problems”. To purchase, call The BIDET SHOP® on 1800 243 387 freecall. (installations can be organised at the same time if necessary for a small charge).
Pelvic Floor Muscle Training cures stress Urinary Incontinence in up to 80% of cases The first issue for 2011 of The Continence Advisor, “The Pelvic Floor: from Teaching to Rehabilitation” recognises the World Continence Week focus for 2011, covering a wide range of topics related to pelvic floor muscles (PFM). From training for women and men, to pelvic floor exercises and the elderly, The Continence Advisor delves into aspects of PFM exercises necessary in obtaining success – for the teacher and patient. “Pelvic floor muscle training is very effective in the treatment of stress urinary incontinence,” says contributor Kari Bø, world renowned exercise scientist and physiotherapist. “The cure rates vary between 36-80% and we know that supervised training is the most effective method.” The Continence Advisor is a free biannual publication for Healthcare Professionals in the field of Continence, from TENA Healthcare. To receive your free copy, contact TENA Customer Service or download the issue online. TENA Customer Service 1800 623 347 | TENA.com.au/ContinenceAdvisor In recognition of the Australian and New Zealand theme for World Continence Week 2011, this edition focuses on the pelvic floor: • Pelvic Floor Muscle Training for men and women • Factors necessary to obtain success from a training program • Pelvic floor and the elderly
Support resources: • Download exclusive Core Wellness support materials including a Motivational Chart • Request your free copy of the Core Wellness Pelvicore Technique DVD featuring Kari Bø • Order free samples for your patients
Simavita helps people everywhere improve quality of life and reduce the cost of care
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imavita is creating solutions to the challenges of rising healthcare costs and an ageing population throughout the developed world. Simavita’s first product addresses urinary incontinence, which is common in older people living in residential aged care facilities worldwide. Incontinence has a significant impact on the psychology, social well-being and quality of life for many aged care residents. Despite the high prevalence of incontinence in
older people, it is poorly assessed and managed. A continence care plan is the most common strategy to manage a resident’s individual continence needs. This usually takes the form of a toileting-assistance program and use of continence aids. Identifying an appropriate continence care plan is a key part in developing person-centered care and funding requirements for aged care facilities. At present, most facilities conduct a manual continence assessment. This requires a carer to manually check each resident every 1 to 3 hours to determine the level of incontinence. It is labour intensive, inaccurate and disruptive. Simavita has developed a medical device called SIM® (Smart Incontinence Management) to address this issue and provide a solution. SIM® allows care givers to do away with costly
Health Check on Quality Applications in Recovering Economy The demand for aged care services will double over the next ten years and the baby boomers requiring care will be demanding greater levels of service and amenities in line with their greater wealth and higher expectations. As a result, services will need to meet the challenges by this increasing diversity of older people in terms of their care needs, preferences and affluence. In line with this is the need to employ a greater diversity of employees with both clinical skills and a skill base outside of direct clinical care to add value, productivity and growth to your business. Finding the right candidate is the key to your overall success. Frontline Health will work with you to source these high-calibre staff by attracting, selecting and helping you to employ people that will deliver. We will combine our knowledge of the local market with the leverage of our National network of offices to ensure that you are not left behind fighting for the attention of top talent. Candidates are on the move in 2011 and will be looking for organisations that act fast and engage them in a way that shows value and urgency. For further information please contact: Belinda Piggott, bpiggott@frgteam.com Phone: 02 9347 3844.
manual continence assessments. SIM® technology enables care givers to perform assessments with precision and reliability. SIM® is an instrumented assessment tool, which provides a person-centered continence care plan. SIM® enhances care, reduces costs and leads to improved quality of life. www.simavita.com
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product news
Ekotek Wireless Positional Duress System
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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.
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.
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.
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.
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.
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 7 of this issue. For more information contact Multitone Australasia on 03 9888 1244
www.multitone.com.au
INNOVATION. What Is It, Where Is It, and How Do I Get It? The industry we are in, is always looking for ways: to be more responsive to the needs of its’ clients; to better manage its’ resources; to reduce its’ operating cost base; to provide better records; to maintain high standards; to develop better systems and on and on and on. It is a never-ending quest in an ever-changing environment of regulation, expectation, and examination. So how do we get there? We often look to innovation. So what is this seemingly mythical product and how do we get our hands on some. Innovation is often talked about in such revered ways, that it must surely solve all our problems in one single dose. I’ve got this car, 4 wheels, 4 doors, engine up front, people inside. Everybody tells me that compared to what was available when Henry Ford first started, it is brimming with innovation, but what is it that is so different? Henry sold cars that had, yep you guessed it, 4 wheels, 4 doors, engine up front, people inside. Yet my car today is full of acronyms that make it safer, more efficient, easier to
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manage, more responsive to my needs, and comparatively, more efficient to run. So where is the innovation? It is in incremental steps laid over and over a good solid idea. Nothing in the last hundred years has been taken for granted, yet there is a very real lineage that can be drawn and seen between the products. So how do we relate this to buildings today? We should start by getting the basics right. Ensure our buildings are planned to make best use of site; maximise solar aspect; utilise best suited materials considering location; achieve efficiency of build in both time and cost without ignoring the ongoing costs. We should spend time to ensure our layouts are staff efficient and consider how much it will cost to heat, cool and light. Our designs should ensure we have made the best use of the systems and technology available considering cost and affordability. So, where is the innovation and how do we get it?.......it is in the detail.