LASA Fusion Autumn 2015

The voice of all aged services Autumn 2015 | www.lasa.asn.au

Global Ageing

Experiencing age services from delhi to durban The politics of dementia

25

consumer choice: what has it amounted to?

39

Critical issues for NFP Directors

51

aged care sector statement of principles

76

The voice of all aged services Autumn 2015 | www.lasa.asn.au

CONTENTS

39 What has consumer choice actually amounted to?

5 CEO Report

45 All I want for Christmas is an LGBTI aged care facility? Well actually NO!

7 Chair Report 9 SA Report 10 NSW-ACT Report

47 Meaningful mealtimes – Supporting residents with dementia

12 QLD Report

51 Critical issues for NFP Directors

14 VIC Report

54 Residential aged care: A system for all

16 WA Report

55 Young people in aged care

19 ‘Let’s Talk’ aged care… for a chance to win $1,000!

59 ‘Riding the wave of aged care leaders’

21 Critical incident management – Containing your risk

60 Factors driving strategic decision making in the industry

25 The politics of dementia 33 What can we do to help Australians die the way they want to?

63 Sage South Africa 2014 study tour report

36 The incredible possibilities of India

81 Product news

EDITOR

76 Aged care sector statement of principles

Justine Caines National Government Relations and Communications Manager

LASA Federal Patrick Reid CEO Unit 4, 21 Torrens Street Braddon ACT 2612 E: patrickr@lasa.asn.au

LASA Victoria Trevor Carr CEO Level 11 600 St Kilda Rd Melbourne VIC 3004 E: trevorcarr@lasavictoria.asn.au

LASA WA Beth Cameron CEO Suite 6, 11 Richardson Street, South Perth WA 6151 E: ceo@wa.lasa.asn.au

LASA NSW/ACT Charles Wurf CEO PO Box 7 Strawberry Hills NSW 2012 E: Charles.wurf@nswact.lasa.asn.au

LASA SA Paul Carberry CEO Unit 5, 259 Glen Osmond Road Frewville SA 5063 E: ceo@sa.lasa.asn.au

LASA QLD Barry Ashcroft CEO PO Box 995 Indooroopilly QLD 4068 E: barry.ashcroft@qld.lasa.asn.au

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DISCLAIMER Fusion is the regular publication of Leading Age Services Australia (LASA). Unsolicited contributions are welcome but LASA reserves the right to edit, abridge, alter or reject

material. Opinions expressed in Fusion are not necessarily those of LASA and no responsibility is accepted by the Association for statements of fact or opinions expressed in signed contributions.

Fusion may be copied in whole for distributed amongst an organisation’s staff. No part of Fusion may be reproduced in any other form without written permission from the article’s author.

2015

LASA Events Develop your skills and knowledge at LASA events across the country throughout 2015.

LASA events cater for all segments of the age services industry to provide you with an opportunity to gain insights from leading experts, understand the age services business environment and share industry knowledge with your peers. Be a part of these fantastic networking opportunities in 2015:

7 - 8 May 2015

11 - 14 October 2015

LASA Q Service Integrated Housing Marriot Resort, Gold Coast

LASA National Congress 2015 Melbourne Convention & Exhibition Centre

28 - 29 May 2015

24 - 25 November 2015

LASA NSW-ACT State Congress The Westin, Sydney

7 - 8 September 2015

Community Care Qld Conference Sea World Resort, Gold Coast

ITAC 2015 Conference Jupiter's Hotel, Gold Coast

���� �tate ���e� ho�d regu�ar �eminar� and training throughout the year. ��ea�e �onta�t your �o�a� o��e for more information.

Co-Design: Tomorrow's Age Services Call for Abstracts OPEN close 16 April 2015 LASA NATIONAL CONGRESS 2015 www.lasacongress.asn.au Visit LASA Events for further information on all of these events plus more:

www.lasa.asn.au/events

TASMANIA

WESTERN AUSTRALIA

FUSION | 5

Report from the CEO IGR underscores the need for continued reform in Aged Care Patrick Reid Chief Executive Officer | Leading Age Services Australia

T

he newly released intergenerational report (IGR) highlights the case for structural policy reform that transcends election cycles and partisan politics.

Sadly the report itself was far more a political piece to justify the budget decisions of government, rather than a visionary dissertation, presenting significant challenges while under valuing the opportunities that an ageing Australia presents us.

Whilst we are amidst reform, projections in the IGR underpin that government and industry cannot take their foot off the reform accelerator if we are to address the demands and seize the opportunities of an ageing population.

Whilst the IGR provides key data and acknowledges a doubling in aged care costs by 2055, the IGR’s value is foreshadowing how all industry stakeholders must respond to the key drivers outlined in multiple intergenerational reports from both major parties We are, however, yet to fully realise the policy and practice levers needed to meaningfully impact at all levels of service delivery.

Much of the analysis within the IGR regarding ageing was expected and simply validates what we already know. I did walk away from the briefing with the overwhelming feeling of the critical need for Australians of all ages to discuss ageing as a normal part of our lives. One of the biggest issues is the topic of intergenerational wealth transfer and how it impacts funding of age services, something highlighted in the seminal 2011 Productivity Commission report on aged care.

It is clear than an essential component in meeting demand both now and into the future, is investment and innovation, particularly in the critical area of technology. Age services is currently under invested in technology and the productivity yield from modest government investment has the capacity to make considerable transformation.

Increasing productivity goes hand in glove with sustainability challenges that lie ahead for all community services. We have clearly heard the message of doing more with less. However it is appropriate for industry to expect investment from government to provide assistance in capitalising on the core components required to meet this challenge. Other professions such as general practitioners, diagnostic imaging and pharmacists have consistently received financial assistance from government to

improve their productivity through I.T, so why not age services where it is obvious that leveraging latent capability (off a low base) leads to high productivity realisation with relatively modest investment. In fact the fiscal trajectory outlined in the IGR can only be achieved with these measures. One must ask why, then they are not a focus of current reform.

With the clear government mantra of living within our means why then is there little activity in managing the expectations of those approaching the need for age services?

The funding and designing of age services is the quintessential intergenerational issue and a national conversation on the implications of Australians living longer is well overdue.

One of the IGR’s interesting figures is there will be a staggering 40,000 centurions in 2055 compared to the 122 in 1975 (300 times the centenarians in 2055 than there were in 1975), further underscoring that we should celebrate a country where in 2055 the average life expectancy will be 95.1 years for men and 96.6 years for women.

As the voice of the age services industry LASA believes industry is ready, and more importantly willing, to do everything it can to maximise productivity and is driving innovation in a number of areas, however we cannot do this alone.

Despite suffering from an incomplete reform process, along with recent funding uncertainty, it must be said that with a smart policy approach and importantly some vision there is an ability not only to meet the demands of older Australians but also to export our capability globally. Aged services have been highlighted in the recent Free Trade Agreement with China and there is certainly considerable opportunity to monetise the practice and experience of our relatively longstanding and stable industry. However, first things first; we need long term agreement on the sustainable pathway forward from all political partners to ensure we do not become flotsam and jetsam through competing populist policies driven by election cycles.

In order to maximise this effort industry needs government to be a meaningful partner and commit to implementing further reforms and lead Australia to a contestable aged care market in order to meet demand while living within our means. â–

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FUSION | 7

Message from the Chair United we Stand…

Dr Graeme Blackman OAM Chair, LASA

A

t the recent LASA Tri-State conference, LASA CEO Patrick Reid briefed delegates on the recent LASA Federal Board decision to proceed with a unitary structure and the resultant timeframes. In February the board met and resolved that a unitary organisation was the most productive option; internally as a representative association and for industry services as a whole. LASA since inception has clearly articulated the need for a single industry voice, and we do not resile from this position, in fact I would suggest that as a board our commitment is stronger than ever. The motto created

by Alexandre Dumas in his novel The Three Musketeers should be adopted by age services, “all for one, one for all” (“tous pour un, un pour tous”), as this approach is the best way to elevate our industry in the eyes of decision makers, providing an organisation that delivers a sum greater than its current parts.

In the lead up to an external report on the best methodology and structure for this change program, state offices will work with you, our members, to ensure we have engagement and discussion on any issues that need further consideration or assessment in order to develop a structure that is fit for purpose and strengthens your advocacy and services. It is envisaged that by July 1 2016 the process will be complete. Coming to the role of LASA Chair after its formation it is very clear to me that in order to live by our initial intention and develop a single age services voice; we must evolve our internal organisation while constantly improving the quality and reach of our services to you.

LASA has considerable strengths and I am confident that the skills and experience across our state offices will unite in the development of a formidable advocacy, industrial and educational force. Our NSW office has a long standing history of employer representation underpinned by its registration as an industrial body with Fair Work Australia. Recently LASA developed a national employer relations service to ensure all members benefited from this expertise and up to the minute information on all relevant employment matters.

The development of a national training and education institute through the expertise of LASA Victoria and Queensland is also exciting. LASA has already shown considerable leadership and vision in the training and education space. A particular example of this was the demonstrated success of the Aged

Care Nurse Graduate Program in Victoria. Despite the hurdles facing residential aged care the LASA partnership with Monash University resulted in incredible success in raising the profile of industry and placing Nurse Graduates who previously may never have seen aged care as a career option. Over the 3 years of the program the retention rate for graduates was 80% and the average age of graduates was 34 years, compared to the industry average of 50 years this is a real achievement.

Considering the success of this program it should undoubtedly be rolled out nationally. A unified LASA organisation is better placed to do this and in turn can provide greater input to government in supporting workforce development and attraction programs with proven outcomes rather than the plethora of ad hoc programs previously or currently funded.

Our events team is also operating in a united fashion and sharing resources to deliver a world class national congress and fantastic state events. This ensures staff at all levels of the industry are provided with the latest research, innovations and inspiration to support the wonderful yet challenging frontline care of older Australians.

It is clear that these practical support services to members have enhanced since LASA’s formation and will continue to do so. I am also looking forward to greater strength and focus in the advocacy space. Together LASA has been unrelenting on the removal of $643 M through the cessation of the aged care payroll tax supplement and underwhelming realignment of the dementia supplement for residents displaying severe behavioural symptoms.

Both state and federal offices have run strong campaigns highlighting the impact from loss of income to the industry, inequity of funding and the very real adversity created when funding is removed directly from care budgets.

The work ahead of LASA to establish a more sustainable age services is considerable. I am confident as we progress with you the unification of our organisation we will be buoyed with developments for a single representative voice across age services; I believe is the only way we will achieve our desired aims to establish the profile and funding commitment to ensure that all older Australians indeed live well. To the remainder of the industry we say “tous pour un, un pour tous”. ■

8 | FUSION

FUSION | 9

South Australia Report Paul Carberry Chief Executive Officer | LASA SA

F

orecasting is a tricky business. If you don’t believe me have a look at page 106 of the 2015 Intergenerational Report (IGR). The table compares Australian population projections for the year 2050, as provided in the four IGRs we have had so far.

The 2002 IGR projected the population would be 25.7 million in 2050. Given that, in 2015 the actual population is already 23.8 million, the 2002 IGR was out by around 29 years.

Just as well, since population is one of the three key drivers of economic growth which the report talks about, having only 25.7 million people in 2050 wouldn’t have got us the necessary growth to maintain our standard of living.

The other main economic drivers are participation and productivity, conveniently all commencing with the letter “p” for ease of remembering.

If the above example is anything to go by, we need to treat the long-term forecast numbers with caution, however that does not detract from the overall messages of the IGR. • Life expectancy will continue to increase, and the proportion of people aged 65 and over will continue to grow.

• This means the proportion of people of working aged will decline compared to those over 65, leaving fewer people paying taxes to support the pension, health and aged care needs of the elderly.

• This trend can be reduced by increasing the participation rate of women and of people aged 65 and over.

• It can also be reduced, or hindered, by the decisions we make about migration in the future.

• We will need to improve productivity growth, which has slowed since the 1990s, and this will depend on our ability to develop and adopt new technologies and improve workplace flexibility.

The IGR talks about choices, and some of these will be reflected in how we deal with the issues raised above.

For example, participation rates for women in the workforce will be affected by decisions we make about childcare. Improving the participation rates for older workers might involve offering tax concessions, or re-training opportunities.

Improving our uptake of technology may require an increased emphasis on maths and science in our schools and universities.

Recently we have slipped behind our Asian neighbours in this areas and that is where the competition will come from.

It might seem a long stretch to connect the quality of health and aged care Australians will receive in 2050 with the maths and science skills of today’s students, however that is the reality.

The other kind of choices we will have to make are about how we apportion the money raised and spent by the government between different sections of society.

For example, a dollar spent on aged care can’t be spent on teachers’ salaries, and a dollar spent on subsidising medicines can’t be spent on school computers.

Do we increase taxes on younger workers to pay for the escalating health costs of older people? Should superannuation incomes be tax free and should the family home be exempt from the pension asset test, or the aged care means test for that matter? If the answer is “yes” then which group makes up for the revenue which is foregone?

To my mind, these are the real intergenerational questions, and there are no right or wrong answers. What’s fair from one person’s perspective may be unfair from some else’s.

As advocates for the ageing and the sector which cares for them, LASA needs to ensure it argues a consistent, long-term case, one which tries to balance the many competing needs of Australian society, now and into the future. ■

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NSW-ACT Report Aged care industry must set the tone Charles Wurf Chief Executive Officer | LASA NSW-ACT

E

ntering 2015, the aged care industry is implementing a reform process which promises to unshackle many traditional practices and provide opportunities for providers who understand current and future care needs and wants. Entering 2015, the aged care industry continues to struggle through cutbacks, failures in Government systems and processes, and political leadership which has consistently failed to articulate a vision for future care and a viable industry to deliver it.

Which of these statements is correct? Is there some truth in both, or neither?

Our reality, frustratingly, is that the aged care industry enters 2015 far more polarised in outlook than has been the case for many years. We knew the reform process would be challenging, but we could not have estimated Departmental lack of preparedness, or the illogical decisions to cut vital Supplement funding.

In 2015, for each incidence of a provider evolving to meet the opportunities afforded by reform, there seems to be a story of another provider looking to make difficult decisions as it attempts to shore up its budget following unexpected Supplement cuts. No matter how many angles those responsible for aged care policy in Australia look at it, industry consolidation is not growth.

The challenge the industry must embrace in 2015 is to set the tone, create the space for debate, and succeed in its advocacy. I believe LASA is the only peak body or organisation which can achieve this.

The New South Wales experience Each State and Territory has its own unique challenges.

One of the unexpected consequences of the illogical Federal Government decision to cease the Payroll Tax Supplement was to exacerbate the unfairness in the delivery of care, based on geographical location.

The rate of payroll tax varies between States and Territories, and some providers will pay more than others just being on a particular side of a border. Who is most impacted by Federal

Government cuts to Supplements? The residents, through tightened budgets as providers struggle to make savings to remain viable.

Other differences include, most notably from a New South Wales perspective, legislated staffing requirements. New South Wales is the only State where there is a requirement for registered nurses to be in residential aged care facilities 24 hours a day, 365 days of the year. Who funds this? The provider (and for the private provider a higher unsupported payroll tax obligation). Definitely not the State Government that regulates it.

Cutting the Payroll Tax Supplement has led to much anger directed toward the Federal Government. But what seems to have gone unnoticed in Ministerial and Departmental offices in Canberra is the white-hot hostility which has resulted from the Government turning its back on the consequential problems cutting the Supplement created, many of these through different obligations and requirements of State Governments.

Australians are not treated the same when it comes to the funding of aged care. It should not matter whether a person receives care in Tweed Heads or Coolangatta, Canberra or Queanbeyan, or Albury or Wodonga. But in reality it does, and the Federal Government’s actions in 2014 did far more to exacerbate cross-border differences in one year, than has taken place over decades.

LASA NSW-ACT Office Upgrade In early January 2015, after months of planning and preparation, LASA NSW-ACT commenced an upgrade of our Surry Hills office. When completed the office will provide a platform to better educate, support, and inform our Members.

Following lengthy negotiations for our new lease, we can now assure Members we will remain in our current location for at least the next five years. We have achieved a range of considerations in our negotiations enabling the Association to maximise the new resources available to Members, including two new dedicated education rooms. â–

12 | FUSION

Queensland Report And we have a winner…or do we?

Barry Ashcroft Chief Executive Officer | LASA QLD

A

fter what seems like an eternity, the results from the 31 January 2015 Queensland Election are finally in, seeing the Labor Party form a minority government, with the support of Sunshine Coast Independent MP Peter Wellington.

As Queensland’s first female Premier elected from Opposition, Annastacia Palaszcuk announced a 14 person Ministry (down from the previous 19 Ministers), which she herself describes as ‘a mix of experience and fresh faces... with much hard work ahead of them.’

So what does this mean, if anything, for the age services sector in Queensland?

Despite the limited responsibility and jurisdiction of the State Government with respect to age services, LASA Q has identified a number of areas of interest and/or concern for the sector; requesting meetings with the relevant, key Ministers and their senior staff to discuss.

In our letter to Minister Enoch – Minister for Housing and Public Works, LASA Q reinforced our commitment to the collaborative, consultative and productive relationship we share with the Department of Public Works, with a particular focus on progress made following the release of the Consultative Regulatory Impact Statement (CRIS) as part of the review of the Retirement Villages Act 1999. Similarly, we sought to continue to work in partnership with the department on its Compliance and Education Program; ensuring our members are well-informed and prepared for village visits and audits, and supported the ongoing funding of the Park and Village Information Link (PAVIL) in informing and assisting residents of retirement villages and manufactured home parks in Queensland. We also highlighted our ongoing concern in regard to the limited and unsuitable care and accommodation options currently available to vulnerable older Queenslanders and younger people with a disability.

In contacting Minister O’Rourke – Minister for Disability Services and Minister for Seniors, LASA Q again acknowledged the collaborative and consultative relationship we have fostered with the Department of Communities, Child Safety and Disability Services, particularly around the Qld Community Care Program.

We highlighted that a key focus of our association was the availability of appropriate funding through the Community Care Program to ensure older Queenslanders, deemed ineligible under the National Disability Insurance Scheme (NDIS), continued to have access to appropriate resources to support them living in the community. We emphasised industry concern around the unmet needs of consumers (already receiving disability funding) being provided through the Home Care Package Programme, and questioned whether consideration had been given to this as part of NDIS discussions. We also raised the issue of limited and unsuitable care and accommodation options currently available to vulnerable older Queenslanders and younger people with a disability, and enquired about the State Government’s interface with the Australian Government’s My Aged Care site in terms of providing information, advice, advocacy and access to services to Queenslanders aged 65 years and over.

In welcoming Minister Dick – Minister for Health to his new portfolio, LASA Q highlighted our most recent cooperation with the Department of Health around the proposed replacement of The Health Act 1937 (Qld), repeal of the Health (Drugs and Poisons) Regulations 1996 (Qld), and introduction of the Drugs, Poisons and Therapeutic Goods Act and Regulation.

In this regard, we reiterated that suggested changes to the Act, particularly as they relate to medication management, will have a significant impact on the age services industry, and predominately, the Residential and Community Care sectors. This was especially relevant in the context of medication administration and unregulated workers, an area in which LASA Q sought to continue to work in collaboration with the Department of Health.

Whilst LASA Q has been quick in introducing the industry and the Association to the new government, and in outlining the policy platforms critical to ensuring the age services sector and the older Queenslanders it supports are represented, we are cognisant of the need to allow for a ‘settling in period’.

I certainly look forward to meeting with the new Ministers and their staff in the coming months to discuss how we can continue to work together in productive partnerships that produce ‘wins’ for all the stakeholders involved. ■

FUSION | 13

14 | FUSION

Victoria Report LASA AGED CARE HEALTH & SAFETY MANUAL Trevor Carr CEO | LASA VIC

A

t the recent Leading Age Services Australia (LASA) Tri-State Conference in Albury, LASA Victoria announced the development in 2015 of the LASA Aged Care Health & Safety Manual.

The LASA Aged Care Health & Safety Manual will provide the first comprehensive set of peer reviewed template health and safety policies, procedures, safe work practices, forms and checklists covering both residential and home care that can be tailored to individual workplace needs.

Applicable to all Australian employers irrespective of operational size, approach or jurisdiction, this unique industry resource is being developed by the industry to meet the health and safety needs of the industry.

This initiative originated from members of the LASA Victoria OHS Committee who identified the need for an industry

specific resource to assist providers continually improve safety performance in the sector, which has been identified by WorkSafe Victoria as having a disproportionately high injury rate when compared to other health sectors.

As a positive investment of accumulated reserves for direct member benefit, LASA Victoria has chosen to fund the development of this new resource as a demonstration of our commitment to continue to work with members to promote health and safety awareness and a safety culture across the industry.

Valued at over $1,200, the investment of accumulated funds will enable the purchase price of the final product to be discounted for LASA members across Australia.

In addition to the template documents, the LASA Aged Care Health & Safety Manual will also contain a safety framework to enable providers to identify and address gaps in their safety practices and continue to improve their safety performance.

A Working Group comprising the below LASA Victoria member providers and external safety and legal consultants has been formed to oversee the development of the manual, which has a completion date of mid-2015: • Villa Maria • Care With Quality • Calvary Community Care • MPD People • Doutta Galla • Norton Rose Fulbright • Embracia Lawyers.

The Working Group will ensure the final product achieves the following objectives: • Be user friendly and assist aged care providers comply with H&S legislation • Be a scalable and legally reviewed resource applicable to all employers irrespective of operational size or approach • Contain a safety framework and risk assessment process to identify and address gaps in safety practices to enable continued improvements in safety performance • Promote a health and safety culture across the industry to emphasise the value and importance of incorporating safety into work practices • Reduce current duplication of management effort in drafting policy and procedural documents in isolation, allowing time to be better spent proactively addressing in-field safety issues • Provide a basis for individual employer accreditation under Australian Standard AS4801 Occupational Health and Safety Management.

• LASA Victoria wishes to thank the abovementioned members for volunteering their time and resources to help develop this important industry resource ■ More information about LASA Aged Care Health & Safety Manual will be made available in coming weeks, prior to its official launch in mid-2015.

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WESTERN Australia Report Enough already!

Beth Cameron Chief Executive Officer | LASA WA

L

ike all of you, I hoped that we would leave the debacle that has been Medicare in 2014.

I was as devastated as each of you when January saw an increasing number of problems arise.

Aged care providers have experienced frequent and continuing errors with Medicare payments since 1 August 2014. These challenges have brought about significant cost and administrative burden to aged care providers, including challenges meeting audit requirements and deadlines.

Despite ongoing conversations with the Department of Human Services aged care providers and older Australians in their care continue to be significantly impacted by errors.

The 2015 challenges have occurred because Medicare have been undertaking repeated and differing means assessments of aged care recipients, altering the co-contribution required.

Medicare assess and send one letter stating how much of a means tested/daily fee should be charged, and then reassess the resident and alter the fee schedule.

Some Income Test Fee Subsidy reductions are being incorrectly deducted from subsidies; do not match income test fee letters; or deductions are simply overstated.

This is causing significant confusion and concern for clients, who understandably choose and enter care arrangements considering their needs and financial obligations. Where payments are altered months from the start of care, this can be a significant unexpected cost that families are not prepared for.

Administratively, this burdens care providers with calculating, billing and then reviewing, re-billing for months that have passed as Medicare reduce payments – leaving care providers to chase

Feedback from members suggest that Medicare errors are impacting approximately 15% of aged care recipients. up the resident for the unpaid amount. And leaving care providers to explain the reasons.

The confusion and stress puts strain on the relationship between the older person, their family and the care giver.

Each error impacting a client, their family and generating incredible stress for everyone concerned.

To compound the issue, it seems that responses to concerns raised with Medicare are either going unanswered – or inadequately answered.

We know of aged care providers currently owed over $100k due to these errors, single facilities owed $50k+ and growing numbers of residents now owing thousands of dollars.

This issue is exacerbated for DVA clients, where records do not automatically get shared with Medicare. Care providers have had to contact DVA and request income statements from them and then have to send these on the client’s behalf to Medicare.

This process delays reimbursement of overcharged reductions by around three months and places a huge administrative burden on staff.

The issue is also a particular problem for clients receiving a foreign pension.

LASA-WA are requesting that: 1. Every effort be made to correct the systemic issue in the DHS system that results in errors occurring.

2. The government waive any unexpected debt on older Australians in care that has arisen due to system failure.

3. Given the significant costs this and other Medicare issues has had on providers, repayments for previous systems failures should not be required at this time without the providers approval.

This has been an abject failure by the government, with enormous imposition on the sector. To continually claim the issues are fixed, as Patrick so eloquently put it to Minister Fifield’s Office, is a gross diminution of the angst it is causing all concerned. ■

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FUSION | 19

‘Let’s Talk’ aged care… for a chance to win $1,000!

T

alking about aged care no longer has to be the subject you prefer to avoid. In fact, encouraging your clients, or prospective clients, to chat about their care needs can be beneficial to their future wellbeing.

Whether they fancy five-star luxury care, tastier meals or the comfort of having their pet stay with them, a new online survey, Let’s Talk, will make having ‘that conversation’ about nursing homes and care in the home much easier.

Let’s Talk encourages people to share their experiences and expectations of residential aged care and home care services.

The survey was co-developed by national specialised aged care advisory service, The Ideal Consultancy and DPS Publishing, an independent national publishing business operating the largest website for aged care in Australia, AgedCareGuide.com.au, which has twice as much traffic as the federal government’s multimillion dollar website, My Aged Care.

The survey takes about 15 minutes to complete. Respondents can choose to remain completely anonymous or provide their contact details at the end of the survey to enter the draw to win a $1,000 Visa Debit Card.

As well as giving people the chance to discuss various aspects of care, offered in either a residential aged care facility or via a regular visit at home, Let’s Talk also aims to improve the quality of communication and delivery of services between aged care providers and consumers as Australia’s population ages.

Respondents to the online survey are asked to list their main preferences for researching and gathering aged care information, and to rank the importance of things such as pet friendly facilities and quality of food in residential care, and much more.

People are encouraged to give honest opinions on their aged care experience and the process they undertake in finding and securing care, whether in the initial stages of investigating the services available or at a critical juncture for themselves or a loved one.

Improving the care of residents Social media interaction on DPS Publishing’s Facebook page, DPS News, which initiated debate as a forerunner to Let’s Talk, exposed consumers’ proposals for the types of activities aged care facilities should adopt to encourage greater stimulation among residents and recommendations of changes to facility dining menus.

The responses on the DPS News Facebook page also gave aged care workers advice on how to improve the care of residents, while also discussing the negative stereotypes

associated with the aged and community care industry, and how consumers see the future state of the industry in a decade.

Fiona Somerville, The Ideal Consultancy Commercial Director, says while they work strategically with Boards and executives of aged care organisations across Australia, Ideal also understands that consumers are seeking more choice and the best options for their own circumstances.

“We saw an opportunity to conduct a significant body of research that will not only benefit consumers, but also aid the broader aged care industry,” Ms Somerville says.

“With a similar ‘can-do’ approach to business, and with DPS having the most visited residential aged and home care website (www.AgedCareGuide.com.au) for consumers in Australia, we knew this was the best company to partner with,” she adds.

The aged care journey Communication plays an essential role in maintaining resident autonomy and sense of self, and ultimately affects mental and physical wellbeing.

Many aged care staff are rewarded by building relationships with residents, and can have higher levels of job satisfaction when they can do so.

The sooner people start talking about aged care and planning ahead, the more choices they will have and, possibly, the better the outcome.

Sometimes, people don’t think about their aged care needs until an unexpected event or health problem occurs. If this happens, it can be a confusing and emotional time and trying to find information and support to help understand their options can be difficult.

The ‘aged care journey’ is not chosen; it is imposed by illness, accident or chronic health conditions.

Becoming aware that home and community care or nursing home care is needed might be sudden, a result of a crisis, or can sneak up slowly. Regardless, it is seldom planned.

Deciding on the care, treatment and living arrangements for a resident can be incredibly stressful. If they are feeling overwhelmed, confused, stressed or concerned, there is some consolation in knowing that these emotions are normal.

The most difficult part of this journey is actually not the knowledge, but in fact talking through the decision-making based on the information.

It is not unusual to want to make the best decisions. While this process can be challenging, it’s important to encourage older people to ‘talk’ about their, or that of a loved one’s, care needs. ■ Complete the Let’s Talk survey: dps.com.au/letstalk

20 | FUSION

2014 winners, left to right: Janine Buckley, representing Feros Care; Graham Custance, Care Connect; Paula Fievez, Ageing Wisely.

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FUSION | 21

Critical incident management – Containing your risk

By Julie McStay – Hynes Legal

A

critical incident in an aged care facility has the potential to expose the organisation to legal, financial and reputational risk. By examining a recent factual scenario we will demonstrate how an organisation’s level of preparedness can have a direct impact on how quickly and efficiently the organisation is able to manage the outcomes of a major incident.

Factual scenario – major incident Sally and Tom are residents of the dementia unit of an aged care facility. They have both displayed challenging behaviours in the past. Sally and Tom have had a few run-ins with each other since Tom moved into the facility and staff have been trying to keep them apart as best as possible.

One evening, the residents are all in the common area having their evening meal. There is only one staff member supervising the residents as the other staff member on duty is on a tea break.

Sally approaches Tom and tries to take his cup away from him.

Tom puts his hand up to try to stop her and Sally grabs a handful of Tom’s shirt. Tom pushes Sally, seemingly to get her out of his personal space, but Sally falls over and bangs her head. It all happens too quickly for the staff member on duty to intervene.

Sally gets up and is able to walk away from the incident reporting no pain. However, later in the evening her condition deteriorates and she is taken to hospital. Sally has sustained a herniated haemorrhage and passes away in hospital. The police arrive at the facility to investigate the incident on behalf of the coroner.

What happens next will determine whether the organisation is able to contain the situation and respond in a controlled manner, or whether the risk will be compounded by the organisation’s response. We will now depart from the factual scenario to compare two possible responses and demonstrate the impact each response could have on the outcomes of the situation.

The underprepared response In the first response scenario, the organisation faces a number of issues.

1. The organisation has no policies or procedures in place regarding critical incidents. Staff are unsure of their roles and responsibilities • The RN is not called until Sally’s situation becomes critical and Sally is not transferred to hospital until hours after the incident.

No one contacts the facility manager who only hears about the incident when arriving at work the following day, long after the police have completed their investigation and left.

• A disgruntled staff member fills in the official Incident Report form, using it as an opportunity to voice opinions as to why the incident occurred and how it could have been avoided.

The incident report form contains inflammatory statements and errors and inaccuracies.

2. Staff have not received any training in relation to responding to a critical situation or communicating with the police and the media • Staff members volunteer to give statements to the police.

In their statements, they complain about the facility being understaffed, saying management refuses to acknowledge or fix the problem. All of the formal statements contain information that is irrelevant to the issues and potentially prejudicial to the organisation’s legal position.

• No one contacts Sally’s family to advise them of the incident.

• One staff member answers a call from a local reporter.

She tells the reporter that a resident has died after a violent altercation with another resident and the police are currently raiding the facility to investigate the incident. She says she is not sure exactly what happened because she was on a break at the time and the other staff member on duty was run off her feet so she did not witness the incident either. The next morning, an article is published in the local paper with the headline Resident killed at aged care facility and there is not enough staff for anyone to notice.

3. There is no procedure in place for post-incident management or investigation • Responding to the content of the Incident Report form and the statements given to police, the coroner commences an enquiry. The organisation does not seek any external

22 | FUSION

guidance or assistance in dealing with the coroner. During the enquiry, the organisation attempts to explain that the Incident Report form and formal statements contain some irrelevant information, statements of opinion and errors and inaccuracies.

However, the coroner will not depart from the information contained in these official records. The coroner finds that there are serious systemic issues present in the organisation and it could have done more to prevent the incident occurring.

The coroner decides to hold an inquest.

• The Department of Social Services (Department) conducts its own investigation and finds that there are systemic issues within the organisation and considers there to be a significant risk to resident safety. The Department imposes sanctions on the facility which, if left unresolved, could result in the facility’s status as an approved provider being revoked.

The pre-planned response In the second response scenario, the organisation has planned for a critical incident. Although it faces the same issues, the outcomes are markedly different from the first response scenario.

1. The organisation has policies and procedures in place that comply with the relevant legislation and are specifically tailored to the organisation. Staff are acutely aware of their individual roles and responsibilities in the event of a crisis • As soon as the incident occurs, the RN on duty in the main facility is called to attend and respond to the residents’ clinical needs. The resident is immediately transferred to hospital.

The RN identifies that this is a critical incident, preserves the scene and calls the facility manager to attend immediately.

• The most senior staff member on duty compiles the necessary information from other staff to complete the Incident Report form without delay, ensuring it contains only accurate, relevant information of fact and no expressions of opinion.

2. The organisation conducts regular training sessions for staff. Staff understand how to respond to a critical situation and how to deal with the police and the media • When the police initially arrive, staff on duty tell the police they are happy to cooperate. However, they explain to the police that they only have authority to release the names of the resident, the resident’s next of kin and doctor, explaining that any further information will need to be sought from the facility manager who is on his/her way.

• The facility manager arrives promptly and explains to the police that while staff are willing to cooperate, they are tired and shaken up and need the opportunity to rest, gather their thoughts and obtain legal advice if necessary, before providing a formal statement.

• The facility manager contacts both resident’s next of kin to explain what has occurred.

• The facility manager fields a call from a local reporter and provides a measured response. In line with the organisation’s media policy, the facility manager simply states that there has

been an incident at the facility, the facility is cooperating with the authorities to deal with the situation and a formal statement will be released in due course. The newspaper does not publish a story, deciding to wait instead to see if further details of the incident come to light.

3. The organisation has a procedure in place for postincident management and seeks external assistance • Once the immediate situation has been contained, the facilities manager contacts the CEO. The CEO engages solicitors to conduct a thorough, independent investigation into the matter.

• During the independent investigation, the organisation is made aware of some operational shortcomings and takes immediate steps to rectify the issues under the advice of its solicitors.

• Because this information is communicated by the solicitors to the organisation for the dominant purpose of giving legal advice, the information is subject to legal professional privilege and the organisation is not required to disclose it to the regulators in these particular circumstances.

• The organisation’s solicitors provide the coroner and Department with information and statements in a controlled manner.

• The organisation takes positive steps to address any systemic issues or risks to resident safety and is able to demonstrate this proactive approach to compliance to the regulators.

The coroner finds there is no need for an inquest.

• The Department does not consider there is any immediate risk to residents and decides not to impose any sanctions as the organisation has already resolved the issues and is fully compliant.

How can you prepare for a critical incident?

The comparison above demonstrates that there are steps an organisation can take to minimise risk and control outcomes as much as possible. We can assist you with a number of these steps, including: • Providing policies and procedures that are compliant with the relevant legislation and tailored to your organisation, bearing in mind the risks inherent in the aged care industry and unique to your particular facility; • Conducting staff training to ensure staff understand the policies and procedures and have the necessary skills to respond to a critical situation and deal with police and the media; and • In the unfortunate event an incident occurs, conducting an independent investigation, preparing statements and liaising with regulators on your behalf.

If you need assistance with any of the matters raised in this article please contact Julie McStay, director and head of Aged Care and Retirement Living, Hynes Legal. ■ This article is not intended to be a substitute for legal advice. Providers should always seek legal advice in relation to any specific risks or requirements that will apply to the individual circumstances of their business

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FUSION | 25

The politics of dementia

By THE HON SHAYNE NEUMANN MP, SHADOW MINISTER FOR INDIGENOUS AFFAIRS SHADOW MINISTER FOR AGEING, FEDERAL MEMBER FOR BLAIR

THE 6TH ANNUAL DEMENTIA CONGRESS SHERATON HOTEL, MELBOURNE FRIDAY, 20 FEBRUARY 2015

L

abor’s Shadow Minister for Ageing and Indigenous Affairs, Shayne Neumann, delivered a speech to the sixth annual Dementia Congress in Melbourne.

He outlined Labor’s vision for dementia-friendly communities within the current political climate. Mr Neumann is hosting a forum in Canberra later in March to explore innovative staffing models, providing greater continuity to aged care residents and so far showing promise of enhancing care and providing greater job satisfaction. Below is an excerpt from his speech.

Introduction As I have travelled around this country over the past year, I’ve witnessed great advances in technology, care practices and science.

I’ve visited amazing facilities and met memorable characters.

I’ve enjoyed a multitude of coffees, conversations and conferences with many aged care providers, consumers, peak bodies and researchers.

Last year I stated that Labor would be ready for the next election with a detailed ageing policy.

We are on track.

We are still learning from and listening to you.

I look forward to discussing elements of policy with a number of you over the next few months.

Reframing “ageing” and “dementia” When I spoke last year, I mentioned that former US President, Ronald Reagan’s experience with Alzheimer’s Disease, and his family’s openness, helped us to start talking about dementia in the 1990s.

Through the 2000’s Hazel Hawke courageously opened the door further and we shared hers and her family’s experience.

Alzheimer’s Australia has introduced us to some incredible individuals.

Christine Bryden – a dementia survivor for 20 years. Christine is an inspirational advocate, author and speaker and a refreshingly normal woman.

Kate Swaffer – a fierce consumer advocate and a consultant with Alzheimer’s Australia who has given us an insider’s view of younger on-set dementia.

This year there is an Oscar nominated movie, Still Alice, which has introduced a much wider audience to the experiences of those with dementia, particularly those with younger on-set dementia.

These stories and experiences remove a curtain and allow us to see beyond the disease itself and remember there is a soul; a soul that does not have dementia.

Unfortunately Ronald Regan’s successor, George H W Bush, did not embrace ageing so openly.

He once said: “Ageing’s alright … better than the alternative.”

Before we can truly change the public perceptions of dementia, we have to deal with the terrible truth about ageing.

You cannot go through a supermarket checkout without seeing a plethora of magazines, all teasing us about the latest celebrity secrets to eternal youth.

But I sense the public mood is beginning to shift.

A photograph of former super-model Cindy Crawford went viral on social media recently.

The photo had not been touched-up.

It revealed a soft, marked belly, showing signs that it had previously carried two children.

The skin on her legs and torso was uneven, wrinkled and even lumpy.

The public response was immediate praise.

Previously, she has admitted that her body has changed but the changes remind her, not of what she has lost, but of what her body has been capable.

Ageing is not just a better alternative to death.

Ageing represents a host of great achievements.

Ageing is the only path we can take to accomplish the goal of living longer.

Achievements and opportunities There have been noteworthy achievements over the past 12 months.

In September 2014 the Panel for Positive Ageing, chaired by the ever-youthful Everald Compton, released the Blueprint for an Ageing Australia.

The Blueprint outlined that ageing should not be framed as a problem or even an economic and social burden.

26 | FUSION Our longevity is one of the greatest achievements of the 20th century and should be celebrated.

Ageing presents us with opportunities – such as increasing the participation of older people in the workforce.

The Blueprint addresses obstacles that need addressing, including the absence of adequate workers compensation for people aged over 65.

This is taken up in more detail by the Age Discrimination Commissioner Susan Ryan.

Following on from the Blueprint, Susan gave an insightful speech to the Press Club titled The Longevity Revolution.

She addressed the regulatory changes, such as workers compensation and income protection for older workers. More difficult to change though are underlying workplace culture and broader stereotypes.

It is estimated that over 2 million Australians aged over 55 years would like to work but cannot find work.

The Age Discrimination Commission launched its campaign The Power of Oldness, which included a humorous, one-shot video aimed at reclaiming AGEING as something to celebrate.

It then juxtaposed that with the reality of age discrimination and the perceptions preventing meaningful employment opportunities.

In her speech, Susan Ryan recommended a Jobs Checkpoint Plan for Over 50’s.

Much like a health check-up, the plan is to introduce a preventative and regular career or job “check-up”; before unemployment hits.

As people approach the age of 50 they need to assess what they actually see themselves doing for the next phase of their working life.

On this same topic, Emily Millane of Per Capita, released a report called “The Entitlement of Age”.

She argued that the current retirement income system is inadequate to meet the longevity challenge.

The retirement income issue is a BBQ stopper.

As we eagerly await the overdue Intergenerational Report, I would caution the Abbott Government not to use older Australians as an excuse to implement harsh budgetary measures.

Older Australians need not feel guilty for their longevity.

It is important we do not penalise those who have successfully lived longer.

The ageing population certainly presents challenges – increased workforce participation, appropriate housing, public transport, health networks and of course the increased incidence of dementia.

Former Labor Treasurer Wayne Swan set up an Advisory Panel, chaired by Everald Compton, on the opportunities for an ageing population, following the release of the Fourth Intergenerational Report.

In contrast, one Joe Hockey’s first acts as Treasurer was to fire this Panel.

As we head to the next election, Labor is addressing the opportunities of an ageing population in its policy development, across a number of portfolios.

Rather than punishing older people, Labor is looking creatively at how we can maximise the opportunities presented by the longevity revolution.

With more people turning retirement age than working age, as a nation we have to think about a plethora of policy challenges.

These include housing and public transport, work and productivity, taxation and revenue streams, age discrimination and much more.

We need age-friendly communities, as well as dementiafriendly communities.

I want to acknowledge the work of Alzheimer’s Australia in developing the “dementia-friendly communities” campaign.

Last year they brought Steve Milton to Australia from the UK. Steve is a leader in developing innovating ways to engage with people with dementia.

The dementia-friendly community concept provides support to those living with dementia to live a high quality of life.

I had the great privilege of meeting Dr Alexandre Kalache – a former Director of the World Health Organisation, who advanced health and gerontology through the WHO’s Active Ageing Policy Framework.

In 2011-2012 the South Australian Government invited Dr Alexandre Kalache to be a “thinker-in-residence” in South Australia.

He described age-friendly cities as “environments where all the basic assets for you to have quality of life in an urban environment are present.”

He worked with them to develop an age-friendly city concept to make Adelaide a place where older South Australians could maintain their independence and participate in life as a connected member of the community.

Communities need to be equipped so they can be places where Australians can age well, at home within their community.

Communities where older people can remain active, mobile, productive and engaged.

We know that staying mobile and healthy will improve health outcomes.

Health cannot simply be perceived through a fiscal lens, which sees it only as a major expenditure item for the Government.

Primary health needs to focus more on developing and maintaining a healthier and more active population.

One of the features of Living Longer Living Better was the principle of “ageing in place”.

Ageing is no longer something you do in a facility, separated from society.

It is something we do in our communities, in the open, for everyone to see.

The Commonwealth Home Support Program will assist in the provision of services to support people to stay in their own homes longer.

More Australians will receive aged care in their own homes and communities.

I have noticed more aged care providers moving into the retirement living space.

There would appear to be a natural synergy between independent living units and home care.

Downsizing the family home can assist people to stay at home longer.

The previous Labor Government introduced the Housing Help for Seniors pilot program to remove a significant barrier for seniors who wished to downsize.

FUSION | 27 The Abbott Government axed this trial program, before it had a chance to begin.

This was a foolish and rash decision.

I find it interesting that the new Social Services Minister, the softer, kinder, cuddlier version of Scott Morrison, has been espousing the need to provide such assistance for pensioners recently.

I wish he had been as vocal about the idea in Cabinet when they were making the decision to axe the program and make unprecedented cuts to the Age Pension.

Regardless, we welcome the new Minister to this space.

Everald Compton and former Deputy Prime Minister, Brian Howe discussed the importance of appropriate housing in the Blueprint for an Ageing Australia.

The Housing Help for Seniors pilot program would have helped pensioners move into a home which better suited their needs of a lesser value.

It would have only been available for those of Age Pension age, who had lived in their homes for 25 years or more, and who downsized into a home of lesser value.

The scheme would have allowed them to place at least 80 per cent of the excess sale proceeds, up to a cap of $200,000, from the sale of their former home into a special account.

This account would have been exempt from the pension income and assets test for up to 10 years or until a withdrawal was made.

Dementia and disability As we move forward we need to recognise the overlap between aged care and disability care.

The National Disability Insurance Scheme will draw some of its workforce from the same pool as the aged care industry.

Dementia will soon be the leading cause of disability in the nation.

There may be room for group homes, particularly for those with dementia.

Group homes may be a way of accommodating younger people with dementia – too young for an aged care facility, but with complex needs which require additional care and support.

As we “age in place� residential care facilities will become more and more specialised in geriatric conditions including chronic conditions, frailty, and of course dementia.

As they change, the workforce will need to change.

Workforce One of the biggest challenges in aged care is ensuring we have the workforce to meet the ever-increasing demand.

In particular ensuring we have appropriately skilled, and fairly remunerated professionals to deal with the challenges of dementia.

The Abbott Government dismantled the Aged care Workforce Supplement and has yet to detail any strategies to deal with the workforce needs.

I believe we need a national approach; national coordination, quality and consistency in training.

28 | FUSION More than that, we must address remuneration.

The Australian Nursing and Midwifery Federation reported that nurses working in aged care are paid less than those working in hospitals, generally.

In fact, for a Registered Nurse Level 1 there is a difference on average of almost $210 per week or 17 per cent nationally.

The aged care workforce is one of the largest service industries in the nation, employing over 250,000 people, catering to the needs of over 1.1 million older Australians, and accounts for about one per cent of GDP in terms of Commonwealth funding alone.

It is an industry which will continue to grow.

It will grow faster than mining and resource industries.

Faster than manufacturing.

Faster than tourism.

The 2010 Intergenerational Report recommended we needed to see a 300 per cent increase in workers to meet the demands by the middle of the 21st century.

The Abbott Government has no plans for aged care workers and acted with speed and surprising dexterity to remove the Workforce Supplement within weeks of taking office.

The announcement of a Free Trade Agreement with China late last year reinforced what many of us have been saying over the past year about the aged care industry and the potential for international trade.

It is consistent with the Blueprint for an Ageing Australia’s call for a significant Austrade campaign to assist corporate Australia to export goods, services and investment in the ageing market worldwide.

The challenges for us are to ensure we maintain the integrity and future growth of our workforce in Australia, we remain committed to world’s best practice and quality and standards in aged care here in Australia, and we maximise the use of technologies.

With 70 per cent of aged care costs tied up in staffing, it is clear that our workers are the biggest, best and most important asset we have.

They will ensure our place as world leaders in aged care.

Any lapses in quality and standards invariably comes down to staffing.

Labor has tried to work with the Government in a bipartisan way in aged care.

The Abbott Government is rolling out Labor’s Living Longer Living Better reforms.

Labor offers bipartisan support for this and we stand ready to constructively engage with the Government.

We did not stand in the way of the red tape reduction in aged care legislation.

We supported the removal of duplicative building certification legislation.

We will watch and see how the South Australian Innovation Hub works out.

Recent media reports demonstrate the importance of good staffing and adherence to quality assurance.

As part of that, it is essential that there are strong complaints systems and regular monitoring of quality of care.

The Innovation Hub removed some of these elements.

I believe we need to be very careful how we progress this.

Billions of taxpayers’ dollars are devoted to the aged care sector annually. Government regulation and oversight of the sector is appropriate.

Any reports of older and vulnerable Australians not getting the quality of care they need and deserve reduces public confidence in the sector.

We need to ensure we do everything we can to build public confidence in our nation’s aged care system.

Publicly I have called for a proper, open evaluation of the Innovation Hub concept.

Department of Human Services However, there is one surprising challenge the aged care industry and consumers alike are dealing with.

A challenge that you should NOT have to deal with.

The delays in payments to aged care providers from the Department of Human Services, coupled with the long delays experienced by older Australians waiting for means and asset testing by Centrelink.

It is unacceptable and I commend the work of my colleague, the Shadow Minister for Human Services, Senator Doug Cameron for working with us to prosecute the case for immediate action.

It is obviously a difficult and troublesome concern for the Abbott Government which has provided little in the way of explanation or solutions.

Workforce Development Aged Care is not the career of choice for many young graduates.

It should be.

Along with qualified and skilled nurses and carers, the aged care sector needs, specialist health and allied health professionals, IT professionals, marketing and communication professionals, administrators, finance and investment specialists, gym instructors, architects, employment services, and the list goes on.

Also, it might be time to consider that aged care could be an ideal second career for people as they age.

Older people need support as they work.

They need greater flexibility to allow older people time for caring responsibilities, volunteering and community service, as well as leisure and recreation.

Aged care already provides this.

It is an industry which already has a higher than average percentage of older workers.

We know that the average age of aged care nurses is 48.5 years of age compared to 44.5 for all other nurses, with 53.9 per cent of aged care nurses aged over 50 years compared to 38.6 per cent of all nurses across various sectors.

This is not necessarily a negative thing. Aged care workers have experience and empathy.

We know that the demand for carers will increase by 40 per cent over the next five years.

The workforce we have now will need to increase – in numbers, in skill base, in leadership and management.

There are numerous barriers and impediments to engaging older Australians in meaningful work but the benefits are considerable.

FUSION | 29 The Treasurer Joe Hockey, needs only to consult the Deloitte Access Economics report, commissioned by the Human Rights Commission in 2012: “Increasing economic participation among older workers: the grey army advances.”

This demonstrated that a further three per cent increase in workforce participation amongst workers aged 55 and over would contribute an extra $33 billion to the nation’s GDP or 1.6 per cent of national income.

An additional five per cent would contribute a further $48 billion.

This will happen only if we have strong, competent and visionary leadership.

Australia needs to be the place where ageing is more than a better alternative to death, as George Bush Senior so eloquently put it.

Australia has the chance to be world-renowned for ageing well.

There will always be challenges.

Dementia: the Supplement; the Saga.

Dementia is an ongoing challenge that is not going away soon.

As you will be aware, Labor was critical of the way the Government scrapped the Dementia and Severe Behaviours Supplement.

Combined with the axing of the Workforce Supplement, the Abbott Government has made it more difficult for aged care

providers to meet the challenges of dementia and other severe behaviours.

Our criticism was of the way the Government handled the issue – in secrecy and without consultation; With the time it took to discover the oversubscription; And with the length of time it took to come up with a solution; A solution I find curious.

The Severe Behaviour Response Teams – or more often referred to as flying squads, or Dementia SWAT teams, as I heard one provider put it.

An untested and untried solution; a short term fix; with capped funding.

As we are all aware, when it comes to Dementia, demand outstrips supply.

I am concerned that many older people suffering from severe behavioural and psychological symptoms of dementia are going to miss out on care they desperately need.

What happens when the money runs out?

Will flying squads be able to provide adequate support to residential aged care providers?

Will they be available on a 24/7 basis?

Will they be deployed on an ad hoc basis or a needs basis?

Will the teams be able to service remote, rural and regional communities?

I am concerned the flying squads are unlikely to contribute to skilling and preparing the current workforce to meet the day to day needs of those living with dementia.

30 | FUSION One can only assume that the onus for training and skilling will fall back onto providers, creating further issues with consistency of training certification, much worse than we see with the Certificate IV qualifications.

Aged care and dementia are very real issues facing older Australians and they need a responsive approach with genuine planning and investment.

The oversubscription of the original Dementia and Severe Behaviours Supplement highlights the extent of the dementia crisis in Australia.

All of us are touched by dementia – in our loved ones, neighbours, friends, and ourselves.

Shadow Parliamentary Secretary for Aged Care, Senator Helen Polley and I ran a campaign following the axing of the Dementia and Severe Behaviours Supplement which attracted over 12,000 online signatures and many more thousands of hand written signatures.

The social media campaign reached tens of thousands of people.

This is not a future issue. It is a present reality. And it is deeply personal for many Australians.

Those living with dementia, their families, our communities and the aged care sector deserve an adequately funded approach that responds to the complexity of dementia care.

I am concerned that these flying squads will deal only with behaviours and symptoms rather than individuals.

While those with dementia may experience loss of their memories, changes to their personalities and a reduction in their normal faculties and functions, it does not change the fact that these are symptoms of a terrible disease of the brain.

The individual remains. Their soul and spirit remain.

We cannot treat those living with dementia as simply a collection of symptoms or issues to be managed.

They are individual people who deserve to be treated with dignity, care and respect.

At the same time, their loved ones, friends and communities need to be well supported, informed and appropriately skilled.

Those with very severe behaviours make up a relatively small percentage of those with dementia.

Their behaviours need to be managed appropriately while maintaining dignity and respect for each individual.

Indigenous It would be remiss of me not to mention the overlap between the two Shadow Portfolios I hold.

In addition to Ageing, I am the Shadow Minister for Indigenous Affairs.

I note Alzheimer’s Australia’s Review of the Research into Dementia in Aboriginal and Torres Strait Islander people.

The report released in October 2014 outlined that Aboriginal and Torres Strait Islander people experience dementia at a rate of three to five times higher than non-Indigenous people.

Last week the Prime Minister presented the annual Closing the Gap report.

We do not tend to mention dementia in these reports.

The increased incidence of chronic diseases such as diabetes, heart disease, and kidney disease are well documented.

It should come as no surprise that dementia is yet another disease where the gap is widening.

I have learnt a lot from Aboriginal and Torres Strait Islander communities. I am impressed with the Aboriginal Community Controlled Health Centres.

It is a terrific model that provides culturally sensitive care and outreach services, by Indigenous people, for Indigenous people.

I believe this model could be applied to the provision of aged care services for Aboriginal and Torres Strait Islander people.

One of the issues the Alzheimer’s Australia report mentions is that many living with dementia go unrecognised, unreported and untreated in Aboriginal and Torres Strait Islander communities.

Greater emphasis and investment in community controlled health and aged care services is needed to address these problems.

Labor’s commitment Labor will take policies forward to harness the opportunities of an ageing population.

I believe we must continue on the reform path, begun by Labor in Government.

I have never been backward in expressing my disappointment at the cuts to aged care delivered by the Abbott Government.

Cuts Labor believes were unnecessary, unfair and harsh.

The Abbott Government’s cuts were never flagged with the sector, consumer groups or the community before the 2013 election and certainly were not bipartisan.

They are broken promises by Tony Abbott and his team.

The Abbott Government’s aged care legacy will be the axing of the DSBS; cutting the $652.7 million Aged Care Payroll Tax Supplement; cuts to pensions; demolishing the $1.1 billion Aged Care Workforce Supplement; and the abolition of Health Workforce Australia.

But these are symptoms of a bigger ill. The Abbott Government has not taken aged care seriously.

The Living Longer Living Better reform roll-out has been undermined by the lengthy machinery of government changes and the removal of a dedicated Cabinet Minister It is no wonder the DSBS was unchecked and unnoticed, until my colleague, Senator Helen Polley, asked questions through Senate Estimates.

Questions informed by sector input.

My door has been open to anyone and everyone who has wished to see me.

As a Parliamentary Secretary for Health and Ageing in the previous Labor Government my door was always open – much to the occasional chagrin of the department liaison officers.

I believe ageing and aged care need to be at the forefront of Government thinking.

I believe Australia’s aged care sector presents one of the greatest opportunities for the nation moving forward.

Yet the sector faces incredible challenges. Challenges which are great but that will yield great rewards if overcome.

Challenges of workforce, change and reform, regulation and quality.

These challenges are the opportunities moving forward.

We cannot take a step back or wish for a simpler time.

Dementia will be one of the challenges of this century.

Longevity will shape this century.

This sector is best placed to shape Australia’s response, and Labor will work with you in this endeavour. ■

FUSION | 31

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FUSION | 33

What can we do to help Australians die the way they want to?

Hal Swerissen, BAppSc, BA(Hons), MAppPsych Stephen J Duckett, PhD, DSc, FASSA Health Program, Grattan Institute, Melbourne, VIC

A different service mix could better meet end-of-life care needs for little additional cost

A

ustralians are not dying as they would wish.

Surveys consistently show that between 60% and 70% of Australians would prefer to die at home, and that residential care facilities are their least preferred option.1 Dignity, control and privacy are important for a good death.

Choice over who will be present, where people will die and what services they will get, matters. People want their symptoms to be well managed, and they want personal, social and psychological support. It is important to have the opportunity to say goodbye and leave when it is time to go without pointlessly prolonging life.2 “dying is not discussed, and we are not taking the opportunity to help people plan and prepare for a good death�

But dying is now highly institutionalised. Over the past century, the proportion of deaths at home has declined and that of deaths in hospitals and residential aged care has increased. Today only about 14% of people die at home in Australia. Fifty-four per cent die in hospitals and 32% in residential care. Home and other noninstitutional deaths are about half as prevalent in Australia as they are in New Zealand, the United States, Ireland and France.3 Paradoxically, the likelihood and timing of death is now more predictable and there is more opportunity and time to prepare for death because people are now much more likely to die from chronic disease in old age. But dying is not discussed, and we are not taking the opportunity to help people plan and prepare for a good death. As a result, many experience a disconnected, confusing and distressing array of services, interventions and relationships with health professionals when they are dying.

Having the conversation When asked, most people have clear preferences for the care they want at the end of their life. But these preferences are rarely articulated, and they are not supported by the open, systematic conversations that are needed to ensure effective end-of-life care plans. Instead there is an unspoken faith that science and medicine can put off the inevitability of death.4,5

As a result, intrusive and burdensome interventions, including emergency and hospital admissions and intensive care often continue when there is little point. Palliative care is not discussed, offered or provided, and services are variable, inconsistent and fragmented, particularly for support at home and in the community.

Women, single people, older people and Indigenous people die in hospital at a higher rate than the general population. People with culturally and linguistically diverse backgrounds and those from rural communities are more likely to find access to services more difficult.6 These issues will become more prominent in public policy as the baby boomers age and the crude death rate doubles over the next 25 years.7 Four reforms would facilitate a good death. First, we need more public discussions about the limits of health care as death approaches, and what we want for the end of life. Second, the public discourse needs to be translated into personal choices.

People need to plan better to ensure that their desires for the end of life are complied with. Third, we need to ensure that if patients have expressed wishes about the care they want at end of life, those wishes are followed. Fourth, services for those dying of chronic illness need to be reoriented so that they focus more on people’s wishes to die at home and in homelike settings, rather than in institutions.

Encouraging people to plan for death Failure to talk about and plan for death in advance is one of the most significant obstacles to improving the quality of dying. Having these conversations and making these plans is not easy. When death is near and the quality of life is low, it is hard to know how far to pursue treatment, especially when the treatment is stressful, intrusive and likely to further reduce quality of life. Decision making is even more stressful if there has been no previous discussion about treatment preferences so that choices must be made in the pressure cooker environment of a hospital.

Public education programs have been used with great success in other parts of the health sector to educate the public and set the preconditions for policy change.

People could be encouraged by a public education campaign to consider and discuss their end-of-life preferences with their

34 | FUSION families and appropriate health care professionals, and document them in advance care plans. A national public education campaign would focus on encouraging people to discuss their preferences and choices for end-of-life care with health professionals, including general practitioners.

We estimate that a national campaign of 12 to 18 months’ duration that encompassed mass media, public relations, online and digital media, direct marketing and education campaigns would cost $10 million.

There are now well developed and effective approaches for systematic discussion of end-of-life treatment and care and the development of advance care plans. Yet much greater encouragement and incentives are required to ensure that those plans are much more widely implemented.8 Health professionals are in the best position to initiate endof-life discussions. However, they must shift their focus from prevention, cure and rehabilitation at appropriate points in time if these conversations are to occur. It is therefore important that it becomes normal and expected practice for health professionals to discuss and plan for end of life with their patients when it is appropriate. End-of-life plans are personal expressions. They should set out personal choices about the type and level of intervention a person wants: from aggressive intervention through to less interventionist and palliative care.

Initiating discussions about intentions at the end of life can be hard so we propose that “trigger points” for mandatory discussions about intentions be introduced:

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• during health assessments for people aged over 75 years; • for all residents of aged care facilities and for high-needs recipients of home-based care packages as part of assessment and care planning; and • for all hospital inpatients who are likely to die in the next 12 months.

Advance care plans are important, but are not in themselves enough to ensure that the wishes of dying people are met and that end-of-life care is improved. Additional measures need to be in place to ensure that plans are implemented as part of systematic and patient-centred end-of-life care.

What is needed for good end-of-life care?

Good care at the end of life is coordinated and multidisciplinary. Yet this is difficult in Australia’s largely siloed health system. As well, people receiving palliative care often transfer between health care settings, such as home, general practice, specialist medical, outpatient subacute, residential care and hospital.

It is essential to improve the coordination of end-of-life care, as hard as that is to do in a fragmented system. Effective strategies include the use of care coordination, case conferencing and team discussion. People who are dying often need a well qualified and authoritative health professional to act as an advocate for them to get the care they need.

Legislative frameworks and guidelines for advance care plans need to change. They should include clear mechanisms for assigning specific responsibility to health care professionals to coordinate and implement plans when people enter end-of-life care.

If the wishes of most Australians to die at home are to be met, end-of-life care will have to change. More support for dying at home will be required.

Carers say they do not get the support they need from partners, family or health professionals. The end of life does not follow a common trajectory. Often patients who have been discharged home will have a crisis episode that carers have to manage. The inability to manage a crisis at home is one of the main reasons that people at the end of their life are admitted to hospitals via emergency departments. It is not surprising that carers struggle to cope: only 13%–18% of carers report that they could access services such as health professionals, community organisations and government services in a crisis.9 It is clear that community-based palliative care can reduce the burden on carers and significantly increase the proportion of people who are able to die at home. But this will require a significant increase in the availability of community-based palliative care. Packages to support dying at home include coordination, nursing and personal care, specialist medical services where required, carer support and respite.

The number of people dying at home would have to double to reach 30% of all deaths, a level comparable to Korea, Singapore, Ireland, France, Austria, Croatia, the United States, Cyprus and New Zealand. To support these people with home-based care packages would require 39 000 more packages per year to be made available for those who are likely to die within the next 3 months.3

What will it cost?

We estimate that the average cost of community palliative care packages is about $6000 for the last 3 months of life. Extending the availability of community packages to enable 30% of Australians to die at home would require an additional investment of $241 million.10 Increased home and community care for the dying is likely to reduce the demand on hospital and residential aged care services.

If that demand declined in proportion to the increased number of people dying in the community, we estimate that costs would reduce by $324 million in acute and subacute hospital sectors and $275 million in residential care institutions for an overall saving of $50 million.

Taking into account the additional estimated cost of community-based palliative care packages and the savings in residential and hospital services, a net cost of $84 million is estimated as a result of the increase in community-based support for people who are dying.

Competing interests: No relevant disclosures.

Provenance: Commissioned; not externally peer reviewed. ■ Article courtesy of MJA. Reproduced with permission.

References 1. Foreman LM, Hunt RW, Luke CG, Roder DM. Factors predictive of preferred

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place of death in the general population of South Australia. Palliat Med 2006; 20: 447-453.

2. Smith R. A good death. An important aim for health services and for us all. BMJ 2000; 320: 129-130.

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3. Broad JB, Gott M, Kim H, et al. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential care settings in 45 populations, using published and available statistics. Int J Public Health 2013; 58: 257-267.

4. Higginson IJ, Hales S, Koffman J, et al. Time to get it right: are preferences for place of death more stable than we think? Palliat Med 2010; 24: 352-353 5. Ashby MA, Kellehear A, Stoffell BF. Resolving conflict in end-of-life care. Med J Aust 2005; 183: 230-231.

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6. Senate Community Affairs References Committee. Palliative care in Australia.

Canberra: Commonwealth of Australia, 2012. http://www.aph.gov.au/ Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_ inquiries/2010-13/palliativecare/report/index (accessed Dec 2014).

7. Australian Bureau of Statistics. Population projections, Australia, 2012 (base) to

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8. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010; 340: c1345.

9. Cummins RA, Hughes J, Tomyn A, et al. Wellbeing of Australians: carer health and wellbeing. Melbourne: Deakin University, Carers Australia and Australian Unity, 2007.

10. Swerissen H, Duckett S. Dying well. Melbourne: Grattan Institute, 2014. http:// grattan.edu.au/wp-content/uploads/2014/09/815-dying-well.pdf (accessed Dec 2014).

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36 | FUSION

The incredible possibilities of India Beth Cameron, CEO, LASA WA

F

rom 12 – 15 January I joined our Trade Minister, Andrew Robb and ‘450 of his closest friends’ for Australia Business Week in India 2015.

There is incredible optimism in India at the moment, largely due to the current success and popularity of Prime Minister Narendra Modi. The election of a man that began his career selling tea near a bus station has given hope to India, that anyone can achieve success. This optimism and confidence can also be seen in the business community.

Modi’s government is of a similar persuasion to our own, with our respective Prime Minister’s determined to expand our relationship beyond cricket and have committed to sign a Free Trade Agreement this year.

So with Free Trade negotiations commencing, it was very important that Aged Care be a part of the conversation. We joined health in one of fourteen streams to meet with our Indian counterparts, to discuss shared issues and areas of potential collaboration.

Given India is a comparatively young country, it would be easy to assume aged care was not of current concern. But that is not true. The Indian aged population is currently the second largest in the world. India’s population aged 60 years and older is projected to increase dramatically over the next four decades, from 8 per cent of the population in 2010 to 19 per cent by 2050, according to the United Nations Population Division. By mid-century, this age group is expected to comprise 323 million people.

The ageing of India’s population will give rise to the prevalence of conditions requiring care, including dementia. Older adults will need assistance in managing disability that affects their daily living.

The traditional multi-generational family arrangement is fast disappearing, including in rural areas. With urbanisation, families are becoming nuclear, smaller and are not always capable of taking care of older generations. There is a growing market for senior living facilities that provide high quality health care and domestic assistance.

Many of the challenges faced by Australia and India’s aged care providers are shared: the need for more infrastructure; need for quality, affordable technology and a suitably skilled workforce. Our India colleagues shared a huge need for education and training, as well as specific information about best practice in areas like dementia care and palliative care. Indian businesses are interested in partnerships, joint ventures and investment opportunities in Australia.

For those of you that are interested in the Indian market, there has never been a better time to engage.

The Indian population can be divided into three broad segments based on their healthcare needs and socio-economic status. The largest of these segments is made up of a mix of wage earners in the unorganised sector as well as the rural population located in the

Beth Cameron LASA WA CEO with Andrew Robb, Federal Minister for Trade and Investment

remote areas of the country. This segment is mainly catered for by the public healthcare systems and Non-Government Organisations (NGOs) through conventional, traditional and complementary medicine. The second group comprises the middle class in rural and urban India who are increasingly ready to spend more on their healthcare needs and are demanding better healthcare infrastructure and attention. This segment depends on both public and private healthcare operators. The third and smallest segment comprises the upper middle class and wealthy in urban India which is catered for by private healthcare providers.

On a value basis, the healthcare segment in India is dominated by the private sector, with 70 per cent of the market delivered by the private sector catering to the elite. There is almost no regulation

by Government. Public healthcare is highly subsidised by the Government, however private healthcare costs are fully borne by patients and/or their insurers.

There are currently about 30 senior living projects in India and about the same number in the pipeline. India currently offers some Residential Aged Care Facilities operated by NGOs, the Government and private companies. These centres commonly provide basic medical facilities, however the demand for more specialised aged care facilities and services is increasing.

Home Care is just as rare, with some organisations beginning to enter the market with positive reception.

The concept of homes for the aged has undergone a shift in recent years, as shown by the nomenclature in use having changed

FUSION | 37

Beth Cameron, Klaus Zimmermann, CommonAge, and Mansoor Dalal, Association of Senior Living in India

to ‘senior living’ or ‘assisted living’ in India. The services such centres offer include fulfilling the social, security, healthcare, administrative, food and recreational requirements of senior citizens.

Senior living projects are coming up in the suburbs of all the main cities in the country and in some selected destinations such as Coimbatore, Goa and Dehradun which have been traditionally popular retirement destinations.

The senior living industry in India is poised for growth and will offer a range of opportunities for Australian businesses and organisations, including: • Facility management • Home Care • Training and providing specialised home care services • Developing community nursing and health centres.

• Design and consulting around the build of aged care centres • Investment into upcoming facilities.

• Consultancy Private entities that have already made a foray into the sector include Ashiana Group of Builders, Paranjape Schemes, Impact Senior Living Estate, Covai Properties, Brindavan Senior Citizen Foundation and Classic Promoters. Apart from these, there are charitable organisations working in the sector.

Some of India’s reputed corporate and hospital groups are also becoming active in the sector, the latest entrant being the well-known Max India Group with Antara Senior Living.

Companies from the UK and USA are the early international entrants in this sector. There are existing collaborations with MHA (UK), One Eighty (USA) and the American Heart Association.

While select Indian players have already partnered with international groups, the industry is likely to see a rise in the number

and nature of partnerships between operators and owners. It is likely that international operators will become more involved as knowledge and process design partners. Foreign participation as equity partners is also likely. India’s delegates at Australian Business Week in India certainly confirmed this.

There are various channels to enter the Aged Care/Assisted Living Sector in India.

For training/services/facility management/home care/design and build, options to enter the market, include: • • •

Forming a short-term partnership (such as a one or two year contract with opportunity to review the partnership at the end of each term) Forming a joint venture partnership Setting up a local office.

For product distribution: •

Appoint an agent or distributor

• Direct marketing or through sales agents.

When operating in India, it is important to: • • •

• •

Be prepared to visit the market on a regular basis (at least twice a year) Follow up on previous visits through email/telephone calls Participate actively in various aged care/healthcare conferences and trade shows to network with the industry in India and better understand the market Learn about the cultural nuances of the aged care market in India Prepare information packs about your company, products and services offered.

The Australian Trade Commission – Austrade – helps Australian businesses, education institutions, tourism operators, governments and citizens access international markets. ■ For more information on how Austrade can assist you, you can contact them on: 13 28 78 or email: info@austrade.gov.au

38 | FUSION

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Bravien Financial jeremy@bravien.com www.bravien.com Level 1, 29 Bentham St Yarralumla ACT. 2600 (Also in Bardon QLD) 1300 272 843 South Australia DREW POTTS CFP® Senior Financial Advisor

Western Pacific Financial Group drewpotts@westernpacific.com.au www.westernpacificpa.com.au Level 3, 97 Pirie Street, Adelaide SA 5000 (Also in Port Augusta SA) 1300 684 402 KATE PHILLIPS DFS, ADFS, B T. , B Ed.

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Want to know more about aged care? ...Ask the Gurus!

Aged Care Gurus Email: asktheguru@agedcaregurus.com.au Web: http://www.agedcaregurus.com.au

FUSION | 39

What has consumer choice actually amounted to?

Rachel Lane, Aged Care Gurus

The Aged Care Gurus Network consists of 21 Advisers with 19 offices across WA, SA, VIC, ACT, NSW and QLD. Between 1 July 2014 and 30 September 2014 the network provided advice to over 450 people entering aged care and here’s what we found:

I

t is impossible for a supported resident to pay solely by RAC, here are a couple of examples of residents with assets above the threshold but income below the threshold:

Resident A Full pensioner Assets $50,500 DAC $2.40p.d RAC $12,978

Resident B

Residents Seeking Advice

Supported Residents

Of the people seeking advice, 81% were going to pay the market price and 19% were going to be supported residents.

Of the supported residents, 44% elected to pay by combination and 56% chose to pay

by DAC. No clients chose to pay solely by RAC… here’s why ➞

RAC – Refundable Accommodation Contribution DAC – Daily Accommodation Contribution

Full pensioner Assets $152,000 DAC $51.20p.d RAC $276,859 The outcomes are even worse when the resident exceeds the income threshold...

Resident AA Part pensioner Assets $50,500 Income $34,500 DAC $15.29p.d RAC $82,679

Resident BB Part pensioner Assets $45,000 Income $45,000 DAC $27.31p.d RAC $147,676

40 | FUSION

Case Study – Fred and Shirley Full Pensioners Fred moving into care Shirley staying at home Assets Bank $50,000 Investments $100,000 Car $10,000 Contents $10,000 Fred’s Assessable Assets $85,000 Fred’s DAC $18.99p.d Equivalent RAC $102,687 Fred’s max RAC $39,500 Adjusted DAC $11.68p.d What happens when Shirley moves into care or passes away?

• How much is the house worth?

• Will it be kept or sold?

• What is the accommodation supplement for the facility?

• What is the market price at the facility?

• If Shirley passes away does Fred inherit all assets?

Sells House $850,000 Facility Market Price $400,000 RAD $73.97 DAP Facility Accomm Supp $34.56p.d Shirley moves into care Pays RAD $400,000 Fred’s accommodation payment goes from $18.99p.d to $34.56p.d He starts paying a MTCF of $17p.d And his pension reduces from $854pfn to $714pfn

Case Study – Mary Widow Lives with her daughter Not supported but cannot afford market price ($350,000 RAD or $64.73 DAP) Assets Bank $152,000 Contents $1,000 WWP + ISS = $1,124pfn/$29,224p.a Gift $10,000 Buy Funeral Bond $12,000 = Supported Resident DAC $50.28p.d BUT, facility not significantly refurbished so DAC $34.56p.d Equivalent RAC $186,880 Paid $85,500 RAC, $19.03 DAC

RAD – Refundable Accommodation Deposit DAP – Daily Accommodation Payment MTCF – Means-tested Care Fee WWP – War Widow’s Pension ISS – Income Support Supplement

FUSION | 41

Of the clients paying the market price, 54% chose to pay by combination, 39% chose to pay solely by RAD and 7% chose to pay by DAP.

In contrast to the Aged Care Financing Authority where 24% chose a combination payment, 42% chose to pay by RAD and 35% elected to pay by DAP. *DAP included residents yet to elect payment method

Case Study – Jack

Case Study – Betty

Jack is moving into aged care from a retirement village, his assets are: R.V Unit $150,000 Cash $20,000 Term Deposit $25,000 Contents $5,000

Assets House $1 mil Bank $150,000 Investments $700,000 Contents $20,000

The facility Jack wants to move into has a Market Price of $300,000 RAD or $55.48p.d DAP Jack is not able to meet the market price RAD but he is not eligible to be a supported resident either. Jack will need to pay for the cost of his accommodation through a combination of RAD and DAP. The maximum RAD Jack can pay is $154,500 with an adjusted DAP of $26.91p.d The fact that the family home has a capped value of $155,823 and can remain exempt from pension means that people with assets outside the home are likely to use those assets to fund the RAD to maximise their pension and minimise their ongoing cost of care.

For example:

I f Betty sells her house to pay her RAD Assets Bank $450,000 Investments $700,000 Contents $20,000 Pension $0 MTCF $108p.d (235 days, $25,349p.a) If Betty keeps her house, pays $695k RAD $5k DAP Assets Bank $50,000 Investments $105,000 Contents $20,000 Pension $844pfn/$21,939p.a MTCF $42p.d ($15,366p.a) While many people may initially look at the market price as a way to identify the cheaper room, paying for a more expensive room may have financial benefits (as well as nicer digs!).

42 | FUSION

So what has “Consumer Choice” amounted to?

Let’s look at an example:

For many it has lead to confusion. However, for those who seek advice it has meant: • They can keep and rent their former home with exemptions being applied to the asset and the income • They can retain their home and use assets outside to fund their RAD, creating a double benefit for pension and aged care costs • That some people are choosing not to be a supported resident with children gifting or loaning money to fund aged care • That people who are eligible to be supported become “more supported” through gifting and paying funeral expenses • That some residents are choosing a facility with a higher price to get a higher standard of accommodation while receiving more pension and paying less means-tested care fee.

People now have greater choice about the type of care they access and the way in which they pay for it. However, with choice comes the responsibility to make informed decisions. The way in which someone chooses to fund their care can have far-reaching implications from the cost of care itself, their eligibility for pension, their liability for tax, their ability to afford care in the longer term and the assets left to their estate. ■

Case Study – Pearl Full Pensioner Assets House $650,000 Cash $50,000 Contents $2,000 acility has two F prices: $300,000 RAD $55.48 DAP $600,000 RAD $110.96 DAP I f Pearl chooses the $300,000 Room: Pension $679pfn/$17,654p.a MTCF $30p.d/$10,950p.a If Pearl chooses the $600,000 Room: Pension $854pfn/$22,204p.a MTCF $24p.d/$8,760p.a $4,550p.a pension increase $2,190p.a reduction in MTCF

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FUSION | 45

All I want for Christmas is an LGBTI aged care facility?

Well actually NO! Musings from WA Community Organisation GLBTI Rights in Ageing Inc

S

o here I am, sitting on Father Christmas’ knee (no giggling please) and he is asking me what I want for Christmas. He knows I am on the Board of GRAI (GLBTI Rights in Ageing Inc) so assumes an LGBTI* Aged Care Facility is what I want for Christmas. Imagine the look on his face when I say no, no thank you, no way and absolutely not.

It’s probably the same look that I found on the face of a long term member of GRAI when I said I didn’t want one. A mix of horror, confusion and disappointment.

The sad news for the LGBTI community is that a single LGBTI Aged Care Facility will just not work for a number of reasons – some practical and some philosophical. So let me outline my reasons.

Too small?

A specialised or niche Aged Care facility would hold about 80 people. This seems to be a number that is both financially viable and still manageable. So the current membership of GRAI and partners could fit but no more. What about all the other LGBTI people getting to a “certain age”? What about those in existing “non-LGBTI” facilities? Who will be looking after them?

Too expensive?

If we are looking for property within the “golden triangle” of the inner city, this will cost a small fortune – discounting the prospect of Father Christmas or Twiggy Forrest coming to our rescue, an inner city location would make this financially unviable. So we need to find somewhere else?

Too far away?

The only purpose built LGBTI facility in Australia is in rural Victoria. And not somewhere close to Melbourne or to Daylesford.

The property is cheaper but does have of all the downsides of rural and regional living including less health facilities and fewer cultural activities.

Why do I need to move at all?

I’m a suburban gay man. I don’t live in the inner city. I don’t think I want to. I like my community just where I am. Why should I have to move to the CBD to get my LGBTI Aged Care?

What about GRAI members in Albany, Bunbury, Geraldton and beyond? What about the LGBTI community across the country?

Why should they be displaced and removed from everyone they know? This fails the current aged care practice where people are supposed to grow old in their own community.

Do we just give up?

So that’s a sad tale of woe – too small, too expensive, in the wrong place, doesn’t look after all of GRAI’s membership.

It’s a disaster!

Well, not really. Not if I get what I really want.

So what do I want?

I want to change the world. Like all the Board members of GRAI, I want to make it a better place for everyone. I want all facilities to adopt our best practice guidelines (available at the GRAI website – www.grai.org.au). I want all facilities to undergo the Right to Belong training. I want all facilities to start working on the Val’s Cafe program.

I’m greedy!

I don’t want an LGBTI Aged Care Facility, I’m greedy, I have bigger plans in mind. I want every Aged Care Facility to be an LGBTI Aged Care Facility.

Crossing fingers that I’m not on the naughty list, GRAI might just get us closer to this in 2015. ■ (* Sorry for the alphabet soup – LGBTI is shorthand for Lesbian, Gay, Bi, Trans and Intersex. You might also see GLBTI or other combinations. Given that GRAI puts the G first in our name, we tend to put the L first intext. Yes, we just do it to confuse people. For more information about GRAI, visit www.grai.org.au)

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FUSION | 47

Meaningful mealtimes – Supporting residents with dementia Denise Burbidge (APD, AN)

I

n Australia, fifty per cent of residents in aged care homes have a diagnosis of dementia and more than 300,000 people are living with dementia in the wider community.

One of the biggest challenges in dementia care is being able to provide people with meaningful tasks to undertake; and in doing so promote independence, dignity, safety and comfort. Each person’s abilities and their journey with dementia will be specific to them. Individuals living with dementia continue to draw on past experiences and their current environment to help them undertake daily tasks. They often possess the skills to undertake daily activities (for example eating) but as their dementia progresses, they lose the knowledge of the exact steps to take to achieve the activity (e.g. with eating: the need to place cutlery in their hands, put food on the fork, raise the fork to their mouth, open mouth, take food, chew and swallow).

Too often carers can make the mistake of presuming that once a person is having difficulty with daily activities such as eating, little can be done to prevent a loss of independence. Thankfully this is rarely true: with appropriate guidance, a supportive dining environment and engagement in the eating process, people with dementia can be assisted to maintain autonomy in the eating process for longer.

Preparing for a meal In a typical family home it’s rarely a surprise when it’s dinner time, as the house has been buzzing with activity. There has been thought during the weekly shop about what will be on the menu and perhaps some discussion earlier in the day about ‘what’s

for dinner tonight’. There is slicing and dicing and then of course the aroma of food wafts through the house, helping to stimulate appetite. Now step into a supported care setting such as an aged care home. Often residents are not invited to participate in the meal preparation, they arrive to a room already set, with a predetermined menu, and an already-plated meal is placed on the table in front of them. For someone with dementia this can cause confusion around time, place and what activity is supposed to follow.

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48 | FUSION Given that aged care homes are the residents’ home it is important that there is consideration to create a supportive homely environment rather than a generic institutionalised setting. There are some great initiatives in homes already; networking with other aged care providers and sharing ideas can help to identify improvements you can adopt in your workplace.

There are many activities associated with meal times that can provide residents with meaningful daily tasks, thereby promoting a sense of dignity, independence and self worth. Some residents like getting involved with setting tables, folding napkins or clearing plates after the meal; others enjoy tending to vegetable or herb gardens. For those with the strength, tasks such as opening jars and cutting pumpkin pieces can be beneficial. Or one of my personal favourites: in summer, bring out old-style hand squeezers and make fresh orange juice. Encouraging residents to participate in activities that they are capable of doing helps to engage residents in meals and the dining environment. Remember that residents’ preferences for involvement in activities may change from day to day; invite residents to participate and if they decline, honour this choice, respecting that a resident with dementia is also an adult able to make decisions about their daily activities.

The dining environment Creating a supportive dining room is so much more than who sits with whom at the table. A supportive dining room is one that is conducive to eating and mealtime enjoyment; a place where residents are comfortable and engaged. Many residents with

dementia take longer to eat so the dining room needs to be a place of calm which allows residents to eat at their own pace. The concept of protected meal times is a great initiative to incorporate in dementia care. Protected meal times promote that dining areas are only for eating during meal times and that any non-essential staff, such as medical staff, cleaners, or maintenance staff carry out their tasks at other times to allow residents the opportunity to focus on eating.

The physical environment of the dining room for residents with dementia is also very important. Good lighting is critical, well lit with minimal shadows and minimal glare, e.g. direct sunlight that can make it difficult to see eating utensils or cause residents to squint thus limiting vision. Background music can assist in providing a comfortable ambience but the visual aspects of televisions can be distracting – televisions are best left turned off during meal times. Think about all the equipment within a dining area and mentally label each of these as being homely or otherwise. Critically analyse whether all of the ‘non-homely’ equipment is essential or if there is anywhere else these items can be stored. For example commercial catering equipment such as hot boxes or trolleys are not in my mind ‘homely’ and are best stored out of sight, e.g. around the corner from the dining room so that they remain accessible by staff but do not provide distraction to residents.

There has been much thought given recently to the best table settings for people with dementia; in most cases, a minimalistic approach is best. Remove any clutter or unnecessary condiments;

FUSION | 49 provide a simple contrasting plate and plain colour placemat with cutlery that is easy to hold. For residents with colour perception difficulties a red or blue plate may be beneficial as this helps the plate to stand out from the table and the food to stand out in contrast from the plate. Complex table settings are best saved for restaurants and special occasion dining, rather than daily dining in residential care.

Eating with success Refusing to eat, inappropriate mixing of meals, forgetting to eat and messy eating are all common mealtime issues for people with dementia that can result in stress and embarrassment at the meal table. Supervision in the dining room can go a long way to minimising these issues; however the key is how staff communicate with residents: just talking to residents with dementia often has little impact; combining verbal communication with touch and demonstrating activities can be really beneficial. It is sometimes viewed as taboo for staff, volunteers or family members to eat in the dining room with residents; however demonstrating the act of eating or drinking can help some residents with dementia remember how to eat well. Recently I saw a great initiative whereby on ‘Fish ’n Chip Friday’ staff were invited to eat with residents and this changed the whole mood of the mealtime.

No one was rushed, everyone ate chips in their fingers and there were lots of smiles to be seen.

While it may not always be practical to have extra meals for staff or families, seating staff or family at the dining table (even without

them eating) can stimulate meaningful conversation and enable supervision and assistance for residents who require increased mealtime support. Offering one meal course at a time can allow residents to eat at their own pace and avoid being overwhelmed by several meal items being presented concurrently. Providing residents with ‘real time’ meal choice at the point of service: offering two plated meals, (e.g. a sandwich or a hot meal) that residents visually choose from, can be empowering and can decrease meal refusal.

While the list of mealtime strategies could go on, I leave with you the suggestion to undertake some self-assessment. What are your current workplace mealtime practices with respect to preparing for mealtimes, the dining environment and actual mealtimes? Why are mealtime practices this way and what practices may benefit from changes to support meaningful mealtimes for residents with dementia?

For further reading and ideas about supportive dining rooms for people with dementia, take at look at the Alzheimer’s Australia, Enabling Environments project resources available online at www. enablingenvironments.com.au. ■

About the Author Denise is the Chief Dietitian at Leading Nutrition, a group of dietitians who provide specialised dietetic services to residential aged care homes across Australia.

Denise has been working in aged care homes for the past six years and is passionate about helping residents to access their preferred foods and providing practical solutions to food services staff. For more information on Leading Nutrition, see www.leadingnutrition.com.au

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FUSION | 51

Critical issues for NFP Directors – 2015 and beyond

The Australian Institute of Company Directors released the 2014 NFP Governance and Performance Study (“the Study”) in October 2014 and hosted a panel discussion to consider the key Introduction The not-for-profit (NFP) sector has seen a range of reforms over recent years at Federal, State and Territory levels. While much of this reform has been positive, there is still uncertainty for organisations including regulatory changes, funding sources and changing business models. This uncertainty is causing many organisations to re-think their purpose and structures. What is also apparent is the evolving nature of governance in the sector, with the quality of governance continuing to improve.

In addition to operating in a state of flux, the Study reveals a sector contemplating a wave of change originating from within; some 30 per cent of directors report their boards have discussed or taken some action to merge their NFP with another in the last year. This interest in formal amalgamations is probably not surprising in a sector where collaboration is common; however those who have been through such mergers urge a cautious approach.

In some cases, outcomes may never be quantifiable. However, as one non-executive director (NED) pointed out: “We need to continuously align the board’s measurement focus with purpose.

Sometimes we stray and our reporting becomes focused not on the ‘why’ but the ‘how’ of what we do.”

Directors considering these issues might find the points below helpful in navigating this fast changing environment.

Governance, risk and innovation Regulatory and legislative change in the last few years and the consequent focus on NFP governance has seen a continuing maturity in governance in the sector. Eight in ten of the NEDs who took part in the Study believe the governance of their organisation is better than it was three years ago.

One panellist said governance was important not just for its own sake but as a way to evolve NFPs to “for-social-purpose” organisations.

“We should use governance as part of our for-social-purpose advancement; let’s use it as a base and not get too trapped in old models but be looking forward to new ones.”

Many of the NEDs and executives who participated in the Study still believe there is room for improvement; they would like

their boards to attract more highly skilled directors and to further improve governance skills. There was also a call for boards to be more innovative and risk-taking.

“Many trusts and foundations have become more cautious over the years, particularly some of the bigger ones. They have forgotten that when those organisations started, they were quite the risk takers,” a panellist commented. “Sometimes, when we talk about governance and compliance, we are checking to see we are doing things the right way. However, we forget this sector needs to be in the business of taking risks. That’s the only way we’re going to attack some of these really complex decisions.”

Mergers and collaboration NFPs actively collaborate and partner with others to deliver services; many also share resources, sub-contract service delivery and outsource back office functions.

Now it appears there is an increased interest in taking these partnerships and collaborations to a new level. Three out of every 10 NFP directors said their boards have discussed mergers in the last 12 months. However, only a small proportion of those discussions were expected to result in a merger and experienced NEDs suggested caution was appropriate given that many previous mergers in the NFP sector – as in the for-profit sector – have failed to meet expectations. These failures were attributed primarily to differences in culture.

By the same measure, a history of collaboration could be a good marker of a successful merger.

“In my experience,” said one panellist, “the best mergers come out of successful collaborations. If you have spent a lot of time working together, getting to know each other, then a merger can be a realistic outcome, rather than an exercise on paper to save some money.”

Not all NFPs have the luxury of choice. The most common drivers for merger discussions were to improve efficiency, broaden the range of services to existing service users and develop or maintain market share. Some, however, indicated they were being encouraged by government to merge. Regulatory, legislative change and/or budget cuts have also forced some amalgamation.

In the aged care sector, for instance, major changes in the cost of services mean aged care facilities with fewer than 100 beds are no longer viable.

In this sub-sector, four in 10 NFP boards were discussing mergers and half of these were expecting it to happen. The economics of aged care are shifting and maintaining financial stability and compliance with government requirements are now the top priorities for NFP providers of aged care services.

Still, while the sub-sector is only midway through a fouryear reform program, many NEDs from aged care boards were confident about the future and looking at investment strategies.

FUSION | 53

The hunt for better performance measures Donors and other funders increasingly want to measure the return on their social investment in NFPs, increasing the pressure on boards to find better ways to measure what they do. Some 60 per cent of NFP directors are looking for more or better ways to determine if their organisation’s strategy is achieving its purpose.

For most NFPs, this aspect of performance measurement comes down to evaluating quality and impact. Quality – though by its nature a qualitative outcome – can often be quantified in some way. Research organisations, for example, can review how much research was published and where.

Measuring the impact of an NFP’s operations is more complex.

“Impact, for almost all NFPs, is a long-term issue,” a panellist said. “We want to evaluate if the service we’ve provided or the research we’ve done has actually made a difference to someone.

Usually that is a long-term consideration.”

Much work has been done to compare social returns on investment in order to choose between alternative investments; however, these assessment frameworks have not yet yielded evaluation structures that produce consistent results when used by different evaluators. In addition, some NFPs are tackling problems where there are no agreed solutions to test, or which could take decades to diminish.

Due to expense and difficulty involved in measuring impact, many NFPs revert to proxies. “They might carry out some exit surveys, or a bit of follow up,” the panellist added. In the absence of hard outcome measures, directors can be tempted to focus too much on what can be measured, i.e. operations and activities.

“I know, from my discussions with management – and from discussions when I was on the other side of the table (as an executive) – that it is much easier to measure activities than outcomes. It is very important to distinguish between the two when we set KPIs.”

Operating amid policy uncertainty In March 2014 the Federal Coalition government introduced legislation to repeal the Australian Charities and Not-for-profits Commission (ACNC). At the time the Study was released and the panel discussion took place, the government was considering feedback to the arrangements it has proposed to replace the ACNC. The Government is also committed to reforms in education, aged care, disability services, health care and social services.

Many of these will have a major impact on NFPs. While the intent is known, the detail of the new policy, structures and operating environment are not and this uncertainty is getting in the way of long-term decision-making and investment. For this reason, clarity is now top of the sector’s wish-list for government.

In addition, strained budgets, at both Federal and State levels have prompted cuts in spending, with knock on affects to NFPs that rely on government funding. Some 62 per cent of directors nominated maintaining or building income as their top priority in the next year, as they seek to diversify income streams and reduce their dependence on government funding.

Given the NFP sector accounts for 5 per cent of GDP, and 8 per cent of employment and has taken on operational risk that used to be borne by government, some directors believe it is no longer reasonable for policy makers to assume the sector will always find a way to “make do”.

“We have historically had behaviours of “Please Sir, give me some more,” rather than being very clear on our purpose and what we can do,” said one panellist.

“There is a now a responsibility on the sector to communicate about policy: about how it may not fit; about how it can be changed; about what needs to be done. A single organisation or board or CEO cannot do that on their own.”

Given that two-thirds of directors say their organisation already works with other NFPs to advocate for the sector or beneficiaries, there is a strong foundation of collaboration to build upon so the sector as a whole can communicate its importance to government.

Concluding notes Many directors in the NFP sector have either had the ground shift under their feet in the last 12 months or are expecting major policy changes soon. However most are confident that, while there are big changes underway, they are in control. Most believe governance has improved significantly, many are exploring ways to diversify income streams, and consolidation in the sector is expected to help underpin financial sustainability.

At the same time, these organisations are cognisant they need to seek out innovative solutions to some of society’s most difficult problems, even if hard measures of progress are hard to come by. This is frustrating for those looking for better ways to measure their organisation’s impact.

It is also a reflection of the sector’s purpose and the essential role it plays. Experienced NFP directors, used to reconciling the need for sound risk management with innovation and keep seeking meaningful ways to measure effectiveness, are highly sought after.

To view the full report visit http://www.companydirectors.com. au/Director-Resource-Centre/Not-for-profit/NFP-governancestudy#NFP%20governance%20study ■ The 2014 NFP Governance and Performance Study was conducted by research firm BaxterLawley and is proudly supported by our NFP Thought Leadership Program Partner, Commonwealth Bank.

This article has been reproduced with permission from The Australian Institute of Company Directors, © 2014 Australian Institute of Company Directors.

54 | FUSION

Residential aged care: A system for all Bruce Bailey, RSM Bird Cameron

I

n a recent article by Richard Baldwin, Lyn Chenoweth and Marie del Rama “residential Aged Care Policy in Australia – are we learning from evidence” (the report) the authors raised some key points in relation to the likely future structure of the industry, comparing the Australian situation to a number of overseas jurisdictions. The report also raised questions over relative resident care outcomes between providers based on ownership and the possible implications of choice, by ownership particularly in regional areas.

The Aged Care Financing Authority (ACFA), the Department of Social Services (DSS) and the Minister clearly share these concerns.

Over the last eighteen months ACFA has undertaken two significant bodies of work that address the financial issues raised by the authors.

The first of these was to consider what financial information ACFA and DSS needed to collect in order to inform its analysis of the industry.

This work concluded that current financial information collected by DSS is not sufficient to allow a thorough review and assessment of the performance of providers and by extension to inform future policy. The report by ACFA is available on their website (see links below).

Since the publication of this report DSS has drafted a proposed revised reporting format (see link below) and sought feedback from stakeholders. The period of public consultation closed on Feb 27, 2015. As RSM Bird Cameron assisted ACFA in this review we hosted a forum of providers and interested stakeholders to provide feedback on the draft format. While there are a number of matters that require further consideration providers fully support the provision of information that will allow informed analysis of the financial metrics of the industry.

The authors make particular reference to the missing debate on structural facts of size, ownership and location. ACFA’s 2014-15 work program included a detailed study of the factors driving financial performance of providers looking specifically at; ownership, size and location. This report is not yet available on the ACFA website. Based on our experience such comparisons need to bear in mind some important differences; Measuring performance: Most comparative measures of financial performance compare Earnings before Interest, Tax Depreciation and Amortization (EBITDA). While this can provide a comparable measure of performance it does not provide any insight into the return on investment which in the for-profit and in particularly the corporate sector is a key driver. While EBITDA in regional centres may be lower than in the city generally the investment in facilities is also lower.

The link between ownership and financial performance: By their nature for-profit providers are more driven to measure and achieve financial performance hurdles. However because a not for profit provider achieves a lower EBITDA does not mean they are not interested in financial performance. NFP providers continually make explicit or implicit choices that impact their financial performance.

A system in transition: The Living Longer Living Better policy is impacting the system, as I speak with providers there is a strong engagement on refurbishing existing facilities to gain access to the additional accommodation supplement available to significantly refurbished facilities. This resulted in renewed optimism from providers in the 2015 ACAR. Providers in the for-profit and the not-for-profit sector are actively developing strategic plans that include; extending existing facilities and expansion of operations either through acquisition or building new facilities.

Mission and location: One reason that different geographies attract different providers could relate to the breadth of their mission.

A for profit provider broadly seeks to maximise shareholder return so clearly they will be attracted to geographical locations that provide the greatest opportunity for this; generally locations showing net migration with the ability to operate multiple facilities. However the same cannot be said for all not for profit providers in particular community based providers whose mission may be to serve a local community. This narrower mission of some provider’s, impacts financial performance, as their mission can limit both scale, beds in a facility, size and the number of facilities operated.

The needs of older Australians are very diverse, this naturally presents both opportunities and the need for varied solutions. Who owns and operates a particular facility in a particular location is but one factor. This together with policy settings that seek to ensure equity and access within the context of an aging population and the economic challenges this creates will ensure that the debate and discourse on these matters will be both on-going and include a diverse range of views as to the appropriate policy settings. ■ Bruce Bailey is a director of RSM Bird Cameron and National Lead of RSM’s Aged care and retirement living practice Editor’s Note: LASA provided an in-depth submission to the DSS Discussion Paper on Proposed Changes to Financial Reporting. The submission can be found here: http:// www.lasa.asn.au/wp-content/uploads/Discussion-paper-proposed-changes-to-financialreporting-for-providers-of-residential-aged-care-and-home-care-February-2015.pdf Other Links: ACFA Report: http://www.lasa.asn.au/wp-content/uploads/ACFA-Improving-datacollection.pdf RSM Bird Cameron Paper: http://www.lasa.asn.au/wp-content/uploads/ACFA_RSM. pdf DSS Discussion Paper: http://www.lasa.asn.au/wp-content/uploads/DSS-FinancialReporting-Discussion-Paper.pdf

FUSION | 55

Young people in aged care Inquiry into the adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disability in Australia Natasha Chadwick, Managing Director, Synovum Care Group Kay Richards, LASA National Policy Manager

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ecently LASA had the opportunity to make a submission to the Standing Committee on Community Affairs, in relation to the inquiry into the adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disability in Australia.

The inquiry was broad reaching, however LASA predominately commented on one particular section of the Terms of Reference, the appropriateness of the aged care system for care of young people with serious and/or permanent mental or physical disabilities.

LASA’s full submission can be sought on the LASA website www.lasa.asn.au, however this article will summarise the submission and also provide a service provider perspective when faced with caring for a young person with a severe physical, mental or intellectual disability.

As identified by the Young People in Nursing Homes National Alliance, approximately 6,500 young Australians with disability

reside in residential aged care services. The disabilities suffered are often as a result of catastrophic injury or through progressive neurological diseases and generally those young people enter residential aged care on discharge from hospital.

Feedback from a number of providers suggests that a majority of younger care recipients are satisfied with the care they receive in residential aged care, however despite the best intentions of both the resident and the provider, an aged care facility is not and should not necessarily be considered as a first housing or care option.

Ideally, in certain circumstances, admission to an aged care facility should only be considered as a temporary solution until a more appropriate environment is found for the person.

Providers in rural and remote areas have commented that younger people who require care and services often receive that care in the home; it is once the family circumstances change or the lack of appropriate care and support mechanisms are apparent, that young

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56 | FUSION people are ‘funnelled’ into aged care. Waiting for the NDIS process can be considerable and many people find residential care the only alternative until the NDIS processes (eligibility, planning and often funding/accommodation) are operational. At the public hearings LASA supported the concept of case management, but was also concerned that many aged care providers are not familiar with the NDIS system and may not be taking full advantage of the services that can be offered for these residents in addition to aged care services.

Aged care providers indicate that the majority of younger residents in their care require a high level of care; however they are classified for residential subsidies using the same mechanism as older people residing in aged care facilities, via the Aged Care Funding Instrument (ACFI). The LASA submission highlights extensively the paucity of funding that is available through ACFI for younger people.

As residential care providers are well aware, the ACFI focuses on care needs related to day to day activities and a high frequency need for care. The User Guide states that these aspects are appropriate for measuring the average cost of care in longer stay environments. What the ACFI does not discriminate, are the care needs for younger people against the needs of an older person who predominately presents with frailty, symptoms of dementia and palliative care needs.

While the ACFI questions provide basic information that is related to fundamental care needs, it is not a comprehensive assessment package. Here lies a significant problem for aged care providers; in that they cannot provide the specific, wide-ranging and individual care needs for younger people within the funding constraints that ACFI dictates.

ACFI fails young younger people living in residential aged care with no focus or emphasis on returning to a pre-existing level of daily living. This is significant for those who have survived a catastrophic life changing event such as a motor vehicle accident, or those living with a chronic life limiting illness.

A relatively new terminology in the Australian aged care environment is reablement; often this term is used in the context of home care and consumer directed care. However reablement is not a term that can be easily translated into residential care for younger residents. This is because funding, staffing knowledge and skills and support mechanisms are generally not geared to this way of thinking.

Reablement is commonly focused on short term, targeted intervention and is about bringing a person to their full potential, to accommodate their illness by learning or re-learning the skills necessary for daily living. Reablement programs tend to be led by allied health professionals, particularly physiotherapists and occupational therapists but can be delivered by vocationally qualified workers and therefore do not generally follow a medical model.

Whereas, residential aged care currently follows a medical model, and is geared to support the resident with the illness and frailty they live with, not to rehabilitate to a pre-existing level of fitness. Unfortunately some services have made a strategic decision not to admit a person under the age of 65 years, with a view that without appropriate funding they could not ensure the workforce was appropriately educated on the specialist needs of a younger cohort. They specifically question how therapeutic recreation and activities programs would meet the individual needs of a younger person as the majority on offer would be focused on the needs of the elderly. Complex provision of speech therapy, physiotherapy and occupational therapy, as well as specific consumables for tracheostomy, colostomy care are also not adequately addressed in the funding stream.

The current funding envelope is not designed to offer reablement or full rehabilitation services that the majority of younger people in residential care so sorely need. Care needs are therefore developed to maintain and improve current levels of activity, not necessarily to regain those lost.

Why then would an approved provider choose to admit a younger person? While under ACFI, the maximum daily funding subsidy would probably be received on behalf of a younger person (but not always), the outlay to accommodate the specific needs of the individual would often be adverse to the majority needs of the aged population in a particular facility.

A social and moral dilemma faces an approved provider when accommodation needs are sought from family, hospitals or subacute facilities, often with little forward planning in place. It is only in cooperation with the family, and often with financial input from the person (and or their family), that appropriate services (additional to those specified in the Quality of Care Principles) can be provided.

Of equal importance, residential aged care is not well placed to enable community connectedness for young people and is not focused on primary health initiatives; rather services and support mechanisms are geared to services that focus on the ageing population, not those in the younger cohort. LASA supports the premise articulated by the Young People in Nursing Homes National Alliance that “social connection is fundamental to achieving a life worth living for an individual living with a disability.”

Many activities and entertainment that some younger people might prefer (movies/clubs/drinking/contemporary music etc.) are not catered for by age services, specifically because many of these activities may be external to the facility and require additional costs. Often younger visitors feel confronted by the high number of cognitively impaired people that reside in aged care and visitors to the younger resident are often seen tapering off over time.

A major concern of providers of aged care services is the appropriate training, skills and knowledge of the workforce. It is also about the aptitude and propensity of the worker who has chosen aged care as their career path. Training to work in the aged care sector is obviously focused on the aged (gerontology) and often does not include subjects to support knowledge transfer to the younger person’s needs.

In order to optimise the quality of life of the younger person and to provide the right socialisation, it is not necessarily ideal to mix younger people with an older population in which the majority have some level of cognitive impairment. The care delivery is a completely different model. This then brings the problem of occupancy. With an estimated 6,500 people nationwide, even a small cluster within a designated wing of a residential service will potentially suffer from occupancy issues. This has been the main obstacle to providers targeting young people with a disability. Building requirements (or restrictions) may also be a major reason why providers of residential services are reluctant to admit younger people who require specific furniture, fittings and equipment.

This article has so far centred significantly on the residential aged care setting, however a growing number of younger people receive care and services through Home Care Packages. Younger people are not the target audience for these packages as described on the My Aged Care website (http://www.myagedcare.gov.au) and as the growing demand for services increases, many younger people may miss out on vital services or again be ‘forced’ to utilise the residential

FUSION | 57 sector of aged care until appropriate support and services become available.

Interestingly, the 2012-13 Report on the Operation of the Aged Care Act 1997 does not appear to mention young people who receive aged care services, despite their growing numbers. What message is being portrayed by that omission?

The following comments are provided by Natasha Chadwick, Managing Director, Synovum Care Group. Natasha was able to present to the Senate Inquiry during a recent public hearing.

As a provider of aged care services that has a larger than usual number of younger people living in two of our Centres, the average age of our residents is 74 and 79 years in comparison with the national average in the sector of 84 years old. Considering this we welcomed the Senate Inquiry.

It appeared from the questions however that the Committee’s focus was younger people living with early onset dementia and the disablement of the “Younger Onset Dementia Key Worker” program rather than the overall impact of younger people with multiple disabilities and needs being forced to live in nursing homes. Even if this is for a short period of time while looking for more appropriate accommodation and care, the impact this has on the life of a younger person not to mention the inability of the funding tools in aged care to properly meet their very different needs did not appear to be a key area of discussion.

Whilst LASA had provided a detailed paper to the Committee on these issues, it appeared that they were of the firm opinion that an aged care provider could access the NDIS for additional services for a younger person living in an aged care centre to top up the funding provided through ACFI to assist with socialisation, rehabilitation

and advocacy to name some of the additional services that may be required. It is clear however when reviewing the application process for funding through the NDIS that without effective advocacy or case management younger people being forced to live in aged care will continue unless these services are provided in order to be successful in receiving services and funding through the NDIS in the first instance.

It is clear that for aged care providers to continue to provide services for younger people in the short-term, while more appropriate accommodation and services are sought, they need to be supported.

This support should take the form of a case management approach for each individual younger person along with advocacy services to ensure they do not get stuck in the aged care system. We also need to ensure that aged care providers are given the tools and education to enable them to receive additional funding in order to meet the needs of a younger person living in an aged care centre.

Everyone agrees that the best outcome for younger people with a disability is not to be accommodated in an aged care setting, however due to numerous factors including location in particular in regional and rural areas this may not always be a reality. It is with this in mind that the Senate Inquiry needs to ensure that the individual needs of a younger person are able to be adequately met through the NDIS without the continued utilisation of services that are available for people who are ageing. Aged care services are already in many cases struggling to provide services to the ageing population particularly with the current reductions in subsidies such as the Aged Care Payroll Tax Supplement and the Dementia and Severe Behaviours Supplement.

Additional costs involved in caring for a younger person in an aged care setting will add further strain if providers are unable to access services and funding through the NDIS. ■

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FUSION | 59

‘Riding the wave of aged care leaders’ Louise Forster, Innovation & Business Development Manager, CommunityWest Inc.

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’m Louise Forster, I’m under 40 and I’m passionate about aged care and the future of our sector. On February 24 I had the pleasure of travelling from WA to Albury NSW for the LASA Tri-State Conference to talk about engaging young leaders in aged care.

I participated in an innovative leadership program in WA in 2013 and have since been involved in encouraging the next wave of younger leaders in aged care, and also in engaging those leaders on aged care boards.

The 2013 initiative ‘Engaging Young Leaders on Aged Care Boards’ was the brain child of social entrepreneur Alicia Curtis and aged care leader and Southcare CEO Dr Nicky Howe, after securing a WA State Government Social Innovation Grant for the program. As Nicky explains, it started with a conversation between the two, and the outcomes have been far more than either ever anticipated. The program is now in its third year and is funded through the aged care organisations (Community Partners) that it serves.

The program promotes age diversity on boards and enables leaders under 40 access to aged care boards. It does this via a three-pronged approach: firstly, by hosting a series of ‘Unconventions’ (unconventional events to engage directors and leaders in the conversation about age diversity); secondly, by developing 20 young leaders in a three-month program. Thirdly, the program promotes age diversity by creating an online toolbox with resources for the sector.

In my work at CommunityWest, I also use a three-pronged approach to organisational culture change (where a lot of our work is focussed) that we call ‘TSP: Thinking, Skills and Practice.’

This approach holds that to have effective culture change, people need to change their way of thinking, learn new skills and have opportunities to put these both into practice.

I believe that the success of the young leaders program is due to its multiple initiatives, that together address the ‘thinking, skills and practice’ required to bring about the significant cultural change of accepting and embracing younger leader on boards.

Traditional ‘thinking’ around who can govern aged care organisations has been challenged through the Unconvention series, where debates, panel presentations, fishbowl discussions, interactive brainstorming, social media and other innovative techniques have been used. Significant media attention has also helped to get the conversation happening with a wider community audience. Alicia Curtis’ White Paper: The Business Case for Age Diversity on Boards presents research and provides evidence to support the value that age diversity adds to boards.

The three-month leadership program begins to address ‘skills’ young leaders require to pursue governance roles. The skills centre round self-reflection, leadership skills, governance and sector knowledge and are achieved through techniques including self-reflection, a leadership retreat, guest speakers, site visits and discussion forums.

The program provides a number of opportunities for young leaders to ‘practice’ their skills and also for leaders in the sector to put their new thinking into practice. Opportunities to observe board meetings have been successful in bringing both sector and young leaders together and breaking down barriers. Similarly, individual mentoring opportunities have enabled generations to build relationships, recognise the value proposition inherent within each generation.

A wonderful organic outcome of the program has been a number of successful Board Director Traineeships for young and emerging leaders. I was successful in securing one of the first traineeships with SwanCare Group (a large retirement living and residential aged care provider). Since Southcare and SwanCare Group initiated the idea, there have been a total of nine traineeships. CommunityWest’s board are also proud to support the program with the launch of our inaugural traineeship this year. The traineeships provide a safe environment for young leaders and existing directors to explore the benefits of having a younger member without either party worrying about the liability implications. The model has been extremely successful and has been a catalyst for 11 participants securing full board appointments.

I am extremely proud to have been part of this wonderful initiative, and have enjoyed giving back to my community by contributing to the boards of Swancare Group and MercyCare.

I have enhanced my governance skills, graduating from the Australian Institute of Company Directors and further developed my leadership skills, continuing my MBA studies and applying my learning in a new role at CommunityWest in 2015. I look forward to a bright future, supporting aged care and my community through leadership and governance roles. I hope my Tri-State presentation inspires others to take positive action to increase age diversity on aged care boards. The future of our sector will be in the hands of today’s young leaders, so why not embrace them now!

LASA WA has been a proud supporter of the Young Leaders program. ■ To become a Community Partner or to find out more about supporting the program, contact Dr Nicky Howe, CEO Southcare nicky.h@southcare.org.au

60 | FUSION

Factors driving strategic decision making in the industry AN INTERVIEW WITH ROB HANKINS, OUTGOING CEO, ECH Interview conducted by Rod Young

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od: The whole industry was fascinated by the announcement that ECH would divest its residential care assets and concentrate on affordable housing and community care. Can you provide some background to the organisational processes that drove this decision?

Rob: the ECH Board undertakes a major strategic review every couple of years. In 2012 we acquired Masonic Care; the main reason for the acquisition was to grow our community care portfolio. However, Masonic did not want to split the two components so we acquired both arms of the Masonic operations.

Rod: At a time when many providers are looking to expand their service coverage i.e. cover the service continuum of home care, lifestyle living and residential care it would seem that ECH has bucked the trend. Does this mean ECH has a different view of industry viability as compared to other age care operators?

Rob: In 2013 the Board Strategic Review concentrated on the three core businesses of ECH; community care, affordable housing and residential care. Each business unit was subject to an evaluation based on the following criteria: • Viability • Good quality service • Top quartile performance • Unique service that others are not replicating • What does the service add to the organisation in the future?

After considerable deliberation and internal assessment the Board determined that all three business units met the first three criteria but that our residential services were not unique and not offering a point of differentiation for the future.

Rod: What strategic review processes did the ECH Group board undertake in order to reach the conclusion to exit residential care?

Rob: By applying a very rigorous process around the key criteria as outlined above the ECH Board was able to work through some fairly complex issues and to allow itself to challenge the status quo in a way that all possible options could be considered.

A process that supports the Board to undertake an exercise of this nature is crucial to support the Board through the decision making process. Without a clear set of agreed criteria it is an almost impossible task to ask of any governing entity.

Rod: ECH as a not for profit, decided to sell to a for profit aged care operator which was a major surprise to some of your colleagues from the not for profit sub-sector. Can you outline the

ECH thinking behind determining the right entity with which to transact.

Rob: We started out on this journey without any fixed position regarding the ownership type of a potential purchaser. We were agnostic in this regard. However, we did set some clear criteria around the features of a purchaser that we were seeking, namely: • Similar philosophical approach to care service • Agree to maintain staff and general operations during transition period • Agree to meet staff entitlements • Agree to maintain welfare of residents • Capacity to fund a 1,200 place procurement • Speed to completion Rod: The Australian Institute of Company Directors recently completed a study of aged care not for profit operators to determine the level of interest among not for profit boards towards mergers or acquisitions See Fusion Page 51. The survey indicated a surprising level of interest in progressing a merger or acquisition to a suitable organisation. How would you advise not for profit boards to progress their thinking in this area if they are so inclined?

Rob: I have a view that all organisations must review their mission regularly. For Profits obviously have a profit objective whereas Not For Profits have a higher hurdle around their mission.

They both must achieve a surplus/profit if they are to remain viable.

Uniquely Not For Profits must ensure that their mission is being fulfilled. If the answer is yes then the possibility of a merger or acquisition should be an option that the board considers from time to time.

ECH considered that it provided a unique service in community housing and dementia day care but not a unique residential service. ECH’s decision was therefore to divest the business unit that was not satisfying the ECH mission and to use those assets to grow the businesses that are unique and more closely aligned to the ECH mission.

Rod: Having another entity take over aspects of your operations, absorb staff, accept legal responsibilities and accountabilities requires a level of trust and clearly defined lines of responsibility. How did the two parties achieve this level of accommodation?

Rob: ECH undertook an internal valuation and then sought external consultants to undertake a valuation. The two valuations were closely aligned which provided considerable confidence to the internal team.

FUSION | 61 We then engaged our consultants to make highly confidential enquiries of parties that would likely have an interest in an acquisition and the capacity to fund the purchase. These initial steps lead to five/six potential entities who could move quickly to complete the transaction. Confidentiality agreements and Expression of Interest documents were lodged leading to short listing and due diligence processes.

The Expressions of Interest were considered by the Board supported by the Consultants during December and January. The selection process came down to one party who could guarantee quick settlement, maintain service quality to residents, and ensure staff entitlements would be protected.

This party had a history of care and service quality which matched our own.

We then entered a transition process lasting six months, where ECH maintained payroll processing while the new owners negotiated a fresh enterprise agreement with staff. We developed clear lines of communication between both parties to deal with the many issues that arose as the transfer progressed.

In addition, our communications strategy involved an in depth briefing of site managers, area managers, residents and families so there were no surprises and confidence in the decision could be assured.

Rod: Some months after the announcement of the acquisition how would you describe progress?

Rob: It has gone very well. Staff and Resident have not been adversely affected.

We have deployed good communications and ensured that all major stakeholders were informed in advance of any public statements.

Key contact people were appointed to manage the process.

Which has been critical to success.

Four to six months implementation timeframe meant things were not rushed.

Must accept that minor details still being agreed and this requires a clearly defined process, lines of communication and people with requisite delegations.

The original strategic direction that lead to the Board making this decision is now being realised with the first components of the first ten year investment strategy currently being implemented.

The first six renewal plans will be considered by the Board in March this year.

Rod: What would be your advice to any aged care operator considering a similar course?

Rob: expect the process to consume twice as much time and resources you might consider necessary. Considerably more difficult if the sale is to be conducted on a confidential basis. Allocate a key person as a communication link among and between stakeholders. Have a clearly developed communications and stakeholder engagement plan. Ensure major issues such as maintenance of staff entitlements and security of resident’s tenure are clearly agreed in advance as being able to address these issues early and upfront reduces many of the concerns of staff, residents and families. â–

FUSION | 63

Sage South Africa 2014 Study Tour Report

Twenty Four adventurous and spirited Australian delegates, including executives and partners, took the opportunity to pursue the goal of SAGE (Studying and Advancing Global Eldercare) into South Africa from September 28 to October 11. This was the first study tour by the SAGE group in South Africa, and for the majority of participants it was their first experience in the African country.

W

ith representatives from across the senior services sector, including ACSA & LASA members, underpinned by the legacy of ThomsonAdsett’s original vision of hosting a quality program of study tours throughout the world, delegates ventured into an uncertain environment.

Under a backdrop of world strife, alerts to the stated risk of Ebola, heavy crime, chronic poverty and AIDS, delegates were given one of the broadest overviews of services and care in SAGE history. The tour offered insights into the challenges of developing appropriate aged care in post-Apartheid South Africa and how innovative programs and services are overcoming those difficulties.

The title of the SAGE tour was “Implementing Business Models to face Diversity Aged Care delivery”. Visits to a variety of aged care facilities and developments in urban and regional areas made it clear that aged care in South Africa is as challenging as it is diverse.

The tour host, Margie van Zyl from Geratec, gave delegates an overview of senior services in South Africa and the multiple social and health challenges the long term care industry faces in an environment of scarce resources. While South Africa has established a pension for seniors at 65 years, the government does not see older people as a priority. AIDS has placed a huge burden on older people and the traditional African family support networks are breaking down. Innovative service delivery and funding models are needed to ensure support is given to all South Africans as they age.

To understand senior services in South Africa, as in all countries, there is a need to first understand the culture of the country. Tour delegates were provided insights into the culture through our touring of three cities, Durban, Cape Town and Stellenbosch, and surrounding regions.

Arriving in Durban and travelling from the airport there was an immediate and heightened awareness for personal and property security. This stayed with us throughout our study tour, but it was Durban where this was most apparent.

From 1948 the Apartheid laws resulted in the Western Cape being declared a “Coloured Labour Preference Area”. This meant that blacks who already lived in Cape Town could stay, however new arrivals were forcibly sent back to their homelands – the Eastern parts of South Africa – suited to the traditional economy of cattle and summer crops. This changed in the 1980s with the need for urbanisation recognised by President P.W Botha, and his decision that all South Africans would be free to seek work wherever they wished.

Hence the tables have turned; whereas once Cape Town was a city where the whites dominated, today the black and coloured have similar numbers and the whites are the minority.

Some key facts • The number of people aged over 60 in South Africa is • South Africa’s overall ranking on the Global AgeWatch Index in 2013 was 65 out of 91 countries, with Sweden at number 1.

• According to South Africa’s Department of Social Development, there are 605 registered homes in the country, with 453 being state subsidised and only seven being run by the state.

The contrasts between Australian senior services and the attitudes towards older people, and those in South Africa were evident for all delegates to see. Most older people live in rural areas with very little access to services. The work done by enterprising and dedicated advocates to bring them those services in such difficult circumstances was inspiring and encouraging to see. However, much more work needs to be done.

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Specialising in: • Electrical compliance services • Electrical safety gap analysis • Lighting recommendations and installations • General electrical works with rapid response • Falls prevention systems (Bedside Guardian)

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Sage South Africa 2014 Study Tour Report

Water tank that was able to be bought from SAGE contributions to the home over last 5 years – 4 have now been purchased through SAGE donations.

Emseni Rorke’s Drift

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Valerie Lyons, Villa Maria ay four saw delegates take a very long drive through the South African countryside to Rorke’s Drift, a historic Zulu battlefield from the 1800s. Set amongst sweeping grass plains with very few facilities, not even a village store, this little place is home to the Emseni Old Age Home.

Tour host Margie Van Zyl has played an integral role in this facility in remotest South Africa and its success is a credit to her and the leadership team at Emseni. It is also a special place for SAGE Program Leader, Judy Martin, who literally stumbled across the home when on a tourist trip to Rorke’s Drift with her family some years ago. This chance meeting started a program of SAGE support for the home where the Study tour program has assisted funds for the home over the last 5 years.

A not-for-profit facility, it relies on government grants, pensions and fundraising. Staff are poorly paid and have limited resources. Ongoing fundraising support, particularly from the international aged care community, has enabled the centre to make improvements to the facilities and buy necessary equipment, including purchases enabled though the SAGE fundraising initiative, of an iron press and a water tank which has

resulted in the establishment of an impressive vegetable garden.

Clean and comfortable, residents and staff alike are happy.

Delegates were greeted with drumming and singing by residents and staff wearing traditional African dresses and beads.

Many staff travel for hours to work at Emseni. They arrive on Monday and stay until Friday, when they travel the long distance home again. Some even look after their grandchildren because their own child is working.

Delegates made an unexpected return to Emseni the following day, after a storm prevented the bus from reaching the next site visit to St Antonines at Wasbank. The spontaneous visit provided an insight into residents’ strong interest in the political agenda with a focus on political speeches being televised. It was also of interest to note a significant number of younger residents with disability.

Accommodation at Rorke’s Drift was the amazing Isandlwana Lodge and Guest House set amongst the Zululand hills. It is carved into the iNyoni Rock formation, on top of which the Zulu commander stood during the battle of Isandlwana in 1879 and offers magnificent views across the valley. SAGE delegates received a fascinating insight into the Zulu lands and the battles that happened over the centuries.

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Sage South Africa 2014 Study Tour Report

Zulu Cultural Tour, Durban

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Valerie Lyons, Villa Maria he first day of the tour was designed to expose delegates to the real South Africa, with a tour through parts of suburban Durban and the Valley of 1000 Hills. Durban is the largest city in the South African province of KwaZulu-Natal, the busiest port in Africa and the second most important manufacturing hub after Johannesburg. The insightful day included a visit to a traditional healer, an orphanage and a walk through the Valley of 1000 Hills community.

It is a very different environment to that in Australia, with clutter and refuse everywhere. There are great challenges for senior services in these communities. In suburban Durban there are thousands of people living in sheds no bigger than cubby houses making up huge shanty towns.

The environment in regional villages was in some ways better than the urban areas of Durban, as they often retained the more traditional aspects of community.

In all environments it was apparent that grandparents, particularly grandmothers, often took on the responsibility of caring for their grandchildren. This was in large part due to AIDS, but also due to many single mothers leaving their children for vast periods to work.

The Association for the Aged (TAFTA)

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Valerie Lyons, Villa Maria he Association for the Aged (TAFTA) is one of only a few providers of affordable frail care for people categorised as “sub-economic” pensioners in South Africa’s Ethekwini Municipality. Services include accommodation for the fit, frail and those who require assisted living, social services, Meals on Wheels, Home Based Care and transport to and from clinics and hospitals.

In the 2013-14 financial year, 338 people received Home Based Care in the Durban central area, while TAFTA delivered 25,457 Meals on Wheels to more than 2,500 people. TAFTA is constantly seeking greater resources to help deliver services to those they care for, including funding. At one facility, government funding meets just one third of the R7,610 monthly cost of caring for each resident.

The core TAFTA values are: • Integrity • Compassion • Co-operation • Service Excellence • Respect and Environmental Responsibility Site Visit – Entokozweni, Brooks Farm, Amaoti, Inanda Entokozweni is one of the best examples of community care in South Africa and shows what can be achieved when communities, especially black communities, embrace an integrated approach. It includes a residential village with cottages that accommodate older people with their grandchildren. In the last year it cared for 22 residents and two grandchildren. Two assisted living units catered for 11 older people who are unable to live completely independently, with the eldest being 103.

Two cluster foster homes also cared for 13 foster children.

The innovative model recognises that in order to address the needs of the community’s seniors, particularly grandmothers, it must also address the broader community’s needs. The facility includes a multipurpose centre, afterschool care, home based care, gardening projects, laundry, support groups, nutrition programs, paralegal services, craft and training programs, all in a secure, fenced environment. The facility is run by one paid employee and 13 volunteers who are paid a stipend.

Delegates had the opportunity to meet with some mothers and residents and see for themselves how the innovative approach to community care is not only caring for multiple generations, but also enabling the local community to grow their skills sets.

This facility shows that just as it takes a village to raise a child, it takes a village to support seniors.

Site Visit – Langeler Towers, South Beach, Durban Due to the expense of providing accommodation and frail care facilities for sub-economic pensioners in Durban, TAFTA’s three sheltered housing facilities make a substantial loss. This includes John Conradie House, which operates at a loss of R3 million a year. In order to cross-subsidise those losses, TAFTA is building an 11-storey block of flats next door – Langeler Towers.

The higher rentals derived from Langeler Towers through selffunded retirees will help reduce the losses at John Conradie House, which will also be given a makeover. This sustainable model follows a similar TAFTA development in central Durban – Ray Hulett House.

This approach is similar to what many Australian organisations do to cross subsidise underfunded programs and services. Much fundraising work is also being done to help cover the R150 million cost of the development.

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Pietermaritzburg and District Council for the Care of the Aged

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Valerie Lyons, Villa Maria ietermaritzburg and District Council for the Care of the Aged (PADCA) is a not-for-profit organisation based in Pietermaritzburg. It offers Home Care services, respite and accommodation including independent living, residential accommodation and frail care including dementia care. It cares for 600 residents and more than 3,000 seniors in the community.

The PADCA Philosophy: “We ascribe to the Eden Alternative, a philosophy of care which honours the individuality of every senior and encourages the active participation of the residents in activities and decisions.”

Site Visit – PADCA Riverside Park Home This modern home in a secure part of Pietermaritzburg is similar to many aged care residences in Australia. It caters for 102 permanent residents and includes a unit for people living with dementia. It has a heated, indoor hydrotherapy pool, 24 hour nursing care, full catering services and a range of social activities. The cost of accommodation is priced accordingly.

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Site Visit – Sunnyside Park Home and Clivia Place PADCA’s Sunnyside Park Home is set in extensive gardens.

Manicured and very picturesque, it is a stark contrast to the state-run facilities in poorer areas of South Africa.

Described as a “Home with a Heart”, it is an Assisted Living and Frail Care home with Independent Living style residences.

It receives some subsidisation of rent for qualifying seniors, making it affordable to people aged over 60 who are living on a state grant or limited income. It also caters for younger people with disabilities.

Site Visit – Woodgrove Retirement Village The third PADCA facility on the tour, Woodgrove, has 172 independent living units set in 18.5 ha of park-like surroundings, including an undeveloped wilderness area. It also has 23 bed-sitters and 20 frail care beds, with an additional four beds reserved for respite care for Life Right Holders Similar to European and Australian models, it has a nursing and emergency care service, central facilities including a pub and library, catering services, telephone and internet, and the option to age in place with carers.

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Sage South Africa 2014 Study Tour Report

Margie Van Zyl (Sth Africa host for the SAGE trip and also Chair of IAHSA), Judy Martin (SAGE) & Rayne Stroebel MD of GERATEC (he hosted the whole SAGE delegation to a home made dinner/extravaganza)

Ekuphumleni, Cape Town

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Valerie Lyons, Villa Maria kuphumleni (iKhaya iXolo Lase) is in Gugulethu in Cape Town. It is in a very poor black community and has 134 residents. The facility is aimed at enabling the community to be innovative and assist themselves, as funding is limited.

The facility has come a long way since it was established in 1987 as a project of the NGO Phumlani. Its aim was to provide 24 hour care to frail and vulnerable older people as well as younger people with a disability, however it was fraught with problems, including corruption and fraud.

In 2011 administration of the home was handed to Geratec in partnership with Zela Projects. Using government funding, it has since been transformed into a haven of care for vulnerable older people and younger people with disabilities, using the Eden Alternative philosophy of creating a home away from home.

Areas that were tackled in the transformation process included: • Development of and monitoring of menus, diets and special diets • Quality control • Eradicating waste • Energy saving controls, and creative energy alternatives • Strict financial control • Hygiene, occupational health and safety issues need urgent attention • Training and development of staff including Food Service and Dietary Management; Care and Nursing Best Practice Policies, Protocols and Practices; Clinical assessments of residents; Care Plans; Housekeeping and Laundry Management.

• Implementation of proper governance and accountability

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Cape Town

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Valerie Lyons, Villa Maria ape Town, on the west coast of South Africa, is a more sophisticated, cosmopolitan city than Durban.

Delegates had the opportunity to walk around the city, take the cable car to Table Top Mountain and went on a tour of the infamous Robben Island, where Nelson Mandela spent 18 of his 27 years in prison. It was interesting to note that

the jail catered for prisoners as they aged with a dedicated aged care facility. Not something we expected to see in the notorious jail.

Geratec Director Rayne Stroebel opened his home for a Traditional Supper, and delegates were also able to attend an interactive Djeme drumming session ceremony. The group had dinner at GOLD restaurant, which brought together the cuisines of the all the South African regions. Delicious and entertaining!

Highlands House, Cape Town

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Valerie Lyons, Villa Maria his is a very well-resourced Jewish care home that is similar to Australia’s basic aged care accommodation. Like Australia, it has a focus on socialisation with a Lifestyle co-ordinator and a Lifestyle Centre where all daily activities are held.

Highlands House is also an InterRAI Pilot Project. In 2007 Highlands House determined to provide an internationally equitable level of care and improve quality of life for residents. It has now introduced InterRAI – an international resident assessment instrument that uses standardised holistic assessment of individuals, outcome scales, clinical assessment protocols and facility evaluation.

Existing care planning based on “Orem’s Model of Nursing” was integrated into InterRAI CAPs to plan care interventions and an IT programme was developed for care planning. They have

also introduced multisensory rooms for residents, similar to those in Australia, as a way of engaging with residents and to calm or stimulate them.

At the facility, CEO Harris Burman and deputy CEO Delia Kaplan addressed the group.

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Sage South Africa 2014 Study Tour Report

South African Care Forum Festival, Stellenbosch

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Valerie Lyons, Villa Maria rom Cape Town, delegates travelled to nearby Stellenbosch for the inaugural South African Care Forum Festival. The town is known as the City of Oaks, a university city with beautiful European streetscapes.

Accommodation was in a restored manor house in the heart of the city. We also had the privilege of tasting South Africa’s speciality wine – “Pinot Tage”.

Delegates from 12 countries attended the four day forum, the first of its kind in South Africa. It brought together aged care experts from across South Africa and the world to share key insights and learnings. The venue had been “yarnbombed” with brightly coloured knitting from residents in aged care homes around South Africa, which celebrated the richness of ageing (refer photo of knitting on page 14 as prepared by residents of the Highlands House).

There were some insightful and challenging presentations, including a Plenary speech by Dr Marlene Wasserman on ageing and sexuality. She discussed the changing sexual concerns, difficulties and dysfunctions of people as they age, the impact of illness, medication and sexuality, and the various relationships people have as they age. It’s also a time when some people “come out of the closet” and must deal with the implications of that, not just with their own lives but those of family members. Dr Wasserman said there were a number of ways older people “reignited” their passion, which all aged care providers must be cognisant of.

Dr Monica Ferreira, President of the International Longevity Centre South Africa, gave the opening address in which she said care of older people must enable them to experience the richness of ageing. She said there was a rapidly evolving focus on the positive in growing older and sustaining the productive

and developmental capacity of older people. As people live longer, care models and responses will also need to adapt and evolve. However, she said she remained dismayed that knowledge generation on ageing, including in South Africa, remained the preserve of younger people.

Master classes provided an opportunity to discuss a range of aged-care related issues, including falls prevention, psychotropic medication and the value of networking and global partnerships.

A Plenary speech was given by Dr Jaco Hoffman from the Oxford Institute of Population Ageing, University of Oxford. He is also the coordinator of the African Research on Ageing Network (AFRAN), which brings together African and international institutions and individuals to develop and expand African research and training capacity on ageing.

The forum also promoted CommonAge – the Commonwealth Association of the Ageing – to advance the interests of older people by helping to build capability and capacity in health and care services throughout the Commonwealth.

The Association was established by Andrew Larpent and launched in Melbourne, Australia in November 2013.

CommonAge says services and support for older people in many developing Commonwealth countries would benefit from access to the international aged care NGA community.

Delegates also had the opportunity to attend a theatre production, London Road, which explored the unlikely relationship between two very different women living in South Africa – an elderly Jewish widow and a Nigerian immigrant.

Their lives collide after an incident of violence and they discover much in common. It was a thought-provoking and poignant performance, which has won many awards across the world, including a Stage Award for Acting Excellence, Edinburgh 2013, Best Actress for Robyn Scott.

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Post Tour Kanobo Safaris

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Valerie Lyons, Villa Maria elegates had the option of staying on in South Africa for a post tour safari. This tour offered a view of the traditional Africa, through game reserves, ranches and the coastal region.

First stop was a tour of the Cape Town Ostrich Ranch, then through the West Coast National Park to the town of Langebaan.

We then drove through the beautiful west coast fishing villages on the Western Cape, providing spectacular views across the water.

The group visited the Aquila Game Reserve, a four star safari lodge on a 7,500 hectare conservancy in the southern Karoo.

It is home to the Big Five of the wilderness – elephants, lions, buffalo, leopards and rhinoceros. Here delegates learned the sad plight of the rhinoceros, which are still hunted by poachers for their horns. It was incredibly disappointing to learn how rhino numbers, particularly, continue to dwindle due to poaching, and yet heartening to know there are many people committed to saving them and stopping this devastating crime.

A drive through the Karoo and Bokkeveld Mountains then took the group to Kagga Kamma Private Reserve, which is set amongst the rugged beauty of the Cederberg mountains. Here there was bushman rock art, 14 species of game, unique fynbos vegetation and stunning mountains, valleys and canyons.

Guests enjoyed a game drive through the reserve and magnificent sunsets.

The fourth day saw the group travel through the Breede River Valley and Overberg. It was then onto Hermanus, which is described as the “heart of the whale route”. The Marine Hotel holiday resort is widely known as the world’s best land-based whale watching destination, and it certainly lived up to its expectation. On the final day we were able to take a Whale Watching cruise to see the majestic animals from a different perspective.

Emuseni Centre for the Aged, Plessislaer

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Valerie Lyons, Villa Maria museni is a poor home in a periurban area that provides residential and frail care. It caters for up to 55 pensioners and is managed and funded as a NFP organisation.

This home has only black residents whose average age is 55.

Emuseni also caters for people with disabilities and has a Home Based Care Program. With limited resources, including staff, equipment and funding, it is well supported by the community and has a number of volunteer staff.

Emuseni’s vision is: “To be a centre of excellence providing high quality care to all frail elderly people using a team approach”.

Its mission statements says: • The centre is committed to providing immediate and efficient care to all frail and elderly people • Treating elderly people with dignity and respect at all times • Providing an environment that is ready for frail elderly people to improve service delivery

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Sage South Africa 2014 Study Tour Report

St Antonine’s, Wasbank

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Valerie Lyons, Villa Maria his Catholic Mission at Amakaze, Dundee, is deep in the hills of Kwazulu Natal. It is an amazing example of how love, care and respect can ensure older people in rural South Africa age with dignity. In 2008 the Department of Social Welfare had decided to close the small aged care home at St Antonine’s due to the high levels of abuse and dishonesty. It had become synonymous with hardship and hopelessness – until the arrival of Sister Lucia, who knew very little about running an aged care home. But she knew about caring for people and fixing their spirits. By example, she taught

carers to show dignity and respect to the residents, thereby improving their spirits and the quality of care and created a proper, nurturing home for older people.

Whilst we were prevented from visiting St Antonine’s due to the wet roads, our unexpected stop on the hills of South Africa (where the risk of the bus sliding off the embankment meant we needed to disembark) resulted in us being greeted with much merriment, songs and laughter, by the local girls and boys.

Fortunately we did have the opportunity to meet with Sister Lucia while in Stellenbosch, who provided greater insight into the mission.

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AGED CARE SECTOR STATEMENT OF PRINCIPLES LASA has played an active role in the development of the Aged Care Sector Committee Statement of Principles. LASA CEO, Patrick Reid is a member of the Aged Care Sector Committee. These Principles have been signed off by Prime Minister Abbott and were developed as an effort to guide the ongoing reform process and establish effective stakeholder relationships.

STATEMENT OF PURPOSE

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he Aged Care Sector Statement of Principles developed by the Aged Care Sector Committee1 and the Australian Government, sets out the Principles to: • guide continuing reform of the aged care system; and • embed a constructive and lasting partnership between the Australian Government and consumers, providers and the workforce.

The Australian Government and the Aged Care Sector Committee are committed to developing an aged care system that is aligned to the principles articulated in this Statement.

At the highest level, the guiding principles for the aged care system of the future are: • consumer choice is at the centre of quality aged care; • support for informal carers will remain a major part of aged care delivery; • the provision of formal aged care is contestable, innovative and responsive; and • the system is both affordable for all and sustainable.

Within this shared vision, differing approaches and policies will be needed to respond to the wide diversity of older people and their circumstances. Aged care policies will be set by the Australian Government. By working collaboratively with consumers and providers, a strong foundation of evidence-based policy will be built. Partnership will allow the skills, expertise, and strategic insight of all participants to be harnessed.

The Statement of Principles will build on current changes across the aged care system and provide a foundation for continuing change to the aged care system. It will provide a means to frame public debate and galvanise effort.

It is acknowledged that a number of risks will need to be managed in this process such as the availability of formal and informal carers, supporting the sector to transition to new arrangements, and ensuring that quality of care is not compromised.

Within this Statement:

• Consumers refers to all persons needing support and services from the aged care system. This includes older people as well as their families and the informal carers that they choose.

• Providers refers to business and community organisations which deliver home-based and residential aged care.

• Workforce refers to those who are engaged as paid employees, including contractors, and volunteers.

• Australian Government refers to the policy, funding and regulatory decisions made by government and the role of the public service in implementing its programs and services and providing policy advice to the government of the day.

This Statement has been developed in discussion between the Aged Care Sector Committee and the Australian Government.

It is intended to frame a continuing conversation about the future of aged care in Australia.

APPROACH TO PARTNERSHIP The Statement of Principles recognises the benefit in consumers, providers, the workforce and the Australian Government collaborating to realise an aged care system that will meet the needs of Australia’s ageing population. While recognising the role of Government in setting policy, this partnership will shape the future aged care system building upon: • the framing and pursuit of common goals • high levels of commitment to improved outcomes for consumers • effective cross-sectoral leadership to guide reforms into the future • shared recognition of the constraints, challenges and opportunities across the sector • the need for mutual respect and trust between all partners and the community • clarity around the roles and responsibilities of all parties • valuing the contribution of civil society • the need to grow and further skill the aged care workforce • a co-design approach to policy development and regulation In working towards the vision for the future of aged care in Australia the partners commit to the following roles.

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Partners

Roles

Consumers and carers

• Accessing information about aged care services to support informed choices • Contributing to the cost of their care according to their means • Being clear about their needs and how services can best meet them • Actively exercising choice and directing the care they want, to the extent they wish to do so • Caring for themselves and for those for whom they have responsibility

Providers and workforce

• Providing quality aged care services that respect and respond to the diversity of consumers • Supporting consumers to have a high quality of life • Supporting consumers to be active partners in care planning and making choices about their care • Pursuing innovation • Delivering best practice governance and management capability to improve efficiency, productivity and quality in service delivery • Actively contributing to developing sector leadership and reputation • Creating and maintaining strong relationships with communities that contribute to an understanding of local service needs • Building the skills and capability of all organisations and individuals providing care • Providing analysis and experience about how government policies and funding operate at the local level • Providing the necessary information to consumers about the services and support they can access • Being clear about what can be delivered and the level of contribution which consumers will have to make

Australian Government

• Acting as system steward through setting policy with appropriate funding that fosters flexibility, responsiveness and innovation amongst providers • Commissioning a contestable market of public, private and not for profit providers competing on value for money and performance • Embracing an evidence-based approach to policy design • Promoting, supporting and monitoring quality • Maintaining an effective safety net that ensures cost is not a barrier to receiving • High quality care for those in need • Developing and disseminating information to providers and consumers about aged care services • Supporting research which will enhance the expertise and understanding of the aged care needs of the Australian population • Working in partnership to develop and train the workforce needed to care for older Australians • Reducing unnecessary red tape by embracing fit for purpose regulation • Designing programs that are flexible and can be tailored to individual or community needs • Recognising the importance of the carer role through appropriate service system design • Working within and across levels of government to reduce bureaucratic silos and jurisdictional demarcations • Supporting public accountability through frequent engagement with all Partners and encouraging regular distribution of advice on progress across the sector

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PRINCIPLES OF AUSTRALIA’S FUTURE AGED CARE SYSTEM

EXPLANATORY NOTES Empowered consumers and informal carers 1. Exercise responsibility and make decisions People as they age will be able to exercise individual responsibility for decisions that enable them to lead active and fulfilling lives.

2. Drive quality Consumers will be made aware of their right to receive quality care and will have the confidence to pursue this with their provider.

Appropriate safeguards will continue to provide protection for consumers.

3. Are active partners in decision making Consumers will be viewed as active partners throughout the care journey. They will be given the resources and information they need to make informed decisions.

4. Make an equitable contribution to their care costs Consumers will be responsible for meeting some of the costs of their care on an equitable basis where they have the financial means to do so.

5. Are given access to the information they require Consumers will have access to information and support services to enable them to exercise choice. An effective gateway will provide consumers with information and independent, consistent eligibility assessments. The gateway will be easy to navigate and will guide, support and empower consumers as they move through the aged care system.

6. Informal carers are recognised and supported Informal carers play a vital role in providing support to people who receive aged care services and ensuring the sustainability of

the aged care system. Carers are recognised as partners in decision making and supported in their caring role.

Innovative and responsive services 7. Continuous improvement in delivery Providers will accept responsibility for continuous improvement towards best practice accountability, governance and operational management to deliver high quality aged care services.

8. A skilled workforce An appropriately skilled workforce will deliver quality care and services that are evidence-based. Workforce development and training will be supported.

9. Services responsive to consumer diversity Services that are appropriate to and reflect the diverse needs of the population will be available. These services – which include care, assessment and information provision by service providers and Government – will be delivered to consumers in a safe and effective manner that is responsive to and respectful of diversity.

10. Providers who compete on quality, value and performance A competitive market based approach to aged care services that is based on the ability of consumers to exercise choice and control. Contestability of delivery will promote quality, productivity, efficiency, innovation and value for money services that are responsive to consumer needs and preferences.

11. Services responsive to consumer wellbeing Consumers will be supported towards wellbeing and reablement. Services will focus on quality of care and quality of life for consumers.

FUSION | 79 12. Services available when and where people need them Consumers will have access to the care they need when and where they need it. This includes access to care in the home, residential services, or other appropriate location depending on consumer needs and preferences. Consumer views remain the priority in determining solutions for care in the local community, whether it be in metropolitan or rural areas.

A viable and sustainable system for all 13. Financially sustainable but affordable Consumers will have access to affordable aged care.

Financing and funding arrangements will enable efficient aged care services to thrive while being financially sustainable for Government and the public, private and not for profit providers who deliver programmes.

14. Funding attached to the consumer Government funding will be provided consistent with the assessed short and long term care needs of the consumer.

Funding will attach to the consumer allowing greater consumer choice of who provides services and how they are provided.

15. Integrated services delivered in a holistic manner Aged care will be delivered in a holistic manner enabling consumers to access integrated services. System design will ensure strong linkages with the health, mental health, disability

and community services sectors. Services across sectors will complement rather than duplicate each other.

16. Market based funding Government intervention will be focused on areas of potential market failure and consumer protection. A light touch approach to regulation will give providers freedom to be innovative in how they deliver services.

17. Consumers protected by a strong safety net Where consumers are unable to meet the costs of their care, they will be protected by a strong safety net of Government support. Cost will not be a barrier to care and will not create an undue burden on consumers and carers. â–

References 1 Independent Chair; Chief Executive Officer, Aged and Community Services Australia; Chief Executive Officer, Leading Age Services Australia; Chief Executive, Council on the Ageing; Federal Secretary, Australian Nursing and Midwifery Federation; Chief Executive, National Seniors Australia; National Director, UnitingCare Australia; Chief Executive Officer, Catholic Health Australia; Chief Executive Officer, Alzheimer’s Australia; Chief Executive Officer, Carers Australia; Territorial Social Programme Director, Salvation Army; Managing Director, Opal Aged Care; Managing Director, Bupa; Chair, Aged Care Financing Authority; Head Secretariat Aged Care Reform, National Aged Care Alliance

We want to hear from you!

Tell us what you think about Fusion for your chance to The voice of all aged services

Welcome to a brand new feature of LASA Fusion, our feedback page. From next edition we will welcome letters regarding articles in Fusion and suggestions for new content.

WIN AN IPAD! Every edition there will be a prize for the best contribution.

For our first feedback column we are asking readers to answer a short survey on Fusion.

What do you like?

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For 5 minutes of your time you have the chance to win an iPad.

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The voice of all

Summer 2015

aged servic es

| www.lasa.a sn.au

clinical focu s:

Achievin g excellen ce in cAre

services Implement Ing a natIo care IndIca tor progr nal aged 31 am practIca l Innovat the front Ions from lIne 39 Young nu rse leade rs In aged care lasa lau 41 platformnches Its polIcY 49

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Product News An Industry first for Aged Care Catering Software OSCAR Hospitality has developed an industry first – Resident Dietary Information and Menu Management software designed by aged care catering professionals, specifically for aged care catering.

enables nutritious and delicious food and beverages.

A one-stop-solution for aged care facilities catering services management, the Complete Catering Care Program (3CP) cloud software integrates residents’ dietary information/preferences with tailored dietetically assessed menus, automating over 50 operational reports. Supported by over 1200 dietetic suitable/cultural recipes designed specifically for Aged Care, the 3CP facilitates quality catering care.

With a combination of over 60 years in the Hospitality and Aged Care Industries, OSCAR Hospitality offers Operational Support, Catering Consultancy, Auditing and Recruitment for Aged Care Catering, Cleaning & Laundry Services.

Accessible on any computer/tablet/smart phone with an internet connection, the 3CP is ideal for stand-alone facilities and multi-sites.

The 3CP provides a holistic business solution that considerably reduces workload, optimises operational efficiencies and productivity, saves money, meets legislative and industry requirements and

Contact: Diane Buettel 1300 4 OSCAR (1300 467 227) or diane@oscarhospitality.com.au

Everyone’s talking about the Elephant in the Room The 2015 Elephant in the Room Aged Care and Disability Conference is on again this year from Tuesday 12 May to Wednesday 13 May 2015 at the Crowne Plaza Terrigal.

The conference will bring together a host of key industry professionals for a frank and open discussion on the aged care and disability sectors.

After a hugely successful 2014 Elephant Conference, this year we will be broadening the scope to address key areas with workshops and presentations on workforce development, training quality, business and strategy, the future, the changing landscape and clinical governance.

Nationally renowned speakers including Jane Caro, Steve Tighe and Avril Henry will be joining the conference as keynote speakers, with Rod Cooke, Kate Swaffer and Robyn Kaczmarek adding to the plenary presentations.

This will be a great opportunity for Board members and leaders, researchers and policy makers, RTOs, trainers and assessors, aged care and disability workers, consultants and human resource professionals to share information, explore solutions and exchange ideas and innovation in key residential and community care delivery areas.

The wonderful Glen Sorenson will act as Master of Ceremonies for the second year in a row.

For more information and to register visit www.elephant2015.com.au

Special Training Deals for LASA Members Realise Performance is conducting our second training roadshow 18-21 May! After our first Roadshow was so successful (Customer Service, Creating an exceptional experience every time) we have decided to roll out a series of four training sessions for 2015.

See what some of our past participants had to say:

We have two special offers for LASA Members:

• “I am much more aware of the value of customer service. I always thought that my Customer Service was very good, but I now find that I am trying even harder and going that little bit further to help our residents.”

1. M ention the code “LASA FUSION” when registering for our May Roadshow (Bullying and Harassment / Recruitment Strategies and get 10% off (on top of the early-bird rate!) or;

• “I have never been so engaged in a training course. Thank you for bringing this to the front of my mind” • “I have found that I am using the tips and hints EVERY day! Thank you so much for the ongoing support”

2. N one of the training days near you? Feel free to ring us and we can present the course on site. You will receive 10% off the total training rate and no extra for a personalised course.

Please contact us directly for a registration form and your special discounted rates.

P: 02 8624 3300 E: contact@realiseperformance.com.au

82 | FUSION

Payroll and HR models to help drive success.

Many organisations see payroll as just another part of their operational function. When all is going well most people wouldn’t acknowledge its existence. However when something goes wrong there can be dire consequences across the workforce.

Due to Payrolls core functionality (everyone needs to get paid!) it is a primary requirement to get it right.

Payroll can be a very time consuming task that due to workforce size and type, award structures based on role and schedule (roster) can come into play and introduce advanced payroll knowledge and requirements. Keeping up with legislative compliance can make for an exhausting process. We won’t even start to talk about the complexities surrounding contingent workers and proper engagement models.

The same also applies to HR. Depending on the industry, employee count or organisational structure HR’s dependency on accurate payroll data and leveraging HR decisions from that (and other supplemental data) can be crucial in both strategic planning as well as day to day operational tasks.

So what is the solution?

While many organisations insource their HR and payroll many also opt to outsource either part or all aspects (Comprehensive). Outsourcing is

not for everyone… and certainly outsourcing a failing internal process will not fix it. Outsourcing should be looked as a means streamline, improve and reduce or eliminate any internal administrative overheads (including legislative burden) in order to free up time to be more strategic around people management (and activities related to building organisational growth).

It needs to be understood there is rarely a one size fits all. For some businesses insourcing just doesn’t add up... for others it does.

When outsourcing some clients require onshore... others are happy to offshore.

Similarly at NGA we have found many of our customers are able to leverage Preceda’s payroll and its core HR and rostering capabilities … while other client needs are more complex: In which case NGA introduce partner products such as SuccessFactors or Workday for talent or rostering systems such as EmpLive, TimeTarget, Kronos etc.

The NGA service line flexes with a client’s changing requirements.

Speak to a consultant on 1300 866 400 or email: info.au@ngahr.com

Introducing the latest in aged care hygiene to meet demands for chemical-free cleaning Distributor of aged care steam cleaning equipment, Duplex Cleaning Machines, has introduced its latest model of chemical-free cleaning equipment to the aged care sector.

Director of Duplex, Murray McDonald, says many aged care facilities now understand that the temperature and volume of steam produced when conducting touch point and regular cleaning is paramount in producing a deep clean.

“On the outside, the trend towards chemical free cleaning can be seen to be about environmental factors, however, the demand for steam is because of its superiority over chemicals to kill healthcare associated bacteria”, Mr. McDonald said.

“With the rise of anti-biotic resistant superbugs, aged care facilities require a full infection control cleaning approach, and high temperature steam has been acknowledged by infection control Australian standards to be the most dependable, fast and economical method for the destruction of microbial life.

“Our latest steam machine is called the “Evo” and it has 20 – 30 per cent more capacity than traditional steam cleaning machines in Evo used in aged care facility

the amount of steam it can produce”.

Benefits of the Evo include: •M ulti-purpose steam cleaning unit: Cleans all aged care touch points, bathrooms, kitchens, upholstery, tile and grout and more.

Evo product image

•N o drying downtime: Due to its “dry” steam, it leaves surfaces dry within minutes.

•C onnect and go water feature: Provides a continuous water supply.

No refilling required.

• Fast, compact and OH&S friendly: It is compact and lightweight for easy storage and transportation, and replaces mops, buckets, chemicals, rags and manual scrubbing which can attribute to OH&S injuries for staff.

“Our aim with this latest model was to provide our aged care customers with a steam machine that can produce the highest temperature and steam volume possible to ensure infection control cleaning is done to the highest of standards.”

To find out more about the Evo or to book an onsite, no obligation demonstration, visit: www.duplexcleaning.com.au, email: info@duplexcleaning.com.au or call 1800 622 770.

Help recognise excellence in Australian aged care If someone working in the aged care sector has inspired you — through their leadership, innovation or professionalism — now’s the time to let them know their work is valued.

Recognise an innovative team, organisation or an exceptional individual by nominating them for the 2015 HESTA Aged Care Awards.

The Awards acknowledge the dedication and professionalism of those working in aged care and recognise innovations in service delivery in the sector.

Nominations close on 30 May 2015 and the three award winners will share in a $30,000 prize pool — generously provided by long-term HESTA Awards supporter, ME Bank.

HESTA CEO, Debby Blakey, said: “the Awards celebrate innovation and achievement in aged care, and acknowledge the difference those working in the sector make in the lives of older Australians.”

Finalists in three award categories — Outstanding Organisation, Team Innovation and Individual Distinction — will be announced in July 2015.

Interstate finalists will be flown to Canberra for the Awards dinner on Thursday 27 August 2015.

HESTA is the super fund for health and community services with more than 800,000 members and $30 billion in assets. More people in health and community services choose HESTA for their super.

To make a nomination by 30 May 2015 or to find out more about the HESTA Aged Care Awards, visit hestaawards.com.au

Proudly presented by:

Proudly supported by:

Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No.235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.

Outstanding Organisation Award: Feros Care, Queensland, for its innovative role in the delivery of smart and virtual technologies in Queensland, New South Wales, Victoria and Tasmania. The organisation supports seniors via group and individual video calls, online referral services, senior-friendly personal computers/tablets and ‘smart home’ safety installations.

Team Innovation Award: the Re3 Wellness Program — from Ageing Wisely in Western Australia — for developing an innovative wellness program to help older people maintain their health. The program provides simple lifestyle strategies that aim to improve physical and cognitive function, and emotional wellbeing in one holistic program, thus the name Re3 — Re-generate the body, Re-ignite the mind and Re-discover happiness.

Individual Distinction Award: Graham Custance — from Care Connect in Victoria — for developing a model of engagement and service provision that increased the number of Home Care Packages provided to Aboriginal Elders and built capacity in Aboriginal communities to access services that meet their specific needs.

2014 winners, left to right: Jennene Buckley representing Feros Care, Graham Custance from Care Connect and Paula Fievez representing Ageing Wisely.

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The 2014 winners

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Because your staff need to concentrate on patient care Hills Health Solutions brings together the patient care expertise of Merlon, Questek and HTR. By integrating them into a single health-technology platform, we allow health care managers at hospitals and aged care facilities to focus on patients.

We bundle leading edge solutions for patient entertainment, phone service, nurse call, radio pendant systems and security. We’re applying ingenuity, not just to make life easier for patients, but also for the healthcare professionals who take care of them.

hills.com.au