The voice of aged care Winter 2017 | www.lasa.asn.au
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Home care packages to suit everyone LASA SURVEY PUTS HOME CARE REFORMS UNDER THE MICROSCOPE RESORT-STYLE LUXURY VS THE COMFORTING FEELING OF HOME ATTRACTING YOUNG WORKERS TO AGED CARE: CULTURE, PURPOSE, AND IMPACT
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CONTENTS The voice of aged care Winter 2017 | www.lasa.asn.au
OPINION 5 CEO National Update
EMPLOYMENT RELATIONS 46 LASA Members gain additional
7 Chair National Update
benefits through access to new employment relations service
NATIONAL UPDATE 8 Understanding the clinical and operational impact of the 2017 ACFI changes
10 The new operating outlook for residential aged care
12 LASA survey puts Home Care reforms under the microscope
CULTURE 15 Bringing spirtuality into the aged care mix
AGE CARE REGULATION & GOVERNANCE 16 ‘Must have’ governance
Jacqueline Burkitt Corporate Affairs Manager Leading Age Services Australia Ltd E: email@example.com
guide aims to help aged care directors
T: (03) 9805 9417
18 Efficient boards are the key
First Floor Andrew Arcade 42 Giles Street Kingston ACT 2604
to ensuring sustainability
22 12 character traits that can derail effective leadership
25 Home Care packages give consumers ultimate power
28 Will you be prepared for ADBOURNE PUBLISHING PO Box 735, Belgrave, VIC 3160
Melbourne: Neil Muir (03) 9758 1433
Adelaide: Robert Spowart 0488 390 039
Emily Wallis (03) 9758 1436
Administration Tarnia Hiosan (03) 9758 1431
mandatory data breach notification laws?
30 Understand what constitutes
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
HEALTH AND WELLBEING 52 How much is malnutrition costing your organisation?
55 The terror of toast 56 Incontinence: the ‘taboo’ subject 58 With one voice singing program 60 Fostering palliative care, connections
62 New advance care planning and palliative care websites
65 Palliative care research and practise resources
66 Principles for palliative end-oflife care
DESIGN 68 Thoughtful design leads the way 70 Future challenges in aged care design
RETIREMENT LIVING 73 Ethno-specific provider celebrates four decades of culturally appropriate care
OUT AND ABOUT 33 QLD
ENABLERS 74 Medication-related link to unplanned hospital admissions
34 NSW 36 VIC/TAS 37 WA
CONFERENCE 48 The Care and Ageing Expo
38 SA YOUR MEMBERSHIP 40 LASA membership offer
TECHNOLOGY 76 Embracing technology to expand traditional models of aged care
AGE SERVICES MANAGEMENT 79 Attracting young workers to aged care
43 Affiliates gain the LASA edge 44 L ASA takes an over-thehorizon look at workforce capability needs
TOURS 80 Japan leading the way in managing rapidly ageing population
reproduced in any other form without written permission from the article’s author.
82 WHAT’S NEW
REVIEW OF AGED CARE QUALITY
REGULATORY PROCESS ESSENTIAL TO MAINTAIN INDUSTRY
SAFETY AND CONFIDENCE Continuous improvement is the cornerstone of ensuring Australia’s aged care system remains world-class.
ustralia’s aged care industry is a high performing and professional sector, supported by a workforce that is passionate about providing quality care for older Australians. We must remember this when examining recently reported individual cases highlighting concerns care provision. Such cases are in the minority. They are not representative of the industry’s overall good practices, professionalism and performance. A recent review by South Australian Government Chief Psychiatrist Aaron Groves into the operations of the Oakden Older Persons Mental Health Service, revealed significant failings with regards to this facility. While the review stated that ‘Oakden is not nursing home’ and that it is a ‘specialist older persons mental health service for people with severe mental illness’, elements of the facility’s operations remain subject to the Australian Aged Care Quality Standards. Given this, the Federal Minister for Aged Care, The Hon. Ken Wyatt AM MP, has commissioned an independent review of the aged care quality regulatory process to determine why the failures of care at Oakden’s Makk and McLeay wards were not identified. LASA supports the review and has written to the independent reviewers, Kate Carnell AO and Professor Ron Paterson ONZM, offering our assistance. The review is an opportunity to scrutinise the aged care accreditation processes, and to reassure older Australians and their families that the care and services they receive meet stringent national quality and safety standards. In the event that the review reveals any system or process failures, these will form the basis of continuous improvement our industry’s safety and quality. It is worth remembering that Australia has an internationally recognised aged care system that is highly regulated. We are one of a few Organisation for Economic Co-operation and Development countries that requires all residential aged care facilities to be formally accredited.
Sean Rooney Chief Executive Officer Leading Age Services Australia
Furthermore, at a time of increasing demand for age services, the number of sanctions issued against providers as a proportion of the number of approved providers has decreased or remained steady over time. The number of aged care homes failing accreditation standards has also decreased. In addition, the number of sanctions and non-compliance notices in relation to quality of care has decreased as a proportion of the total number of approved providers over the past five years. When a facility fails to meet one or more Accreditation Standards, the Australian Aged Care Quality Agency (AACQA) sets a ‘timetable for improvement’ (TFI) by which the approved provider must demonstrate they meet the standards. TFIs are generally three months and AACQA will visit throughout the TFI period to assess progress. The number of facilities placed on a TFI has decreased over the past three years. This decrease has coincided with the introduction of the AACQA. We also know that most complaints are resolved satisfactorily at the local level. According to the Aged Care Complaints Commissioner's 2015/16 annual report, early resolution was achieved for 87 per cent of complaints received. The 1,746 complaints received last year reflect a small proportion of the 199,449 older Australians in residential aged care. Complaints and issues regarding quality are inevitable in all service industries, and the age services industry is no exception. Our operating environment is underpinned by the quality of our services, the quality of provider and consumer relationships, and spans clinical care, accommodation, hospitality, recreation, domestic and other support services. Recent reports on quality issues are isolated incidents in the overall system. Notwithstanding this, we must learn and continuously improve to ensure Australia’s aged care system remains world-class and that all Australians have confidence that care and services provided in our industry meet rigorous national standards for quality and safety. ■
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NEGOTIATING CHANGE AND
THE IMPORTANCE OF CONFERENCES
IN SHARING INDUSTRY SUCCESS STORIES The sector’s continuing improvement hinges on opportunities to access new ideas, share business strategies and innovative models.
y recent participation in LASA’s State Conferences reaffirmed for me our industry’s professionalism and commitment to excellence. It was impressive to see the age services industry collectively discussing key challenges and opportunities, catching up with peers and friends, and hearing first-hand from aged care thought and practise leaders. Opportunities like these are fundamental to successfully negotiating change and ensuring a resilient and sustainable age services industry. As the ‘voice’ of aged care, LASA’s membership is deliberately diverse. This is never more evident than when we conduct our state conferences each year. This year we hosted state conferences in Queensland, Victoria and New South Wales. At these events small, medium and large, not-for-profit, private and government-owned providers of age services across residential care, home care and retirement living come together in the one place to consider the key issues in our industry. Framed around the Aged Care Sector Roadmap, recent state conferences featured a range of experts from the aged care sector who provided insights into how sustainability, reforms and innovation will shape the future of Australia’s age services. In addition to consulting with our Members, LASA has devoted a lot of time and energy into conference programing to ensure delegates receive the most up-to-date industry information and practical insights which can be readily implemented into the care and services our Members provide. We are determined that conferences provide maximum value and directly benefit our Members. In addition, these events’ success would not be possible without the contributions and support from LASA’s Affiliates, conference sponsors and exhibitors.
Dr Graeme Blackman OAM Chair Leading Age Services Australia
The age services sector’s marquee event—LASA National Congress 2017—is in the final stages of preparation and I look forward to engaging with the industry again on the Gold Coast from 15–18 October 2017. LASA National Congress 2017 will provide a thought-provoking program and is another wonderful opportunity for our industry to move away from demanding daily workcycles, and to network and share insights with one another. Over three days, the conference theme of ‘Ahead of the Game: Age Services – Strong, Bold, Brave’, will allow delegates to explore and discuss how our industry has been responding to systemic change underpinned by the principles of ageing in-place, consumer choice and market-based competition. It is essential that our industry is ‘ahead of the game’ – accessing new ideas, business strategies and innovative care models. Congress is an event where industry leaders can share company-led initiatives, challenge the status quo and explore the possible. A large part of LASA’s advocacy involves putting a spotlight on our Members' achievements and excellence in aged care. The Excellence in Care Awards—recently hosted in conjunction with the Queensland, Victorian and New South Wales conferences—celebrated significant contributions to the life quality of older Australians, while acknowledging our nominees’ efforts to increase public confidence and community involvement in the aged care sector. I congratulate all the nominees, finalists and winners of LASA’s Queensland, Victoria and New South Wales Excellence in Care Award programs for the outstanding efforts and contributions they make daily, not only to our industry, but to the lives of the older Australians they care for. ■
UNDERSTANDING THE CLINICAL AND OPERATIONAL IMPACT
OF THE 2017 AGED CARE
FUNDING INSTRUMENT CHANGES Providers may need to review assumptions and reassess their operating models in order to maintain a strong ACFI funding position going forward.
he recent changes to the Aged Care Funding Instrument (ACFI) has further emphasised the need for providers to be clinically strong in the way they operate.
Decisions with care planning and ACFI should have appropriate evidence to ensure assessed needs are reflected in the care plan and then executed at the site. This may require providers to make adjustments to the traditional way they have claimed on complex health. Making these changes will help to ensure the ACFI changes are mitigated and providers increase and/or maintain their ACFI funding position. To achieve this, it is important to understand:
• the link to Activities of Daily Living (ADL) and Complex Health Care (CHC) • the need to lower the usage of ACFI item 12.4b claims • understanding the margins of a 12.4b in 2017 • closely looking at all items in ACFI question 12 • changing the model needed to maintain a profile of ‘no 12.4b claims’, and reliance on higher medication claiming.
Understandingthe link to ADL and CHC The link between the ADL and CHC has been evident since ACFI was introduced but is still often the root cause of lower claiming. If ADL claiming is poor, this is can be a sign of poor understanding of the holistic/congruent nature of the ACFI process, creating reduced evidence in clinical assessments performed by the multi-disciplinary team. Not only does lower ADL claiming eliminate providers’ abilities to claim some items in ACFI question 12, it also provides clear evidence to underpin most of the key claiming items. It is common to see a low-ADL-claiming provider have a higher 12.4b claiming rate, which is incongruent and also expensive in the new 2017 ACFI world.
Providers need to lower ACFI 12.4b claims Making the most of the changes requires providers to lower their ACFI 12.4b claims while maintaining high CHC claims. The first step to achieving this is to ensure ADL claiming is
strong and that clinical assessments from all professions especially allied health, is providing comprehensive information. Some providers have a model with 70–80 per cent of their residents on 12.4b claiming. Yet, they could have received the same funding and care with only 20–30 per cent of residents on a 12.4b claim. With the time available for new 12.4b claims having been increased to 80 minutes per week, it is crucial to reduce the amount of 12.4b claims made in order to costeffectively maximise funding.
Understanding the margins ACFI teams need to negotiate and understand the margins they are working with for the 12.4b claim. In a large majority of claims if clinically appropriate, the 12.4b would most commonly create a shift from a ‘medium’ to ‘high’ claim creating a funding increase of $144.90. It is important to ensure the financial model allows for the ACFI team to still claim as required, as the cost of an allied health professional for 80 minutes should be significantly less than the funding increase. The cost of the allied health provider also needs to ensure that the provider can uplift 2016-classified claims against 12.4b items as a resident’s needs change. For example, an ACFI ‘MHH’ rating claim uplifted to a ‘HHH’ rating claim creates extra ACFI income of $215.25, but if a 12.4b claim is still needed (often this is not the case, as 12.5 claiming may be more appropriate) then financially the increased cost of moving to 80 minutes with a 2017-classified 12.4b claim should be significantly less than the increased income created by this uplift. Any other uplifts beyond this will result in larger financial benefits and any increased cost with the 80 minutes of time are easily going to be catered for by negotiating the allied health rates. Therefore, uplifts and voluntary submission need to continue. Maintaining lower 12.4b claims can be achieved not only with comprehensive assessments and strong ADL claiming, but by ensuring the ACFI team closely look at all items in question 12. This will mean that each resident should be assessed
individually and providers will be more likely to break the habit of claiming the same patterns. Specifically, strong investigation with 12.5, 12.12b, 12.10 and 12.13 is required as these are often not investigated clinically and claimed for appropriately.
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If you are a provider that had no 12.4b claims and relied on higher medication claims and seven points in question 12, then the ACFI changes are going to significantly impact you. To achieve a â€˜highâ€™ in Complex Health, 10 points are needed. Therefore we recommend that providers consider introducing a 12.4b service. It is best to strategically introduce this and ensure that ADL claiming is strong and all other items are investigated in complex health so the introduction of 12.4b claims can best deliver beneficial clinical and financial outcomes without over-using the 12.4b claim to assist you to maintain and/or increase your ACFI funding. The impact of the 2017 ACFI changes requires providers to undertake a quick and robust operational and clinical review to ensure their operating model is mitigating or eliminating the potential of the changes to reduce their current ACFI position. Xtra AgedCare is a national allied health provider and is able to provide a free meeting and/or analysis in relation to the impacts on providers as part of their commitment with LASA.
THE NEW OPERATING OUTLOOK FOR RESIDENTIAL AGED CARE As reforms continue to roll out, the industry monitors discussions around proposed standards assessments.
Single aged care quality framework
e are moving from the current set of accreditation standards towards a single aged care quality framework (SACQF). We know that the new SACQF will be consumer-focused rather than results-driven, with the expectation that consumers will be better protected, that best practice will be reflected, and that there will be a red tape reduction for providers. The SACQF will translate across all areas of care provision— Residential Care, Home Care etc—with two proposed options for accreditation. Pilots of the new standards will commence in the latter part of 2017. Legislative changes will include the review/revision of the charters of care recipients' rights and responsibilities to form a single charter. Subject to agreement by the Australian Government and amendments to legislation it is expected that the new standards will take effect from 1 July, 2018. Supportive documentation, education and guidance materials will be developed.
The government has proposed three potential approaches for assessing providers’ performance against the proposed standards. These have been outlined in the government’s ‘Draft Aged Care Quality Standards Consultation Paper 2017’ as: 1. Assessing compliance based on the aged care setting, with different approaches for residential and for home community care (seen to be a modified form of the current model). 2. Introducing a single risk-based assessment model which is applicable to all aged care arrangements. 3. Adopting a safety and quality declaration by providers who are delivering low-risk services to the broader population (for example, gardening services). Leading Age Service Australia’s (LASA’s) submission to the government indicates our preference for a combination of options two and three. For more information and insights into what’s next, visit http://www.lasa.asn.au/aged-services-inaustralia/lasa-submissions/.
Australian Aged Care Quality Agency framework and consultation
20 - 21 July
17 - 18 August
21 - 22 September
12 - 13 October
Program now available online Early bird discount closes 30 June
Program now available online Early bird discount closes 28 July Better Practice 2017 Award winners will be announced on Day 1
Registration will open late June
Registration will open late July
We want to explore opportunities and challenge ourselves to consider what is needed to deliver on expectations about the quality of care and services in aged care.
Make sure you’re on our mailing list so you don’t miss out! Email firstname.lastname@example.org to be added to the mailing list. For further information and programs visit our website: www.aacqa.gov.au.
The Federal Government first announced in the 2015–16 Budget that residential aged care providers would be required to pay the full cost of accreditation, including one unannounced site visit per year. The Australian Aged Care Quality Agency (AACQA) has now published a draft Cost Recovery Implementation Statement (CRIS) describing how providers will pay these new fees and charges. Many LASA residential aged care Members have expressed deep concern over proposed new fees and charges on residential aged care providers to cover this cost and LASA wants to learn more about residential aged care Members’ concerns to help inform our submission to AACQA. The draft CRIS is open for public
consultation until 21 July 2017 and further information is available on AACQA’s website.
• classification and assessment tools
LASA will also be engaging with residential care Members to prepare a submission to the Senate Inquiry into the Effectiveness of the Aged Care Quality Assessment and Accreditation Framework. This Framework is aimed at protecting aged care residents from abuse and poor practices and ensuring proper clinical and medical care standards are maintained and practiced. Submissions close on 3 August 2017 and the reporting date is 18 February 2018.
• funding models (including analysis of the resource and infrastructure implications)
University Of Wollongong report The Department of Health (the Department) commissioned the Australian Health Services Research Institute at University of Wollongong to develop options and recommendations for future assessment and funding models in residential aged care. The study was commissioned following years of expenditure for aged care significantly outgrowing projections. These ‘blow-outs’ were followed by funding cuts to residential aged care and resulted in tensions between the Department and providers. The review of the current system and consideration of options for the future addresses five key issues:
• implementation considerations; and audit mechanisms. LASA will be distributing to Members the summary of the Alternative Aged Care Assessment, Classification System and Funding Models Final Report and is looking forward to receiving further Member feedback to the report. LASA will use your feedback to advocate to government the funding option that best supports providers to meet the care needs of their residents. Feedback can be provided via your Residential Aged Care Advisory Group or sent directly to Sharyn McIlwain, Principal Advisor – Residential Aged Care at email@example.com or to Senior Policy Officer Marlene Eggert at firstname.lastname@example.org. Once feedback has been collated, LASA is planning to convene a forum to discuss the alternative Aged Care Assessment, Classification System and funding models. Please send expressions of interest for participation is such a forum to email@example.com. ■ Sharyn McIlwain is LASA’s Principal Advisor, Residential Aged Care.
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LASA SURVEY PUTS
HOME CARE REFORMS UNDER THE MICROSCOPE Providers urged to craft well-documented package transfer procedures and prepare good handover practices to help mitigate consumer concerns.
LASA survey of 73 providers in the eight-week period following introduction of the Increasing Choice in Home Care (ICHC) indicates a number of major teething problems around the quality and accessibility of information about home care packages. Key themes that emerged from provider comments included: • low numbers of home care package activations by consumers from the national queue • continued difficulties in using the MAC provider portal and in interactions with the MAC Contact Centre • reports that consumers are experiencing confusion and poor understanding of official correspondence sent to them for package approval and assignment • reports of provider difficulties associated with not having access to timely and accurate information in the context of the recent policy changes reports of delays in consumers having access to home care package assessments through Aged Care Assessment Teams.
LASA conducted the survey on behalf of our Members to examine the evidence regarding home care package movements and provide recommendations to inform the continued implementation of ICHC. According to the survey results, most home care packages accessed were level two (62.6 per cent) with a combined total of 12,318 packages across all package levels as of 27 February 2017. The number of providers and packages that were accounted for in the survey represented over 10 per cent of home care providers and packages nationally. Consumer exits were reported for 58.4 per cent of providers, consumer regrades for 42.7 per cent of providers, consumer transfers for 33 per cent of providers and queue activations for only 25 per cent. Movements were more likely to occur in level-two home care packages ahead of level-three or -four home care packages, with the least likely area of movement being level-one home care packages. Where such movements did take place, it was
generally of a magnitude of 5 per cent or less of a provider’s total packages being administered. Half of providers experienced a decline in their total number of packages, a quarter of providers experienced an increase in their total number of packages, and the remaining providers experienced no change in package activity. New entrants were also noted as contributing to a small proportion of consumer transfers and queue activations, this being an early indication of the emergence of increasing competition in a market-based environment for delivery of a capped supply of home care packages. As a result of the survey, LASA has recommended: 1. release of information on the national queue and MAC home care package movements that will support the transition of home care package providers into a changed operational environment and can inform market positioning at the local level 2. further investigation of consumer experience of the home care package approval-assignment-activation process to clarify consumer readiness and capability for participation in the MAC approval, assignment and activation process 3. an interim strategy to facilitate active follow-up of consumers who are issued a package assignment, working towards reducing the number of inactive package days between package assignment and activation.
Consumer transfer and unspent funds Members continue to express their concern about a range of issues relating to their interaction with MAC and the Department of Human Services aged care claiming and payment systems for delivery of home care packages. In respect to consumer transfers, both original and new providers should have documented procedures for this transfer process in the event that difficulties occur. Procedures should list responsibilities for communication with the consumer and the other provider, as well as the transfer of any unspent funds.
Continued page 14
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NATIONAL UPDATE Continued from page 12
The expectation of consumers seeking to transfer their package funds from one provider to another is that this should be a simple process with minimal disruption to care. Where difficulties occur, consumer complaints could emerge, but providers with well-documented transfer procedures and good handover practices will minimise any adverse impact that may result from consumer complaints.
• where necessary, support the consumer to raise the issue with the Aged Care Complaints Commissioner. ■
A summary of the process for transfer of home care package funds from the original to new provider is included in Issue 3 of LASA’s ‘Home Care Information Services – Unspent Home Care Amounts and Exit Amounts’. The Department of Health has provided recent clarification to LASA concerning the transfer portion. It must be paid by the original provider to the new provider within 70 calendar days (not 70 working days) from the cessation date as agreed between the original provider and the consumer. New providers that have not received the transfer portion of a consumer’s unspent home care amount within the legislated timeframes should: • notify the consumer to inform them the transfer portion has not been received • liaise with the consumer and the original provider about the delay, as appropriate
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CONNECTION WITH MEANING: BRINGING SPIRITUALITY INTO THE AGED CARE MIX
Meaningful Ageing Australia has developed a tool to help aged care staff engage their clients in discussions around their fulfilment needs.
lmost a year after the launch of their National Guidelines for Spiritual Care in Aged Care, Meaningful Ageing Australia has embarked on its next effort to help aged care staff engage with older Australians and determine older people’s needs for maintaining meaning, purpose and connectedness in their lives. In August, the agency run by ex-pastoral care workers will begin distributing its ‘ConnecTo’ flexible spiritual screening tool, developed by psychotherapist Dr July Fletcher during her PhD research. In commenting on the ConnecTo tool, Meaningful Ageing Australia Chief Executive Officer Ilsa Hampton said it was designed to help equip aged care staff to put spiritual needs ‘into the mix’. She said it provided a visual map and language that would help staff start a basic conversation around their clients’ needs, to engage with them on a human level beyond just being focused on the physical side and the list of tasks the staff member has to carry out for the day. ‘It brings spirituality into the room in a non-threatening, non-intimidating way,’ she said. ‘It doesn’t assume that you’re going to have a long, onehour conversation—although it could be that way if there is time, and if the staff member has the skill to be able to offer that—but what we’re doing is creating something that the staff member, with just a small amount of training, will be able to use to engage with the older person. ‘And out of that they will find out what is most important to the older person, beyond if they want chicken or beef, or they prefer a male or female carer, or if they want to go to “X” activity. It’s getting underneath all that to find out what’s most important.’ During the ConnecTo tool’s pilot phase, the benefits of starting such a conversation were clearly evident when a staff member at an aged care facility used it to initiate a discussion with a client who was new to the facility, and not leaving her room.
Typically, staff would invest effort in trying to get such a client out of their room because it is viewed as important to do so, but using the ConnecTo tool, the staff member found that the client felt very strongly connected to her family, she had lots of photos in her room, she had regular family visits, she felt connected to nature and had a great interest in books and magazines, and she didn’t actually feel the need to be ‘distracted’ by other activities and was in fact, happy in her room. Meaningful Ageing Australia trialled the ConnecTo tool in four aged care organisations in New South Wales, Victoria, Queensland, and Western Australia. Feedback from trial participations showed that staff were confident using the tool at various points along an older person’s journey into residential aged care, including pre-admission, during the first week of admission, and longer term. Staff members who were trained in the use of the tool included those in lifestyle/ diversionary therapy, nursing, pastoral/spiritual care and assessment. Meaningful Ageing Australia will soon be offering a 50pp ConnecTo leader’s guide that will include: • questions to consider before implementation • a full training program to equip staff in using the tool • copies of the tool in three formats • background and supporting information on the tool. For more information, see Meaningful Ageing Australia’s website, and to pre-order copies of the ConnecTo leader’s guide, visit https://meaningfulageing.org.au/connecto. ■
AGE CARE REGULATION & GOVERNANCE
‘MUST HAVE’ GOVERNANCE GUIDE AIMS TO HELP AGED CARE DIRECTORS
CHART THE WAY DURING TIME OF CHANGE Boards looking to address burgeoning issues and challenges in the aged care sector can now turn to new guidelines from Australia’s premier advisory body on governance.
ith profitability, return on assets, and equity under pressure, Governance Institute of Australia’s Adding value to governance in aged care is a ‘must have’ guide for directors and governance professionals struggling to overcome the governance challenges facing the aged care sector which is going through unprecedented disruption.
Steven Burrell Chief Executive Governance Institute of Australia
Wide-ranging legislative reform to the sector is being progressively implemented to formalise and centralise the legislative framework of aged care. The Australian Government is now the key body financing and regulating services across Australia, bringing home care and residential care under one regulatory roof.
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AGE CARE REGULATION & GOVERNANCE
The Productivity Commission’s 2011 report Caring for Older Australians highlighted a number of weaknesses and challenges affecting consumers and service providers including workforce and skill shortages, complex regulation and variable quality of services. These weaknesses not only pose great challenges to users and governments but also to board and senior executives overseeing the sector. Adding value to governance in aged care addresses a broad range of the governance issues including the unique challenges facing the sector; factors to consider before taking a board position; issues the board should consider when appointing a new member; the relationship between the board and management; interaction with stakeholders; volunteer management; and risk management responsibilities. It is the definitive guide for directors committed to overcoming key tests of the sector, including a high regulatory burden, increasing consumer choice and changes to funding. Boards of aged care providers will be subject to increasing scrutiny and pressures as the forces of demographics press up against the issues of affordability and sustainability in the sector. Boards will need to ensure that they can make informed and effective decisions and have in place governance frameworks to enable this. Recognising that the aged care sector is a significant part of the Australian economy which may soon be its largest employer, in June 2016 Governance Institute established a working group of members working in aged care organisations to consider the governance implications for this rapidly emerging sector. Members included a chair of a not-for-profit (NFP) provider, a non-executive director of an NFP, company secretaries and in-house counsel, chief finance officers, as well as business and finance managers. The working group provided input into major sections of the guide, particularly those specific to aged care. The working group reviewed two drafts of the document and signed off on the final document in December 2016. Australians are living longer—due largely to improvements in health care—and as the large cohort of baby boomers ages, the number and diversity of older Australians will grow. The sector is going through unprecedented change, aimed not only at improving care for older Australians but also relieving the cost burden for younger Australians. A lot of boards, particularly not-for-profits, may not be prepared for the regulatory change sweeping the sector and
the demands this brings. Boards need to have a designated skill set to overcome the multiple challenges their organisations are facing. Adding value to governance in aged care is a practical guide for any potential or current member of a board of an aged care provider. Large-scale organisational change will be required in terms of workplace arrangements, staff roles, IT, business processes and capital expenditure to deliver consumer-driven care. Importantly, the guide does not tell boards how to run their organisation, but it does step directors through the issues that they should consider in terms of their governance responsibilities. Governance Institute, as the only independent professional association with a sole focus on whole-of-organisation governance, has recognised the aged care sector as one where it can add value by developing governance guidance for those who sit on the boards of companies and facilities providing aged care. Its aim is to utilise its members’ deep expertise in governance to provide those who sit on aged care boards with practical and concise guidance on how to deal with the issues challenging their boards. You can download Adding value to governance in aged care at governanceinstitute.com.au/agedcare ■
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AGE CARE REGULATION & GOVERNANCE
EFFICIENT BOARDS ARE THE KEY TO ENSURING SUSTAINABILITY
WITHIN EVOLVING STRATEGIC LANDSCAPE
OF AGED CARE REFORMS
LASA puts the spotlight on the increasingly important role that boards play in leading the way through disruptive phases of deregulation.
t the recent New South Wales state conference, there were repeated references to the role of corporate governance and the need for boards to focus on the future sustainability of their organisation in tumultuous times. The following article focuses on corporate governance and board composition in not-for-profits (NFPs), and some of the contemporary challenges that boards face in being sustainable in a de-regulating industry with increasingly stronger disruptive forces. NFPs have complex stakeholder networks, enjoy high levels of public trust, contribute billions to the national economy, and attract generous privileges and funding from the government. However, until recently there was little examination of the role of corporate governance in NFPs. The composition of boards in NFPs in Australia can contribute to improved standards of corporate governance, and as a consequence, improved standards of accountability and business performance.
Why is corporate governance important in NFPs? Corporate governance in the NFP sector is important for a number of reasons, including the size of the sector, its growth, the need for public trust in charitable institutions, and changing business models. The NFP sector contributed almost $55 billion to the Australian economy in 2012, a figure which grew by $22 billion in six years. If this pattern of growth has continued it is estimated that the sector could now be contributing $75 billion to the Australian economy with activity dispersed across approximately 60,000 charitable organisations. NFPs need to maintain high levels of public confidence and trust in order to sustain the social license granted to them which facilitates the pursuit of their charitable purposes and attracts concessions from the government. Therefore, institutional theory suggests that NFP corporate governance needs to ensure accountability and transparency to clients, regulatory bodies, government funding agencies and donors, and members of the community to sustain this license.
In the main, NFP boards in Australia have a ‘stakeholder approach’ to governance. Legislative requirements, not social, largely drive this approach. Boards are more diverse than for-profit boards and often get involved in operational matters due to resource constraints and dependency on their skills and time. Knowledge and loyalty to the NFP sector are frequently key attributes of board members. In a landmark study by the Australian Institute of Company Directors (AICD) into company directors of NFPs, survey respondents reported contributing an average of seven working weeks on directorship duties per year. Many of the respondents had directorships in NFP and for-profit companies which generated insights into the similarities and differences in corporate governance. Positively, the levels of experience and standard of governance in NFPs was not reported as being deficient in comparison with for-profits and half of the respondents felt that the quality of governance was equal to, or better than, for-profits.
The purpose of the board in a not-for-profit Boards are responsible for an organisation’s ‘integrity’ and ‘compliance with the law’, which necessitates directors having the skills and experience to fulfil these duties. Directors in NFPs have a role in accordance with stewardship theory which concerns the balancing of multiple stakeholder interests to align activities towards achievement of the mission and purpose. Mission alignment and values are often viewed as a critical attributes of potential new directors. Mission alignment is also seen as a way to mitigate the issues of agency theory and the resulting uncertainty over whose interest are best served by decisions made by NFP boards. In the AICD study, the primary motivation for becoming involved in an NFP as reported by directors was a ‘belief or passion for mission’. There is an important distinction in corporate governance requirements of for-profit and NFP organisations. In a for-profit organisation, board members are selected on their expertise in ‘managing and accumulating assets’. In contrast, NFP directors are often on boards because of who they represent, rather than any demonstrated ability or experience to manage the organisation’s assets. Performance of the NFP can
AGE CARE REGULATION & GOVERNANCE
therefore be viewed through the prism of who is on the board, not what is achieved by the individuals while in the role. It has been argued that boards exist to protect and enhance a NFP’s legitimacy to its stakeholders based on directors’ professional status, credentials and membership of professional bodies. As a consequence, NFP boards are generally bigger (average of 16) than for-profit companies (average of 11) due to their need for greater network size to secure the resources needed to sustain their organisation, and be stewards of multiple stakeholder interests. However, the mere presence of networks is not a guarantee of success; rather it is the strategic context of these networks that matters. Directors in NFPs need to be aware of this expectation on them, and leverage these networks when needed, as some directors with extensive networks do not draw upon them to derive benefit for the organisation.
there is a high demand for voluntary directors with the range of skills and capabilities needed to fulfil the duties and obligations of company directors. Notwithstanding the many well-run NFPs, there will obviously be a very large number of NFPs whose business performances have shortcomings due to a lack of directors, or directors with suitable capacity. Government funding of social services, which has been traditionally outsourced to the NFP sector, is shifting to a more market-oriented, individualised approach. The most significant examples of this include the National Disability Insurance Scheme and consumer-directed packages in aged care. Both are subverting the previous approach by government of providing funding for outputs (e.g. hours of care to a prescribed number of clients). Under both programs, the care recipient/ client receives an allocation of funds and chooses providers to meet these needs.
Contemporary challenges for boards of NFPs include: doing more with less; demand for services; increasing at a greater rate than revenue; and limited ability to control revenue generation. Board members have a strong role to play in ameliorating these contemporary challenges, securing new or additional revenue sources and maintaining the ongoing sustainability of the organisation in order for it to achieve its mission and charitable purposes. Strategic planning is seen as a primary function of a board that can address these challenges.
Other relatively recent significant changes in government funding approaches to achieving its policy objectives are ‘social impact bonds’ and ‘social return on investment’. These involve partnerships between government, financial/ capital investment companies and NFPs. This is radically transforming the way NFPs operate and presents a further challenge to the skills and capabilities of boards.
As a consequence of these business performance drivers coupled with accountability requirements, NFPs need directors who have service performance measurement, marketing, fundraising, government policy and public affairs skills and capabilities.
The accountability requirements of NFPs demonstrate a need for directors with legal, financial, accounting, auditing and risk management skills and capabilities. The costs of accountability weaknesses include: reputational risks; consequences of noncompliance such as de-funding by government; decreased contributions from donors; and compromised social license to operate. A contemporary example of this is the Royal Commission into Institutional Responses to Child Sexual Abuse (2015) and the public reactions to the findings reached about the charitable institutions. Governments have progressively used their rewards of funding as a method of incentivising NFPs whose goals align with their own, or forced NFPs into areas they may be reluctant to enter, due to funding pressures and their desire to sustain their mission and purpose. Costs imposed on NFPs include: recruitment checks; performance management frameworks; risk management; strategic oversight; external audit; incentives and remuneration arrangements.
Business performance Commentators have marvelled that one of the surprising aspects of NFPs is their high levels of performance given the evidence about questionable standards of corporate governance. With approximately 600,000 NFPs in Australia
NFPs are facing pressure to develop social enterprise models and become more ‘businesslike’ in their corporate governance and management approaches.
Experience as a director is also a positive attribute in order to leverage experiences gained from other NFPs and exposure to directors and processes in other organisations (not necessarily NFPs).
The ‘right’ board at the ‘right’ time Board composition can vary due to factors such as the life cycle of the organisation, the operating environment it faces, type of ownership and governance requirements, organisational performance needs, and social accountability and legitimacy needs. Diversity in board composition may vary depending on the contextual interplay of these factors, with diversity seen as being more valuable in turbulent times. It is argued that NFPs need diverse boards now more than ever. This can be attributed to the increasing complexity of the strategic environment in which many NFPs operate within the aged care and disability sectors. Diversity is associated with the likelihood of a greater range of perspectives producing creative and innovative solutions. The greatest governance challenge faced by organisations, or the environment in which they operate, is moving from one Continued page 21
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AGE CARE REGULATION & GOVERNANCE Continued from page 19
phase of the ‘Holling Cycle’ into another. The Holling Cycle was coined by Canadian ecologist C.S Holling and is now being applied to governance phases appropriate to an organisation’s different environmental circumstances including conservation, release, reorganisation and exploitation.
Board composition is not of its own sufficient to explain organisational performance. In the face of strategic complexity there may be limits to how much a board can influence the organisation’s achievement of outcomes. The AICD identified four attributes of an effective governance team. Trust was highlighted as the most important. Trust is formed from a leader’s character (integrity, motive, and intent) and competence (capabilities, skills, results, and track record). The key attributes of an effective ‘governance’ team are: 1. diversity of view and experience 2. independence of mind (as distinct from structural independence) 3. openness to alternatives 4. trust.
This requires a board and executive to not only identify where they are in the cycle, but also use abductive, strategic thinking to forecast potential outcomes in scenario planning exercises at each stage of the cycle. The necessary knowledge, skills and qualities of directors will vary according to the stage the organisation is in, while the board’s level of involvement will also vary depending on the need for directors’ involvement to support the transition. An edition of McKinsey Quarterly concluded that, “An effective board of directors involves a combination of the right people, the right structure, and the right processes. Determining the appropriate combination for each individual company is the real challenge”. Board composition is important, however, it is just one component of what contributes to business performance and meeting accountability requirements of NFPs.
Accountability and performance are increasingly important to NFPs in Australia as they strive to sustain their operations and deliver on their mission. Board composition is one element of ensuring improved standards of corporate governance, however, on its own it does not entirely explain the complete picture of what NFPs need to provide accountability and high levels of business performance. The most important element to board composition is alignment of mission and values between directors and the reason for the existence of the NFP (its purpose). If your organisation needs assistance developing its strategy to be sustainable in the evolving strategic landscape of the aged care reforms, contact the LASA Business Support Services team. We are here to help LASA members improve their business performance and sustainability. ■ Brendan Moore is State Manager – NSW/ACT and General Manager – Business Services at LASA.
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AGE CARE REGULATION & GOVERNANCE
WHEN POSITIVE INTENT FAILS TO MATCH PERCEPTION:
12 CHARACTER TRAITS THAT CAN
DERAIL EFFECTIVE LEADERSHIP
Analysing your leadership style can help you modify your behavior, build your reputation and inspire staff and stakeholders, says a leadership coach and author.
here is a strong case, which I support, for focusing on strengths in leadership development. And yet the harsh reality is that leadership derailers usually driven by positive intentions can get in the way, and prevent us from using our strengths to full advantage. One way to derail your leadership fast is to allow one of these12 derailers to block your leadership effectiveness. Which one are you guilty of?
Recognising the 12 leadership derailers 1. Staller – analysis paralysis Your positive intention: High quality solid outcome. What others experience: You take too long to take action, often miss key deadlines or opportunities. You are perceived as a blocker to progress. 2. Controller – command and control Your positive intention: Control a quality outcome. What others experience: You are overly directive, and stifle initiative and innovation. 3. Cyclone – bull at a gate
Your positive intention: Get results quickly. What others experience: You are in a hurry to achieve results, and often leave a wake of destruction and disengagement behind you. 4. Doer – can’t delegate Your positive intention: Produce a high quality outcome. What others experience: You hoard work and responsibility, to the detriment of yourself and your team. 5. Avoider – conflict averse Your positive intention: Keep the peace and protect relationships. What others experience: You are reluctant to face tough conversations and situations, often create challenging team dynamics as a result. 6. Fence-sitter – indecisive leader Your positive intention: Get the right outcome. What others experience: You provide a lack of leadership and direction, creating bottlenecks in progress and frustration for others. 7. Know-it-all – closed to other ideas Your positive intention: Back your strengths and deliver quality What others experience: You are reluctant to take feedback, or to consider new ideas or input from others. 8. Guardian – inability to innovate Your positive intention: Guaranteeing consistent quality results. What others experience: You prefer the status quo, are reluctant to change, can’t think laterally, and put a low focus on innovation. 9. Micromanager – management on a leash Your positive intention: Raise the standard through quality output. Continued page 24
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AGE CARE REGULATION & GOVERNANCE Continued from page 22
What others experience: Your supervision is excessive, and you are often perceived as stifling and untrusting. 10. Poker face – showing no emotion Your positive intention: Accurate communication. What others experience: Your non-expressive communication style is hard to read, and/or your direct verbal communication style can be damaging. You struggle to read between the lines. 11. People burner – poor people skills Your positive intention: Get results. What others experience: You lack people skills, put people offside and may even be at risk of a bullying claim by the way you prioritise achieving tasks over people and building relationships.
stakeholders may be concerned about what they perceive is a lack of due diligence leading to rework. So if you are a cyclone, the next time you say ‘let’s just make this happen’, here are a few suggestions to encourage followers: educe an overly strong goal focus – Imagine your • R success depended on working with your team to find five potential problems with the plan. Do that now. ause before taking action – If creating immediate action • P would set off a serious allergy, what would you do instead? • D ecide rigorously – Canvas the opinions of others, and consider the new perspectives before finalising your decision.
Your positive intention: Delivering outcomes now.
If you are a cyclone, it’s time to slow down and get more stuff done, and have it stick. And if you work with a cyclone, look beyond their behavior to the intention, using the ideas above as a guide.
What others experience: You are reactive to daily pressures, buried in the day to day, and are unable to take a broader, strategic view.
Shifting behavior once you recognise a derailer
Bringing it to life
Remember, while you know your good intentions, others only see your behavior and are making judgments on that.
12. Tactician – poor strategic thinker
Let’s go behind one derailer the cyclone to see how this can happen, despite the best possible intentions. If you are a cyclone, slow down for a few minutes and reflect on this. It will help you build your influence as a leader. And if you work with a cyclone, here are a few ideas about how you could help them. If you are a cyclone, a 360-degree feedback about you will include comments like these: • ‘ He rushes into things without seeking input, then wonders why we don't support the plan.’ • ‘ She didn’t plan for what could go wrong; afterwards, we were forced into repair mode.’ • ‘She changes her mind so fast, and we’re expected to make it happen it’s exhausting.’ • ‘Love his energy but wish he had a volume control.’ • ‘Not sure who will burn out first... her or us!’ Your intention: Perhaps your feedback surprises or even enrages you? After all, you work hard, your intention is good, and you’re aiming for results … now! You’re determined to seize all opportunities, and action precedes clarity. You probably learn best on the go. Maybe you experience FOMO: fear of missing out? The problem: You know your (inner) intention. Unfortunately others only see your (external) behaviour. While you just want things to happen (now!), you could be developing a reputation for action without consideration running like a bull at a gate. While you may be admired for your action focus, you could be leaving your team behind, and your
To avoid derailing your leadership: • Decode – build awareness of the problem. iscover – better understand the • D drivers motivating your behavior. evelop – determine a pathway • D forward to build your behavioural flexibility. Increase your impact as a leader by aligning your behaviour with your intention. These derailers come from my latest book Developing Direct Reports: Taking the guesswork out of leading leaders. ■
Special offer for Fusion readers Fusion readers can take advantage of a special offer of $15 plus postage to purchase Developing Direct Reports (recommended retail price is $29.90). Head to the Bookpod website (http://www.bookstore.bookpod.com. au/p/9072698/developing-direct-reports.html) and enter the discount code DEVELOP2017LASA. Corinne Armour is a leadership speaker, trainer and coach. This is an excerpt from her keynote address at the recent LASA NSW Conference, ‘Risk, uncertainty, chance... improve your odds for the road ahead’.
AGE CARE REGULATION & GOVERNANCE
FROM CARAVAN PARKS TO RETIREMENT COMMUNITIES: HOME CARE PACKAGES GIVE CONSUMERS ULTIMATE POWER While home care packages give consumers greater rights, it also brings greater responsibilities for consumers, writes a leading age care financial advisor.
ast year more than 1.3 million Australians received aged care. Around 295,000 received care in what used to be called ‘nursing homes’ while the other 1 million+ received aged care in their own home.
Significant changes to home care packages took effect at the end of February – giving consumers greater access to care and greater choice about who delivers that care to them.
Rachel Lane Aged Care Gurus
But with the increase in consumer rights (home care package recipients now have the ultimate power, the ability to hire and fire their home care provider) comes an increase in responsibility. Consumers need to understand the funding arrangements and the fees and charges that apply when they choose their provider. Continued page 27
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AGE CARE REGULATION & GOVERNANCE Continued from page 25
Possibly the most important thing to understand about home care packages is that they can be delivered into houses, caravan parks, retirement communities, granny flats – anywhere someone calls ‘home’. The funding for home care packages is based on a daily rate and paid directly to the care provider. Currently Level 1 funding is $22.04/day, Level 2 $40.09/day, Level 3 $88.14/day and Level 4 $133.99/day. Additional subsidies are payable for people who are returned serviceman, have dementia or require assistance with oxygen or feeding apparatus. Consumers can also be asked to contribute to the cost of their package. There is a basic daily fee of $10.10 which everyone can be asked to pay (many providers negotiate this). Beyond the basic daily fee the amount someone pays depends on their income. Full pensioners cannot be charged more than the basic daily fee. People with higher levels of income need to pay an incometested care which is assessed by Centrelink based on their income test. The income-tested care fee is calculated at 50c per dollar of income above the thresholds (approximately $26,000 p.a for a single and $20,000 for each member of a couple). The income-tested care fee is capped at $5,276/year for part-pensioners and $10,552/year for self-funded retirees and there is a lifetime cap of $63,313. While the amount someone pays as a basic daily fee contributes to the value of their package, the income-tested care fee is simply an offset of the amount of funding the government provide. Let’s look at an example. Shirley is a part pensioner who is happy living at home. Shirley has been assessed as requiring a level 2 package which provides $40.09 per day of funding.
Outside her home Shirley has $250,000 in a combination of bank accounts and shares and $10,000 in personal assets. Shirley’s home care package cost would be calculated as: Shirley’s income is: $7,387/year deemed income from investments + $20,247/year pension entitlement = assessable income $27,634/year Less the income threshold $26,073/year = $1,561 income above the threshold At 50c/dollar Shirley’s income-tested care fee would be $2.14/day The cost to Shirley of receiving the home care package is $10.10 basic daily fee + $2.14 income-tested care fee = $12.24/day or $4,468/year. While the total value of the package is $50.19/day, or $18,319/year. From an advice perspective, the costs associated with home care packages are fairly straight forward. The complexities come from the various legal and financial considerations involved with the living arrangements these packages are delivered into – granny flats, retirement villages and land lease communities – which are often an integral part of their care solution. Many of these complexities are explained in the latest edition of Aged Care, Who Cares? which I have co-authored with Noel Whittaker. It is designed to help people understand all of the options when it comes to accommodation, including granny flats, retirement communities and aged care facilities, the care services available, the legal tips and traps to be aware of and some strategies for making it more affordable. With the overwhelming majority of people choosing to receive care at home, the million dollar question is, where is ‘home’? ■ Rachel Lane is the principal of education and advisory body Aged Care Gurus Pty Ltd.
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AGE CARE REGULATION & GOVERNANCE
WILL YOU BE PREPARED FOR
MANDATORY DATA BREACH
New laws governing data privacy are designed to encourage businesses to improve their information security practices.
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n February 2018, Australia’s mandatory data breach notification law will take effect.
Aged care providers deal with private and sensitive information of the people in their care on a daily basis. Will you be ready to comply with the law if the unthinkable occurs and you suffer a data breach?
What happens when the law takes effect? After 22 February 2018, an aged care provider must report a ‘serious data breach’ to the privacy commissioner and to affected individuals. A data breach is serious if it is likely to result in serious harm to any individual the breach affects. The following factors are relevant to determining whether the breach is serious: • the kind(s) of information • the sensitivity of the information • whether security measures protect the information • the likelihood that such measures can be defeated • who obtained or is likely to obtain access to the information • the nature of the harm. Although judged on a case-by-case basis, given the nature and sensitivity of the information aged care providers handle, a data breach affecting a provider is more likely to be serious.
Are there exceptions to the obligation? There are several exceptions. The main exception is where remedial action is taken to prevent harm. If the provider takes remedial action to prevent the harm from occurring, then it does not need to report the breach. The exception applies only to the extent the remedial action prevents an individual from suffering serious harm. Therefore, if the action taken only removes the risk of serious harm to some but not all of the affected individuals, then the provider must still notify the commissioner and the individuals who remain at risk of the serious harm.
What happens if more than one entity is affected? If the data breach affects multiple entities, then only one must report to the commissioner and to the affected individuals.
For example, an aged care provider may have outsourced management of its IT to a contractor, and the contractor’s data security is compromised, leading to an unauthorised disclosure of personal information of people within the provider’s care. Either the provider or the contractor must make the report and once the report is made, both entities are deemed to have complied with their reporting obligations. Generally, controlling the message and the method of its communication would be more important to the provider than allowing the contractor the opportunity to make the report. The statutory sharing of responsibility means that providers should understand the following: • what personal information is disclosed to suppliers • what contractors can do with the information they receive from the provider • what steps contractors take to secure the information in their possession • w hat steps contractors take to destroy or de-identify information when no longer needed
AGE CARE REGULATION & GOVERNANCE
• whether and, if so, how contractors alert providers of a suspected or actual breach of information security and what steps they must take (in conjunction with the provider) to prevent or control the breach.
How should a provider notify affected individuals? The provider must include its name and contact details, a description of the breach, the kind(s) of information involved and steps it recommends affected individuals take to minimise the risk of harm. The provider should take reasonable steps to notify affected individuals directly. However, if the provider determines (acting reasonably) that it is impracticable to notify individuals directly, it should then publish a statement on its website. Satisfying this obligation may be complicated where individuals suffer from medical conditions that mean that they are not legally competent. In this situation, the provider would likely need to notify the individual’s legal guardian and/or next-of-kin.
What happens if the provider does not notify the commissioner or affected individuals? Failing to notify affected individuals or the commissioner means the provider may have interfered with the privacy of the affected individuals. This triggers the commissioner’s existing statutory powers to investigate the privacy interference, to make determinations and to order remedies for noncompliance. Ultimately, a provider may be liable to pay civil penalties of up to $1.8 million.
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What steps should a provider take to prepare for mandatory reporting?
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Providers have some time to introduce processes and procedures to ensure they can comply with their statutory obligations. The following summarises the major steps providers should take:
• Raised Flush Button
• Pressalit Sign Toilet Seat • Support Arms
• review and update privacy policies • r eview personal information held to destroy or de-identify information that is no longer required • review and implement internal data security and data handling policies, to ensure that any potential data leakage ‘hot spots’ are plugged • review and discuss with contractors and suppliers their obligations with respect to personal information the provider discloses to them
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• t rain staff on the importance of privacy, with an emphasis on spotting potential breaches • establish a plan for responding to a data breach that complies with notification laws. ■ Craig Subocz is Senior Associate of Russell Kennedy Lawyers
AGE CARE REGULATION & GOVERNANCE
NEW GUIDE HELPS PROVIDERS
UNDERSTAND WHAT CONSTITUTES
Collecting and storing an individual’s details may have wider implications than you think, cautions leading health and aged care lawyers.
he Office of the Australian Information Commissioner (OAIC) has released a guide providing assistance to businesses, including aged care providers, to identify what constitutes ‘personal information’ for the purposes of the Privacy Act 1988 (the Act).
• sensitive information, including information or opinion about an individual’s racial / ethnic origin, political opinion, religious belief, sexual orientation or criminal record
With the community’s growing concerns in relation to privacy, the OAIC’s guide provides a helpful overview of the issues aged care providers ought to consider in relation to the personal information they collect, access, use and disclose.
• employee record/tax file number information.
Personal information The Act defines personal information as information or an opinion about an identified individual, or an individual who is reasonably identifiable, regardless of whether the information or opinion is true or not or whether it is recorded in a material form or not. Personal information includes: LASA Fusion_June_Artwork_PRINT.pdf 1 8/06/2017 1:52:04 PM
• health information • credit information
While aged care providers have traditionally had access to personal information in written form, providers should be aware that information which is shared verbally, recorded, or captured digitally may also be considered personal information.
Identified individual The Federal Court of Australia has recently held that information will be considered to be about an individual in circumstances where there is a connection between the information and the individual. However, aged care providers should be mindful that an individual does not necessarily need to be identified by name to be considered an ‘identified individual’. Other information about the individual (for example, a photograph or detailed description) may identify the individual even in circumstances where the person may not initially appear to be the subject matter of the information. By way of example, OAIC notes that information about a patient who was born with foetal alcohol syndrome reveals that the patient’s biological mother consumed alcohol during her pregnancy and may therefore be considered the personal information of the patient in addition to the patient’s mother.
Further, information included on a patient’s medical record about the patient’s biological father may be considered the personal information of the patient’s biological father in addition Continued page 32
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Continued from page 30
to the patient, even in circumstances where the name of the biological father is not listed.
Reasonably identifiable individual An individual can be considered ‘identifiable’ where the information available is able to be linked with other information that could ultimately identify the individual. OAIC notes that determining whether a person is ‘reasonably’ identifiable requires a contextual consideration of the particular circumstances including the nature and amount of information that the health service provider holds or has access to, who will hold and have access to the information, and the practicability of using that information to identify an individual.
What is not personal information? Broadly, information that cannot identify an individual, information that is not ‘about’ an individual (as the connection with the individual is too remote), business information, information about deceased persons and de-identified information is not considered personal information. However, as always, circumstances surrounding the information are important to consider. For example, if information about a deceased person includes information or an opinion about a living person, it will be considered personal information about that living individual. Information recorded concerning a care recipient’s family or representative in the care recipient’s file will be personal information of that individual and the care recipient and the rights of both parties need to be considered when handling information.
Conclusion When determining whether information constitutes personal information, aged care providers must consider each matter on a case-by-case basis with reference to the circumstances and specific context of the situation. Some information may not be considered personal information on its own however, when combined with other information, it may become personal information.
Approved for funding* ASK US HOW
Aged care providers ought to carefully consider the information they collect, access, use and disclose in the course of providing services to aged care recipients. If in doubt, the OAIC recommends that aged care providers err on the side of caution and treat the information as personal information.
OT Prefered Supplier 1300 367 293
For further advice or assistance, please contact a member of the TressCox Lawyers Health & Aged Care Team. See www.tresscox.com.au for details. ■
AGE CARE REGULATION & GOVERNANCE
Dominique Egan is TressCox Lawyers’ Health & Aged Care Partner. Patricia Marinovic, is TressCox Lawyers’ Health & Aged Care Solicitor.
OUT AND ABOUT
QLD OUT AND ABOUT WITH MEMBERS Recent Queensland forums have provided an invaluable opportunity for Members to meet with the Leading Age Services Australia (LASA) team, gain valuable industry insights, network with fellow LASA Members and hear an overview of the state of our industry.
hese forums were also a valuable opportunity for our principal advisors to hear member feedback firsthand, which will assist LASA to advocate and escalate member concerns to government.
In conjunction with the Department of Housing and Public Works, LASA hosted a masterclasses on Queensland’s retirement living regulations at our Brisbane and Townsville forums in June. Retirement Living and Seniors Housing Principal Advisor Jo Thomason briefed Members on new legislation requiring the compulsory accreditation of retirement villages in Queensland. This was a timely presentation, given that federal Aged Care Minister Ken Wyatt has since indicated he intends to revisit the 2007 federal parliamentary committee report into the retirement sector. If you missed these forums and would like to learn more about retirement living regulations in Queensland, please email Jo Thomason at firstname.lastname@example.org. Our regional forum held in Rockhampton in late May featured a presentation from Regional Development Australia – Fitzroy and Central West (RDAFCW). This service covers Gladstone, Rockhampton, Livingstone, Banana, Woorabinda, Central Highlands, Winton, Blackall-Tambo, Barcaldine, Longreach, Barcoo and Diamantina.
stakeholders and providers on aged care reforms and the Increasing Choice in Home Care changes. The LASA Brisbane team will host its next series of regional forums during July and August in the following locations: Wide Bay, Gold Coast, Combined Sunshine Coast and Moreton Bay, Mackay, Townsville, Cairns, south-west Queensland, Darling Downs and Central Queensland. Please email wendy.gay@qld. lasa.asn.au to register for your next forum. ■
Stuart Brown Partner Stewart Hutcheon presents at the Member Forum in Brisbane.
LASA Member Advisor Chris Edith (far right) provides an update to stakeholders on Thursday Island.
RDAFCW Executive Officer Kalair McArthur and research consultant Prue Hinchliffe explained that residents are moving away from their home towns to access better services, despite their overwhelming desire to age in place. RDAFCW has found that relocation negatively impacts the economics of these regions and is compiling a report on current trends relating to regional and remote aged care services and gaps that need to be addressed. LASA Member Advisor Chris Edith travelled to Thursday Island in June at the request of the Northern Queensland Primary Health Network. Chris provided an update to local
OUT AND ABOUT
NSW OUT AND ABOUT WITH MEMBERS The Leading Age Services Australia (LASA) New South Wales State Conference 2017 held at Doltone House in May attracted more than 300 aged care professionals.
he conference—themed Risk, Uncertainty, Chance... improve your odds for the road ahead—took a look at the challenges and lessons learned from the last 12 months and looked ahead to further changes coming our way. The conference raised the bar this year with the most up-to-date industry information and details which will help delegates progress offerings in their aged care services and retirement villages. We wish to thank everyone for the support and assistance from across the age services industry which went into developing and producing our annual New South Wales Conference. Much effort and planning ensured the maximum benefit, relevance, and understanding of key industry issues for delegates. Over two days the conference provided delegates with a wonderful opportunity to engage with aged care leaders and key industry decision-makers. Delegates enjoyed the conference industry mixer and dinner dressed in the glamour and style of the Casino Royale. It combined entertainment with good food, good company and a great spirit. We would like to thank all speakers who participated to make the two days of conference so successful, and all the sponsors and exhibitors who supported the event. The LASA New South Wales State Conference has helped Members to focus on the issues and challenges the industry needs to address in order to maintain consistently high standards of care to older Australians. We look forward to seeing our Members at future LASA events. ■
Top Image: Robert Orie, CEO, Montefiore Homes; Bruce Bailey, Director PRIDE Living Group; David Dixon-Hughes, Associate Director, Global Health Westpac; John Picot, Aged Care Lead NSW Grant Thornton; David Lo Russo, Managing Partner Marketability were on the panel sessions. Middle Image: Conference delegates enjoy the industry dinner. Bottom Image: Conference trade exhibitors taking a break from speaking about their products and services.
OUT AND ABOUT
VIC/TAS OUT AND ABOUT WITH MEMBERS More than 500 age service professionals, leaders and specialists from around Australia gathered in Melbourne for this year’s Leading Age Services Australia (LASA) 2017 Victorian State Conference and Exhibition – Directions to help you speed through the Aged Care Roadmap. This was an informative and interactive combination of LASA's highly successful tri-state and state conferences.
elegates were taken through the Aged Care Roadmap, and given practical solutions for a consumer-driven, market-based, and sustainable aged care system. The conference also provided research, case studies and insights from eminent speakers. Including keynotes from Saroo Brierley, who was celebrated globally through the film Lion, and paralympian, Jack Swift.
and proceeds raised at the ball go towards the provider’s redevelopment program at its Clayton South site. ■ Lifeview Residential Care receiving the Service Innovation Award for residential care.
Meanwhile, providers were lauded at the LASA Excellence in Care Awards which promote and recognise excellence and innovation across various fields of the aged care industry. Among them were: • Ballan District Health and Care, winning the Community Engagement Award for their ‘Priscilla Queen of the Desert High Tea’. Although the event was originally planned for residents and families, the residents had such joy in the process, that it was opened to the public and sold out. • Randowne Place, Benetas, winning the Excellence in People and Culture Award. • Uniting Age Well, winning the Community Inclusiveness Award for their efforts to incorporate lesbian, gay, bisexual, transgender and intersex-inclusive practices into its residential and community services. • Mountain View Cottage, winning the Service Innovation Award for Community and Home Care for its community program arm that includes 15 social support groups and assisted transport services. • Lifeview Residential Care, winning the Service Innovation Award for Residential Care with its new care model Home 2 Home (H2H). In addition to attending these well-organised events, Victoria-Tasmania State Manager Veronica Jamison was one of the LASA special guests at Fronditha Care’s recent fortieth anniversary gala ball. Fronditha has been providing ethno-specific residential and community care since 1977
Ballan District Health and Care receiving the Community Engagement Award.
OUT AND ABOUT
WA OUT AND ABOUT WITH MEMBERS Crown Australia CEO Barry Felstead has linked the growth of the aged care industry and its impact on the hospitality industry, noting that elderly guests are increasingly approaching Crown to explore permanent hotel live-in options with their carers.
e made the observations during a recent Crown ‘masterclass’ at the new Crown Towers in Perth, which was delivered in partnership with Leading Age Services Australia (LASA). During the one-day event he also said he was aware of staff ‘transitioning’ from the hospitality sector to the aged care industry. LASA CEO Sean Rooney joined the masterclass and Crown senior executives to explore the synergy between hotels and residential care facilities. The full day’s agenda covered customer service, food and beverage, procurement, workforce, room design and innovation. A behind-the-scenes tour of kitchen and food preparation areas was included, as well as inspection of rooms and suites. LASA participants in the masterclass said they were privileged to have an insight in to how a large hospitality organisation operates – with access to key personnel who openly shared both their challenges and opportunities.
Incoming minister welcomed LASA has held an industry function titled ‘Political Harmonies’, to welcome the incoming state Minister for Health/Deputy Premier to the aged care industry. Minister Roger Cook addressed the audience with a promise to listen and engage with industry. Special guests at this event were the Friends in Harmony choir which is made up of people living with dementia. They rejoiced in a rendition of ‘Take Me Home Country Roads’ (with a slight change in lyrics from West Virginia to West Australia) as the whole audience sang along with them.
to talk about the zoo’s program for ageing animals and how animals also lived with diabetes and dementia. The presentation complemented the overarching LASA session entitled ‘Who’s Who in the Zoo’, with themes around diabetes, dementia and palliative care. Presenters were encouraged to deliver from a different perspective and the dementia presentation was delivered by a gentleman who was has lived his past seven years with Alzheimers. In this unique session participants were able to interact and openly ask questions of the presenter. LASA’s next clinical and care session will be Heads Up in Joondalup.
Inaugural Care and Ageing Expo Anticipation is brewing for a new LASA initiative, the inaugural Care and Ageing Expo. Set for 29–30 July at the Perth Convention Exhibition Centre, Federal Minister for Ageing, the Hon. Ken Wyatt will open the Expo which will be the first of its kind in Western Australia. A wide range of providers, suppliers and services are locked in as the whole of the aged care industry comes together in a one-stop-shop for the ageing consumer – to empower the consumer to explore what is available in aged care, to compare the market, and to make more informed choices. ■ New state Minister for Health and Deputy Premier Roger Cook with members of the Friends in Harmony choir.
Who’s Who in the Zoo Perth Zoo’s education officer joined a recent LASA-hosted clinical and care session at the zoo Perth Zoo’s education officer speaks to Members at LASA’s clinical and care session.
OUT AND ABOUT
SA OUT AND ABOUT WITH MEMBERS As part of the review of the proposed Retirement Village Regulations 2017, Leading Age Services Australia (LASA) SA-NT State Manger Rosetta Rosa and Principal Advisor–Retirement Living and Seniors Housing Jo Thomason welcomed the opportunity to meet with Vanessa Clarke, Chief Retirement Village Officer, Office for the Ageing (OFTA) and South Australia Health in May.
anessa addressed questions in relation to concerns that LASA raised about the draft regulations, and clarified key points. LASA recognises and supports the intent of the draft regulations to provide standardised formatting of documentation and encourages that the draft regulations provide appropriate guidance and structure to enable the effective functioning of a ‘residents’ committee.
LASA thanks OFTA for the opportunity to comment and we look forward to supporting Members to fully understand the new regulations though ongoing consultation leading up to the draft regulations submitted for Cabinet by 1 January, 2018. LASA also welcomed Tony Harrison, Chief Executive Officer of the Department of Communities and Social Inclusion: Ageing and Disability and Lynn Rosetta Rosa speaking to Members. Young, Executive Director Disability and Domiciliary Care Services, to the LASA Leader's Lunch at Jolley's Boathouse Restaurant. With a number of significant reforms impacting both the ageing and disability sectors, the lunch was a great opportunity for Members and industry peers to hear Tony share his experience and insights on the effects of the reforms for service providers,
Tony Harrison, CEO Department of Communities and Social Inclusion: Ageing and Disability and LASA SA-NT State Manager Rosetta Rosa
consumers, the workforce, the economy and the community at large. LASA continues to deliver engaging events for our Members and SA-NT State Manger Rosetta Rosa invites Members and the age services community to join in the conversations and benefit from South Australia’s reputable standing in research and innovation. Great opportunities include the potential for LASA and Members to work with South Australia Health and Medical Research Institute and The Wellness and Resilience Centre. For more information on upcoming events and programs, or to submit an expression of interest in joining the LASA Member Advisory Committee please contact Rosetta Rosa on 08 7070 2568 or email email@example.com. ■
palliAGED is now live All the content on the palliAGED website is evidence-based and trustworthy, to ensure a high quality of care is provided to older people. The work has been supported by an Evidence Advisory Group and a National Advisory Group.
Subscribe to the palliAGED newsletter or follow us on twitter @palliAGED for the latest palliative care news, evidence and information for aged care.
visit www.palliaged.com.au palliAGED is funded by the Australian Government Department of Health. palliAGED is managed by CareSearch, Flinders University
LASA MEMBERSHIP OFFER A Leading Age Services Australia (LASA) membership supports your business to deliver care and services to older Australians.
Providing you with the right advice at the right time LASA provides you with access on the phone or online to expert advice from our residential care, home care and retirement living specialists who provide practical advice on day-to-day management issues and help you navigate the state and federal governments’ policy, payment, registration and regulatory systems.
Helping you respond to change Through our weekly newsletters, website and quarterly Fusion publication, LASA provides you with insight and intelligence on key issues in the age services industry, including aged care reforms, new technologies, increasing consumer demand and changing consumer expectations. Through our state conferences and National Congress, we will provide you with opportunities to learn from policy makers, international experts and industry innovators so you can stay ahead of the game and expand your business horizons.
Building your organisation’s skills Through the wide variety of training courses offered by our national registered training organisation, LASA provides you with management and leadership development and your staff with the skills they need to deliver the care and services to older Australians.
Giving you a say LASA engages regularly with you through Member forums, Member events, Member surveys, Member advisory groups and leadership forums so we can hear directly from you about the issues important to you and represent those issues to government and other stakeholders.
Giving you value for money LASA delivers services to you efficiently and effectively, and provide you with access to discounts to LASA events and conferences as well as further discounts on services ensuring you get great value for money from your membership.
LASA Member support The following services are part of your LASA membership: Advocacy and influence As the age services industry peak body, advocacy and influencing is a core service offering to you. Our advocacy activities are focused on your issues and concerns, we provide a platform for you to bring your views to government and stakeholders on issues of importance. Through active engagement with government, politicians and ministers, we influence policies, programs and practices on your behalf. Industry news and information Through LASA’s industry news and update services, we provide you with timely, relevant and accurate industry information. LASA’s team of experts are able to interpret information to ensure you are across the latest industry news and changes that directly affect you. Advisory and support services Through your membership you have access to LASA’s industry experts over the phone or online to assist you in addressing compliance, policy, and business issues. LASA also leverages our Affiliates’ expertise to ensure you receive high-quality technical advice, support and services. Exclusive access The products and services you can access include purchasing discounts to third-party provided products and services, discounts on LASA events, and access to our online services directory connecting your needs to the products and services of LASA Affiliates.
Additional services The following additional LASA service offerings are available at discounted rates: Workforce training and development Through our workforce training and development services we ensure your staff members have the skills and accreditation required to deliver effective and quality care to older Australians.
This service includes accredited and non-accredited training, professional development, and workshops delivered by industry experts. Consultancy We provide consultancy services in a range of specialist areas such as business administration, accreditation, compliance, employee relations, human resources, and financial management. Our team of experts will help to ensure your organisation is high-performing and sustainable. Conferences and events Our conferences and events provide you with access to industry information, networking opportunities and trade exposure. You will have exclusive access to event discounts and early bird tickets. Events include our National Congress, state conferences, forums, seminars and webinars.
Employment relations support Our employment relations services provide your organisation with resources, advice and support to help you deliver effective and quality services to older Australians. Included in this service are tribunal representation, HR consultancy and documentation review, enterprise and comprehensive bargaining support, consultancy and documentation review, as well as workplace resources and manuals. Business services To ensure your organisation operates efficiently we provide a range of business administration services so you can focus on what you do best – meeting the needs of your clients and residents. The business services we can help you with include payroll processing, client billing, accounts payable and other financial services. For more information and a Membership application form, contact the LASA Ltd Member and Affiliate team. Tel: 1300 111 636 Email: firstname.lastname@example.org ■
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AACS ACFI Review Services AACS currently provides ACFI Review Services for all aged care providers. Lead by Dr Richard Rosewarne, AACS were the original architects of the ACFI and so have an intimate understanding of the documentation requirements and the review process. We work in partnership with your staff and conduct high quality audit reviews covering files notes, assessments and all documentation to build an evidence profile that informs not only on the ACFI claim but the quality and consistency of your documentation. We can help you get the best possible ACFI funding outcome. The AACS ACFI Review services are as follows:
Our reviews deliver:
• Remote ACFI Reviews: Detailed ACFI Appraisal Reviews
• Comprehensive reviews of your documentation & assessment practices
• Monthly ACFI Outcome Reports by Facility
• ACFI submission reviews based on the residents assessed care needs
• E-Mail Based Support: AACS will respond (usually via a phone call) within 24 hours of questions or clarifications. • Budget: AACS charges a set fee per review and no lock in contract.
• One fee per review unrelated to gains or savings
AACS ACFI recommendations are evidence based!
For more details of other AACS Services please call
03 9836 8852 or visit www.aacs.com.au 42
AFFILIATES GAIN THE LASA EDGE LASA Affiliates provide products, services and support to providers of aged care services, across residential aged care, home care and retirement living. Becoming a Leading Age Services Australia (LASA) Affiliate connects your business to providers that deliver care and services to older Australians.
Leading Age Services Australia Leading Age Services Australia (LASA) is the national peak body representing providers of age services across residential aged care, home care and retirement living. We represent our Members by advocating their views on issues of importance and we support our Members by providing information, services and events that improve their performance and sustainability. Our vision is to create a high performing, respected, and sustainable aged services industry delivering affordable, accessible, quality care and services for older Australians.
LASA’s Affiliate offer LASA offers Affiliates opportunities to: Be seen: Make a lasting, positive impression without picking up the phone or leaving your office by promoting your products and services through various channels, including LASA events, newsletters, conference programs, periodicals, brochures and on our website. Be found: LASA connects Affiliates’ products and services direct to LASA Members through our online services directory. The services directory provides a one-stop shop for Members to access the products and services they need, while providing Affiliates the opportunity to showcase their offerings and provide discounts and promotions direct to LASA Members. Be an expert: Affiliates of LASA are invited to submit content for consideration in LASA publications and have opportunities to speak at LASA events as an authority on relevant industry topics.
The Affiliate package Your profile and connection with the age services industry is enhanced through our value-adding Affiliates package. The package includes: Direct access to LASA Members Affiliates gain preferential access to LASA Members through:
• invitations to attend LASA Member and Affiliate networking events. • discounted rates to attend all LASA state conferences and National Congress. • discounted exhibitor rates at LASA state conferences and National Congress, and • preferential access to LASA sponsorship opportunities. Enhanced sales and promotion Sales and promotions opportunities are enhanced for Affiliates through: • inclusion in LASA’s online services directory connecting LASA Members to Affiliates’ products and services. • opportunities for customised LASA sponsorships for National Congress, LASA state conferences and other products and events discounted advertising rates in LASA publications, and • discount and promotion offers made by Affiliates exclusively to LASA Members. Industry intelligence Affiliates gain industry insight and intelligence through: • receiving LASA’s fortnightly eNews and quarterly printed issues of Fusion magazine. • invitations to participate in industry policy discussions (where appropriate), and • invitations to attend LASA Member and Affiliate networking events. LASA’s online services directory At LASA we are keen to help you promote to our Members the services and products you provide that will help them deliver high quality care and services to older Australians. Let us know about the services you provide and we will promote them directly to our Members via our online directory on our website and provide you with a range of other opportunities to learn about your offerings. For more information and an application form, contact the LASA Ltd Member and Affiliate team: Tel: 1300 111 636; Email: email@example.com ■
LASA TAKES AN OVER-THE-HORIZON LOOK
AT WORKFORCE CAPABILITY NEEDS FOR THE NEXT DECADE AND BEYOND Your age care peak body offers the training and support that will equip you to remain an employer of choice.
id you know that LASA, your age care peak body, can be supporting you in your workforce strategy, particularly in the area of work force development?
that will impact on our workforce and develop strategies to address such factors. Doing so will place your business in a strong position now and also into the future.
Let’s start with the facts …
Many providers are already adapting their workforce strategies to ensure flexibility and responsivity, including asking the hard question of how they attract new workers to enter the industry and their organisation, as well as focusing on retaining their existing workforce.
1. Australia has a rapidly ageing population. 2. Australia has an ageing workforce. 3. Many Australians jobs are at high risk of digital disruption in 10–15 years. 4. Aged Care is in great demand and is less likely to be fully automated. 5. Australia’s employee pool is changing. (We are witnessing the introduction of the ‘gig’ economy i.e. growing numbers of workers abandoning traditional 9–5 employment in favour of working independently on a task by task basis for various employers). 6. The aged care landscape is changing. 7. Central to delivering high quality aged care services that meet the needs of older Australians is an appropriately skilled and well-qualified workforce. Australia’s aged care workforce is a topic of much conversation. The Productivity Commission estimated that the aged care workforce will need to have grown to around 980,000 workers by 2050. The Community Services and Health Industry Skills Council in its Aged Care Workforce Strategy 2024 stated that to avoid a future care crisis Australia needs to address the changing service demand, uncertainty in policy environment, workforce supply gaps, difficulties in recruiting and retaining staff, and threats to training capacity. As we know in the recent budget announcement, the government has committed to $1.9 million over two years to establish and support an industry-led taskforce to develop an aged care workforce strategy. The government has also provided $33 million focusing on the care support network workforce, i.e., aged and disability providers. It has also committed to investing in increasing support for training and reskilling older Australians. So how does this impact on your workforce? As an industry we need to be considering the internal and external factors
What can LASA offer? Not only are we your peak body but we are a nationally-accredited registered training organisation (RTO). As the age care peak body, we want to be your first choice for accredited aged care, leadership and management courses. Further to this, we want to be your trusted advisor in your workforce development. As part of our commitment, support the age care industry to ensure that staff are confident in their skills and capable and committed to their valuable roles in supporting older Australians. We can assist you to: • Gather specific information about your current workforce skill profile, experience, knowledge base and its overall existing capability. From this we assist you to gain a clear picture of the strengths and weaknesses of your workforce and recommend development pathways. • Explore whether your current workforce skill repository will be the composition you need to meet your future goals. If not, we are there to assist you to develop a professional development program to get you moving towards your goals by upskilling existing workers and looking at ways to motivate and retain your current employees through professional development. • Provide nationally-accredited aged care, leisure and leadership qualifications, which respond to new entrants into the industry as well as upskilling the employees within your organisations through various leadership courses and professional development opportunities. • Work with your employees to recognise their experience and prior learning. Through our engagement with both commonwealth and state governments, and our representation on national and state
working groups, LASA is at the forefront of key developments which affect the industry. Being your peak body’s RTO, we provide the most current and relevant training that is contextualised to the age care environment. Workforce training and development needs are continuous. LASA has introduced innovative models of learning to reflect your company’s needs and your employees’ preferred learning styles. Workforce is a critical issue for this industry. To complement the advocacy and operational support that is being provided though our employment relations service, our RTO staff are here to support you to ensure that your workforce planning and your business remain ahead of the game. Our highly experienced vocational education team members are looking forward to discussing your workplace planning requirements. For more information on our services, visit www.lasa.asn.au/education or contact us by emailing firstname.lastname@example.org or calling 1300 111 636. ■
STAY UP TO DATE WITH THE 2017 AMH BOOK OR ONLINE AMH 2017 includes up-to-date drug information to help you stay informed in your profession. Every edition has hundreds of amendments, updates and additions to reflect the latest shifts in evidence and practice. More than 20 new drugs have been added to the latest edition, including Ulipristal for emergency contraception, Idarucizumab for reversal of dabigatran anticoagulation and Paritaprevir with ritonavir, ombitasvir and dasabuvir for chronic hepatitis C. Therapeutic topics have been reviewed and updated, eg Dyslipidaemia now includes evolocumab and a table comparing lipid-lowering drugs. There is also new safety information, eg severe skin reactions with bromhexine. New to AMH online is a drug interactions search capability, for interactions between drug/drug or drug/class pairs. To find out more, go to www.amh.net.au
OPTIMISE CARE TO THE ELDERLY WITH THE AMH AGED CARE COMPANION The AMH Aged Care Companion is a trusted, practical reference for doctors, nurses and pharmacists who work with older people. It contains the latest evidence-based information and is useful when conducting medication reviews and other activities (eg case conferencing) aimed at improving patient outcomes. Latest edition changes include: • a new topic on actinic keratosis • information on the process of deprescribing - important for optimising the use of medicines in older people • new illustrated inhaler device guide with links to instructions for choosing inhalers suitable for older patients Other topics reviewed include asthma, COPD, gout, hypertension, dyslipidaemia and dyspepsia. Available in print or online.
LASA MEMBERS GAIN ADDITIONAL BENEFITS
THROUGH ACCESS TO NEW
EMPLOYMENT RELATIONS SERVICE An experienced LASA team of industrial relations practitioners and employment experts are providing essential support to aid age care services employers.
s part of their membership benefits, Leading Age Services Australia (LASA) Members now have access to a new employment relations service offered by a team of experienced industrial relations practitioners and employment experts. The team offers the best advice, support and assistance through day-to-day and complex human resource matters.
The new service continues LASA’s long and proud history of representing and advocating for age services employers on employment relations issues. The employment relations advisory service provides LASA Members with telephone and email advice on (but not limited to): • wages and allowances • awards and enterprise agreements • leave entitlements • legislation and regulations • codes of practice • managing sickness absences • staff attendance and absenteeism • managing employees on workers compensation • dismissal decisions • performance management procedures and steps • serious misconduct • bullying complaints • workplace grievances • workplace investigations • recruitment and selection processes • mandatory reporting and police check obligations • reward and recognition programs • transfer of business. The LASA employment relations team also assists LASA Members when writing employee and workplace letters including (but not limited to):
• notice to attend an interview • letters of appointment • interview outcomes • dismissal decisions • workplace complaints • workplace memos • union responses and correspondence reviews. Many tips, case studies and employment matters of interest for aged care employers are discussed in the newsletter Employment Directions, which the LASA team publishes monthly. The newsletter also includes decisions of interest from the Fair Work Commission, details of current Bills before parliament, inquiries and public consultations, updates on the four yearly modern award review proceedings and other award variation processes that may impact staffing decisions, general articles of interest and employer alerts. This comprehensive publication is a must-read for aged care providers and human resource practitioners. The LASA employment relations team is also busy refreshing and developing Member resources that all members will be able to access on the LASA website. Included in these resources will be a workplace health and safety manual, human resources manual, employer assist information sheets, and links to relevant industry resources. In addition to the LASA employment relations advisory service, the employment relations team also offers members a broad range of consultancy services. These include employment tribunal assistance and representation (excluding arbitration), on-site or remote human resource support including reviews of contracts, policies and procedures, checking systems to ensure award, agreement and legislative, human resource and employment relations education workshops, research and analysis and enterprise bargaining support.
As Member representatives, the employment relations team also supports LASA advocacy and submissions regarding workplace relations and workforce matters at a state and national Level. By convening the LASA National Workplace Advisory Group, engaging with Members through targeted roundtable discussions, canvassing Member feedback for submissions and policy direction and attending external workforce and employment relations events and committees, the LASA employment relations team supports you and is your champion for improved and appropriate employment relations outcomes.
Engagement in current issues
− Modern Award Review process oA CTU applications (family friendly measures / family domestic violence) o Payment of wages − Relevant decisions of the Fair Work Commission o Redundancy Decision – and casual service − Enterprise agreement decisions o BUPA and NSWNMA Enterprise Agreement Decision − Annual Minimum National Wage Case o Decision expected early June 2017 − Penalty rate decision
− Modern Award Review proceedings o casual and part time employment o public holidays o plain language drafting o Aged Care Award 2010 o Social, Community, Home Care and Disability Services Industry Award 2010 o Nurses Award 2010 o Health Professionals and Support Services Award 2010 − 457 visa changes − Portable Long Service Leave (ACT/VIC) − Enterprise bargaining (bargaining and research)
Get to know members of the LASA Employment Relations Team Keiran Brown – Senior Advisor Keiran holds a Bachelor of Business, a Graduate Certificate in Industrial Relations and is currently studying towards a Master of Dispute Resolution. Prior to joining LASA in 2016, Keiran worked at the Chamber of Commerce and Industry of Western Australia within the Construction Services Team and worked on large scale construction projects in the
− WorkSafe Legislation Amendment Bill 2017 (Vic)
Western Australian resource sector. In this role, Keiran
−F air Work Amendment (Protecting Vulnerable Workers) Bill 2017
was responsible for providing advice on a range of
oE ducation and Employment Legislation Committee Report recommends the Senate pass the bill − Fair Work Amendment (Corrupting Benefits) Bill 2017 oE ducation and Employment Legislation Committee Report recommends the Senate pass the bill −F air Work Amendment (Repeal of 4 Yearly Reviews and Other Measures) Bill 2017 oE ducation and Employment Legislation Committee Report due 22 May 2017
employment relations matters including union right of entry, award and agreement interpretation and employment relations strategy to resource sector clients. Jenna Field –Advisor Jenna holds a Bachelor of Business and is currently studying towards a Maters of Employment Relations. Prior to joining LASA in 2015, Jenna worked in the transport and logistics sector as a human resource generalist.
−F airer Paid Parental Leave Bill 2016 (Omnibus Bill 2017)
Jenna brings to LASA a solid understanding of the
−R oll out of National Code of Conduct for Health Care Workers
practical management of day to day human resource
oT asmania – likely that legislation will be introduced to the Tasmanian Parliament in the second half of 2017.
matters, in addition to experience working closely with managers and employees through a number of significant restructure projects.
THE CARE AND AGEING EXPO The Federal Government’s recent aged care reforms are driving massive waves of change across the aged care industry, putting the consumer at the heart of service delivery.
ith the national population projected to grow to 39.4 million by 2055 and the number of Australians over the age of 65 anticipated to more than double to 8.5 million, it is clear that planning for the future
Leading Age Services Australia (LASA) is spearheading efforts to assist consumers on this journey. LASA has launched the Care and Ageing Expo which will take place from 29–30 July at the Convention Exhibition Centre in Perth, Western Australia. LASA identified a gap that exists within the community as the ageing population (and their carers) search for information around availability and choice. An additional challenge is understanding the complexities and confusion associated with accessing aged care funding, support and services. These issues are set to escalate as baby boomers head toward ‘old age’ and demand more information and clarity in regard to choice – what is available now for their parents and what they will expect and demand in the future. One of the aims of the expo is to create a greater awareness of the industry – showcasing all aspects of the aged care sector. This includes the various options available in retirement living, lifestyle villages, residential aged care facilities, home care services and other aligned products and services that relate to the consumer’s current and future ‘aged care’ needs.
This new initiative is set to revolutionise consumer choice by providing a one-stop shop, allowing consumers to research, explore and make informed choices as they plan for their twilight years. The looming impact of an ageing and rapidly increasing population has been on the radar for some time now and it has long been recognised that the consumer is reluctant to plan ahead beyond retirement. When it comes to making what can be life changing decisions either for themselves or their elderly loved ones, in most cases they are forced to start this journey under times of duress following a serious incident or diagnosis. And although there is a myriad of information available, the reality is that in the midst of a crisis they are confused and don’t know where to start. As we enter a new era of competition and choice in aged care, the onus is on us as an industry to ensure that we are ‘consumer ready’ with information and answers to the many questions that the consumer will inevitably demand before making their choice. With so many options becoming available, it is imperative that providers and suppliers are able to clearly define their offering and promote their points of difference. One of the key features of the Aged Care Roadmap notes: “Consumers, their families and carers are proactive in
preparing for their future care needs and are empowered to do so.â€? LASA is embracing the changing environment under consumer directed care and believes that this important event will indeed provide a forum that showcases the whole of the aged care sector and ultimately empowers the ageing consumer to be proactive and enables them to make an educated and informed choice. The LASA Care and Ageing Expo will deliver a significant (and comparatively inexpensive) marketing opportunity for the entire aged care industry. Members will be offered a reduced rate and will be given first preference on booth size, location
and participation in social and promotional programs. This event will provide an environment for industry and members to showcase their products and services and highlight their point of difference in a competitive marketplace. The expo aims to present new business development opportunities for members and will also help to grow the industry by encouraging new business endeavours and enabling the smaller home care providers to capture a share of the ever increasing home care provider sector of the market. For more information on the Care and Ageing Expo contact Ruth Metcalf on 08 9474 9200 or email email@example.com. â–
LASA National Congress
2017 15â€“18 OCTOBER GOLD COAST, QLD
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LASA National Congress is a key fixture in the diaries of the leaders and decision makers across the aged care industry. As the biggest age services event in the region, our Congress attracts over 1100 staff and service providers from across retirement living, home and community care and residential aged care.
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Paynter Dixon Queensland (PDQ) is a leader in the design and construction of Aged Care, Supported and Retirement Living facilities. Their specialised team will bring ‘fresh eyes’ to your operating model, and provide innovative design solutions that enhance both your commercial and project goals. PDQ ensure ‘cutting edge’ design is underpinned by contemporary research that facilitates a positive lived experience for elderly residents. Their aged care and supported living team ensure the successful delivery of your project through the involvement of their dedicated construction team who specialise in new and complex refurbishment projects and are well versed in working within busy operational environments. Our design team and construction team work ‘hand in glove’ to translate your vision into the built form.
Paynter Dixon Queensland are able to support your senior management team from ‘go to wo’, from site master planning, through design, feasibility analysis, construction and offer a well proven methodology for commissioning your new building. We would be delighted to discuss how our services may be tailored to your project. To learn more about PDQ’s Design & Construct services, please contact our Head of Aged Care, Erica Lambert. p 0407 227 795 w firstname.lastname@example.org
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HOW MUCH IS MALNUTRITION COSTING YOUR CLIENTS AND YOUR ORGANISATION? are compromised. In addition to this, under-nutrition is also associated with confusion, depression and anxiety, and reduced quality of life in our older adults. Malnutrition also costs the health service, with clients more likely to be admitted to hospital, and stay in hospital longer. With our growing population of older adults, improving the quality of nutritional care will be pivotal in optimising the health of older adults and minimising the burden of care placed on aged care providers and our health systems going forward. So how can we improve our nutritional care? Luckily, there are a few simple things aged care service providers can do to help ensure they are looking after the nutritional status of their clients, both living at home and in residential care.
Provide a nutritious menu Nutrition Australia sends a strong message about the health and economic costs of poor nutritional care of seniors.
t’s no secret that Australia’s population is ageing. The proportion of people over 65 years is expected to increase from 14 per cent in 2011 to approximately 20 per cent in 2031.
However, just because we’re living longer, doesn’t necessarily mean we are healthier or happier. Recent studies have estimated that between 20–65 per cent of older adults living in residential care are malnourished, and nearly 75 per cent are at risk of malnutrition. For older adults living at home, up to 10 per cent are likely to be malnourished, and a further 35 per cent are at risk. These statistics should not be ignored. The cost of malnutrition is high, both for the health and wellbeing of our older adults, and our health systems, not to mention the costs to providers’ health care services. When clients are undernourished they are at much greater risk of illness, injury, and premature death. Falls are more likely with reduced strength and physical function, wounds will take longer to heal and are more susceptible to illness, and immune systems
As a first step, residential services should ensure their menus provide the minimum nutrition requirements and variety that older adults need to maintain good health and pleasure at meal times. Having your menu assessed by an accredited practising dietitian will ensure you get high quality support from a clinically trained and qualified nutrition professional. They will provide you with practical and relevant recommendations to improve the nutritional value of your menu/s, such as modifying recipes, changing portion sizes, and texture considerations. And sometimes just a few changes can have a huge impact, such as fortifying mashed potato with butter or cheese to increase the energy and protein content, which is essential for anyone at risk of malnutrition.
Invest in staff training There are many early signs of malnutrition. Commonly overlooked signs of malnutrition include feeling tired, poor concentration, delayed wound healing and lack of appetite or interest in food. Training all care staff in older adults’ nutritional requirements, and common nutritional conditions, is important to ensure they can identify these early signs, and initiate an action plan to prevent further complications. After all, prevention is much better than cure.
HEALTH AND WELLBEING
For care staff working with older adults in their home, look for a training program that provides advice specific to the home setting, including ideas for simple nourishing meals and snacks, tips for fortifying foods at home, and ways to introduce new foods and drinks through shopping and cooking.
Encourage regular (nutritious!) meals and snacks
Engage with a dietitian Involving an accredited practising dietitian as part of the client care team is also essential. Dietitians are university-qualified health professionals who can provide thorough nutrition assessments, and work with the care team to develop a tailored nutrition plan that will ensure each client is receiving adequate nutrition.
Many older adults struggle with a lack of appetite. Eating small frequent meals (for example, five or six small meals each day rather than three main meals) can be a good strategy to make sure they are getting enough nutrition in, and keeping their energy up while they do it.
Finding an expert
Additionally, offering anyone at risk of malnutrition a high energy/ high protein snack in between meal times can help to increase their nutrition intake in a manageable way. High protein milk drinks, biscuits with cheese and sandwiches made with meat or cheese fillings are all good options.
Nutrition Australia is a reputable, not-for-profit and national organisation providing expert nutrition services in aged care. Nutrition Australia’s range of services includes training workshops, menu assessments and tailored nutrition services. All services are facilitated by our expert team of accredited practicing dietitians. For more information about Nutrition Australia, visit the website www.nutritionaustralia.org/vic, or telephone 1300 515 523. ■
Make mealtimes enjoyable Little touches like setting the tables nicely, playing some background music, and creating a ‘dinner party’ atmosphere can help clients to relax and enjoy the meal experience, which in turn often means they eat more.
Finding a reputable nutrition provider can tricky. When looking for someone, make sure you look for an accredited practicing dietitian to ensure you are receiving the best, evidence-based information and care.
Zoe Taylor is an accredited practicing dietitian and senior project officer at Nutrition Australia’s Victoria Division.
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HEALTH AND WELLBEING
THE TERROR OF TOAST:
HOW AN UNASSUMING FOOD CAN PROVE TO BE LIFE THREATENING Swallowing difficulties among the aged can be dealt with by supportive and educated staff, say leading speech pathologists.
hen we chew food and drink fluids we use 26 different muscles. A complex sequence of muscle movements are involved every time we chew, suck, sip and swallow.
It is estimated that up to 30 per cent1 of people living in the community aged over 65 and 50 per cent2 of people living in aged care have swallowing difficulties. A swallowing difficulty is known as dysphagia (dis-fay-jah). Speech pathologists have a pivotal role in the assessment and management of dysphagia. They know first-hand that eating certain types of food can increase a person’s risk of choking and aspiration pneumonia. Alarmingly, researchers3 have found choking was the second highest cause of preventable death in residents living in aged care facilities. This figure highlights the need for community and aged care providers to be well equipped and informed on how to support people with dysphagia to prevent choking incidents and possible death. Surprisingly, bread and toast require the same number of ‘chews’ as raw apple, nuts and steak. Those that aren’t able to chew these foods sufficiently are at a high risk of choking. In 2015, Bernadette Dutton, Principal Speech Pathologist at Loqui Speech Pathology surveyed health professionals at a Primary Health Network (PHN) forum in aged care and alarmingly, 40 per cent of those surveyed incorrectly believed toast was suitable for people on a soft diet. Understanding the dietary standards for fluids and foods is essential for community and aged care organisations to ensure people with dysphagia or general age related swallowing symptoms are safe. Swallowing issues can arise as a result of general ageing, however can be further complicated by age related illnesses, chronic diseases, fatigue and prescription of multiple medications. The most frequent swallowing difficulties reported by people as they age include4;
• sensation of food stuck in the throat • esophageal reflux • chronic obstructive pulmonary disease impacting the breath/ swallow cycle • adverse socioemotional effects • excess phlegm and saliva • problems chewing. It is not uncommon for people over 65 to report difficulty chewing and swallowing hard, dry, textured foods such as nuts, medications, and toast, or stringy fibrous foods such as celery, carrot and lettuce. Under the Australian Standards for Texture Modified Foods and Fluids, these foods are classified as ‘normal’ texture. To reduce the risk of choking a speech pathologist may recommend a ‘soft’, ‘minced moist’ or ‘puree’ textured diet. Prevention is the best cure. Refer to a speech pathologist for an assessment if someone is suspected of having swallowing difficulties. Educate staff to ensure they understand the Australian Standards for Texture Modified Foods and Fluids and are well informed on how to support a person with dysphagia. Supporting a person with dysphagia improves their quality of life, reduces their sense of fear when swallowing and importantly it reduces the incidence of aspiration pneumonia, choking and preventable death. ■ Bernadette Dutton and Laura Blasdale are speech pathologists with Loqui Speech Pathology. 1. Barczi S, Sullivan P, Robbins J (2000), ‘How should Dysphagia Care of Older Adults Differ? Establishing Optimal Practice Patterns’, Seminars in Speech and Language 21, pp 0347–0364. 2. Speech Pathology Australia – Swallowing Awareness Day, May 2017. 3. Ibrahim JE, Murphy BJ, Bugeja L, Ranson D (2015), ‘Nature and Extent of External-Cause Deaths of Nursing Home Residents in Victoria, Australia’, The American Geriatrics Society 63 954–962.
• taking a longer time eat
4. Roy N, Stemple J, Merrill RM, Thomas L (2007), ‘Dysphagia in the elderly:
preliminary evidence of prevalence, risk factors, and socioemotional effects’,
• throat clearing
Annals of Otology, Rhinology & Laryngology 116, pp 858–65.
• choking before, during, or after swallowing
HEALTH AND WELLBEING
THE ‘TABOO’ SUBJECT THAT MORE OF US SHOULD BE DISCUSSING Ageing plays a big part in incontinence, but it can often be better treated and managed if identified early.
s June’s annual World Continence Week has recently passed, it offers a reminder for those in the age care industry that as people become older, incontinence can become more prevalent and more severe.
The Pharmacy Guild of Australia notes that more and more community pharmacies now have dedicated sections of products and services to help manage incontinence and the staff are trained to help sufferers select the most appropriate treatment for individual needs. Private counselling rooms are also often available to help avoid any embarrassment when discussing the condition. Yet there remains a large proportion of sufferers who avoid talking about incontinence, even with health professionals. Incontinence is surprisingly common and the Continence Foundation of Australia estimates that in Australia alone, more than 4.8 million people experience bladder or bowel control problems – out of a total population of about 23 million. That’s more than 20 per cent of the population who are affected. Incontinence is the term we use to describe a loss of control over bladder or bowel function. In most cases it is not regarded as life threatening but it certainly can be life alerting through the dramatic impact it has on the lives of sufferers. It is also important to be aware that incontinence can be a warning sign of some potentially more serious health problems so the advice of a health professional should be sought when the condition first makes its presence known. However, surveys of patients in GP waiting rooms, has shown that only 31 per cent of people with incontinence have sought advice and help from a health professional. Understanding exactly the nature of incontinence is the first step. Incontinence ranges in severity from what can be described as ‘a small leak' to what can be a complete loss of bladder or bowel control. However it is important to realise that with help it usually can be treated and managed, and in many cases it can also be cured. The condition manifests itself in different ways and some of the signs of poor or weak bladder and loss of urine control include:
• frequency – wanting to go to the toilet frequently • nocturia – waking up to go to the toilet more than twice at night • urgency – sudden urges to go to the toilet • involuntary or unintentional loss of urine from the bladder – wetting yourself or wetting the bed. Some of the factors which increase the risk of continence include menopause, pregnancy, childbirth, already having had children, being overweight, and suffering from urinary tract infections. Women are much more likely to be affected by incontinence than men, and the survey of patients in GP waiting rooms showed that 65 per cent of women and 30 per cent of men had some type of urinary incontinence. Not surprisingly, men are less likely to do anything about it. In men, incontinence can be related to prostate problems and related prostate gland enlargement is often the cause. About 60 per cent of men are affected by incontinence after prostate cancer surgery. Other medical conditions such as diabetes, obesity, constipation and chronic cough can cause or aggravate continence problems. Significantly, incontinence is not just an old and elderly person’s condition – it can happen to anyone at any age during their lives. Ageing does, however, play a big part. In addition, some age-related conditions including stroke, dementia, Parkinson’s disease or simply impaired mobility, can increase the risk of incontinence. For instance, research shows more than half of all residents in nursing homes—both men and women—have bladder control problems. Sufferers can help to reduce the impact of incontinence by following some simple steps and making lifestyle changes. Make sure you drink enough to stop becoming thirsty, but try to reduce your intake of drinks that have caffeine in them such as coffee, tea and some soft drinks. Also, limit your alcohol intake and don’t smoke. Keeping your weight at a healthy level is important, as is eating plenty of fruit, vegetables and grains. ■
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WITH ONE VOICE
SINGING PROGRAM AMPLIFIES ENERGY AND CONNECTS THE HEARTS OF SENIORS Creativity Australia’s With One Voice choir program has proven to be a powerful way to improve health, wellbeing and quality of life as people age. Inclusive With One Voice choirs are located at public venues and at residential centres including Benetas St Georges and Royal Freemasons Centennial Lodge. These programs break down the stereotypes of residential care by creating stronger connections between residents, staff, families and the general community. For the past two years at the Benetas St Georges Home in Altona Meadows residents have joined with family and the local community to sing. Residential Manager Justin McCarthy said, “It’s far more than just a choir. With One Voice truly provides the residents and members the opportunity to belong, connect, engage and express who they are.”
One resident in particular, Ms Walker, has relished having the opportunity to spend quality time with a special fellow choir member; her daughter, Jeanette. t’s no secret that Australia’s population is ageing. The proportion of people over 65 years is expected to increase from 14 per cent in 2011 to approximately 20 per cent in 2031.
Neuroscience shows that singing fires up the right temporal lobe of people’s brains, releasing endorphins and allowing neurotransmitters to connect in new and different ways, improving memory, language and concentration. When we sing with other people this effect is amplified. What has not been understood until recently is that singing in groups triggers the communal release of serotonin and oxytocin, the bonding hormone, and even synchronises our heart beats. Group singing can produce satisfying and therapeutic sensations even when the sound produced by the vocal instrument is not of high quality. So belonging to a choir is a great way to address isolation, boredom, anxiety, depression and even dementia. Creativity Australia is sharing the benefits of singing with many sectors of the community—including seniors—through its With One Voice program which operates community choirs in Victoria, New South Wales, the ACT and Queensland.
“Mum and I absolutely love singing in the With One Voice Altona Meadows choir,” Jeanette says. “We feel closer with other residents at Benetas St George’s and enjoy meeting and getting to know the members of the community who participate.” Recent Swinburne University research showed that 98 per cent of With One Voice participants experienced less stress; 91 per cent improved social bonds; and 66 per cent felt less depressed. Yet society has skewed views on the value of singing, leaving us with destructive criticism of our own voices. Singing is instinctual and necessary to our existence. You do not have to be an amazing singer to benefit from the basic biological and neuroscientific benefits and with practice, the benefits increase. When singing a song together, we become participants rather than observers of others. Singing gives us an opportunity to make ourselves really and truly present. No one has to be a perfect singer, or have the most beautiful voice, to be a part of a music group. As a well-known quotation reads: The woods would be very silent if only those birds sang who sing the best. With One Voice choirs are led by professional conductors and meet weekly for 75 minutes. A professional conductor leads the
HEALTH AND WELLBEING
group through warm ups and songs. Many participants in the aged care setting enjoy revisiting songs from their youth. During each rehearsal, Creativity Australia staff offer singers the chance to make and grant wishes for each other. Afterwards, supper is shared, which is an important time for singers to connect. The benefits of the With One Voice choirs are numerous: FEATURES
• weekly rehearsals
• engagement between residents, families, staff and general community
• professional conductors
• community interaction and inclusion
• songs everyone loves, with requests taken
• joy, laughter and unlocked memories
• no auditions or singing experience needed
• wellbeing, self-esteem and confidence
• support and promotion from With One Voice HQ
• opportunities to give back to others
• amazing performance opportunities
• improved immunity, blood flow, breathing, posture, neural pathways, brain plasticity and more
Each With One Voice program has a group of passionate and dedicated volunteers that support the choir. Volunteer roles include weekly check in, member support, finding and coordinating performance opportunities, promotions and fundraising. Volunteers not only get to help people in need, but also the chance to sing and perform too. Creativity Australia is offering a limited number of community’s seed funding to start their own With One Voice program. The With One Voice movement is about strengthening communities and inspiring individuals to find their voice. A With One Voice program is more than just singing with your local community choir. It is an opportunity to create real connections between the diverse people in your community. It is about reaching out to those who are experiencing disadvantage and encouraging the socially advantaged in our community to engage with, learn from and help these people. We have also commenced a Conductor Development Program. Find out more at creativityaustralia.org.au. ■ Tania de Jong AM is a soprano, social entrepreneur and founder of Creativity Australia and the With One Voice program, Sing for Good and Creative Universe.
• wishes made and granted
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HEALTH AND WELLBEING
FOSTERING CONNECTIONS BETWEEN
PALLIATIVE CARE, AGED CARE PROVIDERS AND SERVICE PROVIDERS IMPROVES END-OF-LIFE CARE PRACTISES
The Decision Assist Linkages project is improving understanding of service providers’ various roles and raising the quality of end-of-life care.
new cross-sectoral approach to improving end-oflife care outcomes for palliative care and aged care residents and their families is demonstrating a positive impact on decision making, policies and behaviour. Evaluation from the first phase of 20 demonstration projects across Australia conducted by the Queensland University of Technology (QUT) over the past 18 months has also shown higher use of ‘end-of-life care’ practices which include advance care planning, reduced hospital presentations at end of life, case conferences, and end-of-life care pathways. The Decision Assist Linkages project managed by QUT is part of the broader Decision Assist program funded by the Australian Government which aims to provide palliative care and advance care planning support to aged care workers and general practice workers. The linkages project aims at improving high-quality and wellcoordinated palliative care, teamwork, partnerships and cooperation across services and care providers. The project is already seeing innovative new practices emerging as a result of improved understanding of roles both internally within aged care organisations, and externally across the sectors of care provision. Now in its second phase, another 10 new project sites are developing their own new projects tailored specifically to improve end-of-life outcomes. They are linking with specialist palliative care teams, GPs and other relevant organisations in their regions or communities to develop stronger partnerships and understanding for improved care delivery. Each project site is receiving facilitation and supported mentoring from a linkages project coordinator for the duration of the project to help develop and continue their activities towards new system changes through seven evidence-based strategies. Project sites that take on one or more of these strategies are fostering stronger effective cross-sector linkages. The strategies include: communication pathways; role clarification; upskilling and education to increase knowledge; skills and confidence in
carers; formalised agreements; continuous improvement; and multi-disciplinary team approaches. One example is Nambucca Valley Care, on the New South Wales mid-north coast. The not-for-profit aged care facility has 192 residents. Nambucca Valley Care partnered with the Mid-North Coast Local Health District (MNCLHD) to achieve a number of objectives including to: develop improved linkages between aged care and palliative care settings; develop a palliative approach within the aged care setting; develop capacity of aged care staff in palliative approach and delivery; increase knowledge and confidence amongst staff; and develop the mentoring role for the palliative nurse to aid staff growth and development. Outcomes were numerous and substantial and comprised the development of a number of resources, including the ‘Palliative Approach to Care’ document on iCare (computerised resident management system), the Nambucca Valley Care screening tool to identify areas for improvement, the point of care ‘comfort care chart’, and the ‘End of Life Care Plan’ to cover all domains of care. Purple Palliative Care folders were also introduced (containing the comfort care chart) as a way of sharing information to families and carers. Shared care plans are available and are disseminated among partners and ambulance officers when required. GPs, allied health care staff, specialist palliative care, and ambulance staff were all consulted and involved in the development of system and care management changes. Families and residents were consulted, educated and kept informed through regular communication about the new organisational shift. Discussions around the language used about palliative care and end of life were interesting and informative providing clarification further for all parties involved including the resident and their families. New resources for families and staff were also provided using the Decision Assist and Care Search websites. The delivery of these resources was optimised through the appointment of the designated linkage nurse to Nambucca Valley Care who was able to provide a planned and coordinated approach to the change management process. The Palliative Care clinical nurse
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consultant mentored and supported the linkage nurse, with both nurses supporting clinical staff. Staff members at the Nambucca Valley Care facilities now have increased confidence to communicate the clinical status of residents to their GP and the GPs have gained a better insight into the palliative approach, which aids the timely prescription of comfort medications when needed. As both partners in this project were extremely committed, an extraordinary number of outcomes were achieved in a very short time frame. This linkage project illustrates the effectiveness of strong partnerships and is an example of what can be achieved when mutual objectives are openly and clearly described from the outset. Going forward, both partners are committed to embedding the palliative approach and it has become a standing agenda item on clinical and quality meetings. Feedback from family/carers post death will continue to be collected and incorporated as required. Nambucca Valley Care went from a non-existent relationship with specialist palliative care with limited access and resources to broad organisational and culture change. It grew to a point where palliative care is embraced, providing residents more choice in their lives with regular reviews and open discussions and having their wishes known. Nambucca Valley Care staff report that they are more confident in the care they are providing. They have effectively integrated their palliative care approach, including the emergency services and GPs. Nambucca Valley Care has become a leader in their region as a model of palliative care in an aged care facility using a proactive approach to palliative care and developing linkages. The overall outcomes from the phase one 20 projects have included: • increased access to palliative care for older people in residential aged care facilities and in the community
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FOR NEW ADVANCE CARE PLANNING AND PALLIATIVE CARE WEBSITES Digital e-learning resources spearhead new approach to on-the-ground practise for aged care workers.
dvance Care Planning Australia and Decision Assist have launched new websites that promote education and training for advance care planning and palliative care for aged care and health care workers.
The Advance Care Planning website (advancecareplanning.org.au) is the gateway to key advance care planning information including introduction to advance care planning, supporting resources about why advance care planning maters, eLearning modules and case studies. The site also features legal fact sheets and forms for all states and territories. It provides a range of factsheets in other languages.
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Meanwhile, Decision Assist has developed its website (decisionasssist.org.au) to focus on digial e-learning resources in advance care planning and palliative care for aged care and general practice. Resources include webinars and online learning modules, case studies, and videos, as well as links to other resources. The two websites share a common resource hub and a common news and events area to make finding information about
29/6/17 12:30 pm
HEALTH AND WELLBEING
advance care planning and palliative care easy, whether the user is an aged care worker, from general practice, health care, or family and friends.
Modules on the system so far include an introduction to advance care planning, advance care planning conversations, and advance care planning decision-making: the legal implications.
Dr Karen Detering, Medical Director of Advance Care Planning Australia and Decision Assist said the sites have been updated to make information easily accessible to people advising and assisting with advance care planning and palliative care.
‘We wanted to ensure the resources created specifically for aged care workers and general practice teams working with ageing Australians could be easily accessed; that they are maintained, reviewed, and remain available for as long as they are relevant to best practice,’ Dr Detering said.
‘Aged care and health care workers can have advance care planning conversations arise as part of their normal work, and our sites make it easy to find supporting resources for people to build their skills and knowledge to feel confident about these discussions, and access the necessary information to assist with the process,’ she said. ‘Advance Care Planning Australia and Decision Assist have been creating and gathering substantial resources and we wanted to build a cohesive, accessible website and learning management system to make everything easy to find.’ A new learning management system—learning. advancecareplanning.org.au—complements the two websites, and has also been jointly developed across the Advance Care Planning Australia and Decision Assist platforms.
‘These sites have been designed to make finding information, resources and education easy. We urge you to explore the site and send us feedback, so we can continue to make improvements,’ As the Decision Assist program draws to a close, the shared resource, news and events and learning management systems will enable Advance Care Planning Australia to ensure resources are maintained and kept up-to-date, or removed if the information becomes inaccurate with changes to practisce and policy. ■
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HEALTH AND WELLBEING
NEW DIGITAL HUB FEATURES
CONTEMPORARY PALLIATIVE CARE RESEARCH AND PRACTISE RESOURCES
TO GUIDE HEALTH PROFESSIONALS AND FAMILIES Online platform extends Australia’s international leadership role in developing tools to inform and educate on end-of-life care.
ealth professionals and family members are set to benefit from a new online platform that connects them with best evidence-based industry information and support for palliative care.
The palliAGED platform builds on Australia’s history of developing guidance to support palliative care in aged care settings. Australia was the first to develop guidelines for palliative care in residential aged care and for palliative care for older Australians in the community. The project’s lead researcher—Flinders University Associate Professor Jennifer Tieman—said palliAGED was an important new step in ensuring more people received the highest level of palliative care possible. ‘Aged care staff and health professionals will be able to find trustworthy information and resources that can guide their care,’ Professor Tieman said. ‘Families and older people can also find out more about what is likely to happen and how to find services and supports. Being online means they information is there when it is needed.’ The Australian Government Department of Health funded the project and Australian Minister for Aged Care, The Hon. Ken Wyatt AM, MP launched the new resource during Palliative Care Week in May. Speaking at the launch the Minister said, ‘The need for appropriate end-of-life care and palliative care support is important given that Australia’s population is both growing and ageing’. ‘The proportion of older Australians is expected to grow to 22 per cent or 8.7 million people by 2056 and to 24 per cent or 12.8 million by 2096. And more people will die due to chronic progressive diseases such as dementia. ‘The new palliAGED website is both timely and hugely beneficial because care for older people is becoming ever more important
as the older Australian population grows in number. We are seeing that Australians are living longer and healthier lives. When needed though, good palliative care provides comfort and compassion for patients and their families.’ The palliAGED platform also provides health professionals in community and residential practices with a range of information including palliative approach framework, advanced care planning, case conferencing and terminal care planning. It has tools to help families understand how things change as an older person moves towards death and highlights different types of relevant care. Minister Wyatt said that the evidence-based data palliAGED had assembled, the practical resources it offers, and the guidance it provides is valuable for consumers and their families. ‘And I believe that in the years to come, the palliAGED website will also prove of immense value to the range of professions across the palliative care sector, and to those they care for,’ he said. All palliAGED resources are free to use and available online, meaning that the evidence will be continually updated and there when you need it at www.palliaged.com.au. If you want to keep up to date with the latest palliative care news, evidence and information for aged care subscribe to the palliAGED newsletter or follow us on twitter @palliAGED. The CareSearch project team at Flinders University manages the website. ■
HEALTH AND WELLBEING
LASA UNITES WITH PEAK BODIES TO DEVELOP
PRINCIPLES FOR PALLIATIVE AND END-OF-LIFE CARE
In agreeing that palliative care must be core business for aged care providers, peak agencies take the lead on defining high quality service.
uiding principles on the delivery of palliative and endof-life care services in residential aged care have been agreed by LASA and other peak bodies representing aged care consumers and providers.
The principles reflect the need to recognise when an aged-care resident is approaching the end of life, in order to ensure their physical, emotional and spiritual needs are adequately assessed and met. They represent a shared commitment to ensuring that people who are approaching the end of their lives in residential aged care services have the best death possible and are able to live life to the fullest with dignity and comfort. The principles were developed collaboratively by Palliative Care Australia, Leading Aged Services Australia, COTA Australia, Alzheimer’s Australia, Aged & Community Services Australia and Catholic Health Australia. They draw on the National Consensus Statement: Essential Elements for Safe and High-Quality EndOf-Life Care, developed by the Australian Commission on Safety and Quality in Health Care. The principles were released at a parliamentary ‘lunchbox’ during National Palliative Care Week, which this year focused on aged care with the theme ‘You matter, your care matters. Palliative care can make a difference’.
The document, ‘Principles for Palliative and End-of-Life Care in Residential Aged Care’ is available at http://palliativecare.org.au/ policy-and-publications/position-statements/. It provides details to support each of the following eight principles: 1. C onsumers’ physical and mental needs at the end of life are assessed and recognised. 2. C onsumers, families and carers are involved in end-of-life planning and decision making. 3. Consumers receive equitable and timely access to appropriate end-of-life care within aged care facilities. 4. E nd-of-life care is holistic, integrated and delivered by appropriately trained and skilled staff. 5. T he end-of-life care needs of consumers with dementia or cognitive impairment are understood and met within residential aged care. 6. C onsumers, families and carers are treated with dignity and respect. 7. C onsumers have their spiritual, cultural and psychosocial needs respected and fulfilled. 8. F amilies, carers, staff and residents are supported in bereavement.
The joint authors acknowledged that palliative care must be core business for aged care, particularly as around 75 per cent of those aged 65 or older had used aged care services in the 12 months before their death.
Liz Callaghan said it is important that older people are supported to receive end-of-life care in the setting of their choice, and residential aged care services are home for many older Australians.
‘Despite these statistics, only around 1 in 25 people in residential aged care are formally assessed as requiring palliative care,’ said Liz Callaghan, CEO of Palliative Care Australia.
‘Ensuring the availability of high quality palliative and end-of-life care services in aged care facilities will enable them to have a good death and will also better support their families and carers during the dying and bereavement process,’ she said. ■
‘This highlights the importance of adequate residential aged care funding and for end-life-care to be considered a core competency for all aged care staff.’
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THOUGHTFUL DESIGN LEADS THE WAY
IN DE-INSTITUTIONALISING AGED CARE FACILITIES AND CREATING A HOME Future aged care buildings need to emphasise an inviting lifestyle as much as efficient care provision, says a leading architect who specialises in seniors’ living environments.
t is no secret that Australia has an ageing population. As the population’s median age increases, so too do the expectations of high-quality design, comfort and community living. The built environment now plays a vital role in the future of seniors’ living design – a future that doesn’t compromise lifestyle. When designing a seniors’ living project, we need to understand we are designing someone’s home – places we’d like to live in, want our families to live in, or places we’d like to visit. Too often, aged care environments provide emphasis on the efficiency of care provision to the detriment of occupant experience. These are not mutually exclusive – as architects, we must be able to provide an environment where technology, furnishing and materiality facilitate all care functions, while creating an environment that feels just like home. The latest education market research shows students value a sense of community and a feeling of belonging more than almost anything else when choosing a school or university. This is no different for seniors moving into aged care. Our proposed new aged care development in Ipswich, with Aspire Aged Care, indicates the growing need for high-quality design and community living. At the core of our design is a communal building, which connects to a series of elegant, domestic-scaled residential buildings. We’ve undertaken extensive research into dementia care, and have incorporated this into our design. An example includes landscape walks specifically designed for dementia sufferers, revolving around particular scents, colours and patterns.
The use of greenery is highly effective in seniors’ living and aged care. Patients with dementia often experience confusion in highly disorienting environments such as hospitals and aged care facilities. Effective landscape design creates a space that helps to reduce stress in these patients, and evoke a sense of serenity, calm and gentle engagement. Evidence-based dementia design emphasises the importance of wayfinding, simplicity and familiarity, and engaging the senses with colour, touch, texture, smell and sound. Studies show that images alone of greenery are proven to produce a soothing effect in stressful situations. Blood pressure, brain activity, respiration rate, and the production of stress hormones all decrease. The ability to integrate nature through gardens or views to gardens has been shown to reduce stress and improve the cohesion of mind, body, and spirit. Just as light and air quality, acoustics, temperature and access to views can mitigate stress in an internal environment, a carefully planned outdoor landscape can have a similar impact on our health and wellbeing. Nature not only provides a distraction from pain and discomfort, but offers respite from the competing stimuli in our increasingly technology-focused lives. We recently completed Caboolture GP Super Clinic, where we focused on the experience of the occupants and visitors using a Salutogenic approach – a method coined by professor of medical sociology, Aaron Antonovsky.
This approach promotes wellbeing in health care, and focuses on factors that support human health, rather than on factors that cause disease. This is equally relevant in aged care design.
Thoughtful design not only creates healing environments, but supports aged care and health care providers and operators with their long term investment strategies.
All waiting and circulation spaces at the Caboolture GP Super Clinic present views of the courtyard, offering an outlook to nature, light and activity. These are spaces conceived for human interaction, promoting concepts of health and wellbeing, as well as de-institutionalising what are often seen as clinical and alienating places.
Urban densification has also led to an increasing trend towards high-rise models for advanced aged care (including dementia). Many forward-thinking aged-care providers are already integrating seniors into inner-city and suburban centres. Our recent high-rise retirement village, The Henley on Broadwater, is an example of the progression to multigenerational living within cultural hubs.
Green spaces also work to reduce energy consumption, improve air quality and assist with storm water management. Meanwhile, landscaping and ponds can give staff a muchneeded refuge from the stress of clinical work.
Baby boomers will no longer tolerate residential care environments that mirror hospitals rather than homes. Rather, they seek aged care that will support them to live a normal life, and remain active within their communities.
Hamilton Wilson is the managing director of Wilson Architects.
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RESORT-STYLE LUXURY VERSUS THE COMFORTING FEELING OF HOME:
FUTURE CHALLENGES IN AGED CARE DESIGN
Ignoring evidence-based aged care design can have long-term implications for residents, carers and providers, warn design and construction experts.
ustralia is rapidly establishing itself as a source of building design inspiration in aged care settings. What has contributed to the ‘Australian way’ of aged care building design and what challenges require ongoing vigilance to ensure we remain innovative and fresh in our approach to design? Firstly, in this country there has been a two-fold and complementary process occurring – the dilution of the medical/ institutionalised model in building design, and a powerful shift towards a social model of care where the resident is front and centre. This has been driven of course, through the aged care reforms but also by a combination of highly informed clients/ families, innovative and courageous providers, and agile, knowledgeable design teams. Disturbingly, however, there remain remnants of an embedded, paternalistic approach in both design and service delivery, both of which have the potential to deny residents the positive, fulfilling lived experience that they are increasingly aware is their right. It also has the potential to lose your most valued staff – those who are creative, smart and seeking to march to the beat of a different drum. The recent findings (Ageing Agenda Jan–Feb 2017) of Linda Justin’s experience living as a resident was telling. Linda (Director of Practice and Quality, Uniting) chose to live in aged care facilities, experiencing exactly what residents experienced in order to understand residents’ quality of life and inform her organisation’s care model. She learnt that aged care services are about understanding life, as opposed to imposing health care routines. It is therefore incumbent on us all to continue to engage with residents regarding the design elements they favour, and understand how providers’ responsibilities can be appropriately located within this paradigm. While in some areas outmoded design (and care and service models) is perpetuated, in other areas we need to question
if the pendulum has swung too far the other way. The aged care landscape now includes facilities that resemble five-star resorts, where style looms over substance and where the subtle, comforting feeling of ‘home’ is missing. In these types of facilities, evidence-based design principles are diluted in favour of an actual or perceived market appeal so that some buildings achieve a ‘wow’ factor, but internal spaces are overwhelmingly large, and residents feel socially isolated. Elements such as shadows and light cast from sky tubes cause confusion, and a predominance of hard surfaces causes excessive noise and stress for residents. A provider’s business model may aim at attracting predominantly fee-paying consumers with higher personal assets and income bases, and their contemporary care design may focus on luxury and providing amenities usually attributed to a lifestyle retirement village. However, design decisions must be predicated on residents’ diminishing physical abilities and cognition, with this balanced against the provider’s vision for a luxury product. Anyone involved in new residential aged care or supported/ assisted development projects understands that design is a complex and often delicate balancing act. The design outcome is dependent on the interplay of many stakeholders, sometimes with competing agendas (owners, management/boards, carers/ nurses, hotel and maintenance teams, design team, financiers). Residents or their families are rarely consulted or included in design discussions and yet they unfailingly bring the detail of what constitutes comfort and security to the design table. While most with experience in designing new or refurbishment projects understand the significance of consultation and inclusiveness during design development, the art is in how the various strongly-held views are resolved into a single solution that provides a successful outcome and supportive environment for all parties.
The loudest voices during the design development process, while needing (demanding) to be heard, don’t necessarily carry the shared view of others or indeed have any carriage through evidence-based research. Having knowledge of, and respecting the enormous body of research-based design (which has very strong international consensus) is critical. If ignored, the longterm impact for residents, carers and the provider can be a bitter pill prescribed daily, for life. One of the refreshing and fundamental shifts in the mind set of some teams designing aged care communities in recent times has been challenging regulatory requirements and seeking alternative ways to achieve compliance which better support a more resident-focused outcome. This means that the process becomes one where prioritising the resident is first and foremost, and implementing the operational procedures that support an alternative compliance solution follows. In this way, the resident takes precedence and the regulatory framework becomes one of the many informative and important considerations, rather than THE driving force. It is often the combination of many alternative compliance solutions that
collectively improve the overall result. Examples are: deletion of corridor handrails, deletion of manual call points/break glass, significantly reduced exit signage requirements, removal of clinical hand wash basins in corridors, designing to negate the requirement for fire/smoke doors, deletion of requirement for people with disabilities-accessible rooms. We must remain vigilant in our ongoing interrogation and evaluation of the effect of the built environment (building design) on residents’ quality of life and how we can work with and respond to regulatory requirements. We must be the residents’ design champions and prevent the wrong compromises being made. We can do this by taking on the regulators, keeping informed about and influencing decisions using researchbased information, remaining current regarding the impact of industry related reforms, and understanding what it means to ‘walk a mile in the resident’s shoes’. This approach will inspire innovative, fresh, and informed design approaches. ■ Erica Lambert and Andrew Spilar are members of the Paynter Dixon (Queensland) design team.
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CELEBRATES FOUR DECADES OF CULTURALLY APPROPRIATE CARE Australia’s only Finnish aged care provider champions familiar traditions, food and language to aid clients’ wellbeing.
inncare is the only aged care organisation in Australia for people of Finnish descent. Many people are shocked when they discover that there is an aged care organisation providing residential aged care, in home services, day respite, wellness and reablement centre, and retirement village that has for Australia Finns. ‘Are there really that many Finns living in Australia?’ they ask. They are even more surprised to learn that these services have been around for more than 40 years.
In the 1950s and 1960s a great many Finns migrated to Australia as they had skills in construction, engineering and architecture. The Finns were instrumental in building some of Australia’s major infrastructure including the Snowy River system. Many settled in the Canberra area with their young families, assimilated well into the Australian way of life, and became Australian citizens. In the early 1970, two Finnish churches and the Finnish Club of Australia (which by then had outreaches in all major cities of Australia) came together to discuss the needs of their elderly and those who were starting to require care. Those that work in aged care know that people who come from non-English speaking backgrounds often revert back to their native tongue as their cognitive ability declines.
The organisation continues to thrive after four decades, and recently changed its trading name to Finncare to better reflect the full nature of the services provided. Finncare offers services options. These include: small aged care facility complete with a memory support unit; home care services across south-east Queensland; a small retirement village; a day respite program connecting elderly Finns with others of their heritage and providing traditional Finnish fare and fun; and a state-of-the-art wellness centre fitted out with the finest seniors’ gym equipment. There is also Helsinki University Research (HUR) Student House housing Finnish nursing, physiotherapy and lifestyle students who come to Australia to undertake a placement at Finlandia Village for three months. These students bring a little piece of home to the many Finnish elderly who live in Finncare facilities. Finland is famous as being the highest coffee drinkers per capita in the world and the Finlandia Village kitchen is famous for making Finnish delicacies such as Korvapuusti – a cinnamon scroll that goes well with coffee, or Karelian pies which are eaten throughout Finland, served warm with ‘egg butter’. These tasty treats cooked onsite daily can be purchased onsite at Poro Café (Poro means reindeer – after all Finland is the home of Santa Claus). ■
These dedicated groups commenced fundraising and looked for a suitable site on which they could build a retirement home for the Finns. Although preference was for the facility to be in either New South Wales or Victoria, land was made available in the eastern suburbs of Brisbane at Redland Bay. The first buildings were built with volunteer labour and donations. The organisation is called Australian Finnish Rest Home Association Inc and the property is known as Finlandia Village.
MEDICATION-RELATED ISSUES LINK TO OLDER PEOPLE’S
UNPLANNED HOSPITAL ADMISSIONS
The Pharmacy Guild of Australia urges the elderly to talk to community pharmacists about their medicines regimen.
iving longer is generally a good thing and thanks to medicines our quality of life when we are older is also improving. However, this has resulted in the oldest 10 per cent of the population using more than 20 per cent of all prescribed medicines. One reason for this is that as we get older we are more likely to have one or more health conditions, or multi-morbidities. According to joint-South Australian universities report, Multiple Chronic Health Conditions in Older People – Implications for Health Policy Planning, Practitioners and Patients, the occurrence of multi-morbidities is increasing and current estimates are that 40 per cent of Australian adults have three or more chronic conditions, a four-fold rise since the 1980s. This of course means we are taking more medicines to manage these illnesses. With this increased medicine usage comes a responsibility to take the medicines properly, and as we get older we have to be more careful about how we take our medicines. Medication-related problems can result in harm. Use of potentially inappropriate medicines is associated with increased hospitalisation, higher mean numbers of inpatient, outpatient and emergency department visits, poorer self-reported health, and death. Australian data suggests one-in-three unplanned hospital admissions in the older population are medication-related. Further, the increasing use of medicines associated with the increasing prevalence of chronic disease appears to be increasing the prevalence of medication-related problems. Many of the medication-related problems are preventable and a systematic review of adverse drug events in the community estimated 21 per cent were preventable. Studies of medicationrelated problems provide higher estimates of preventability, ranging from 40 per cent to 80 per cent. Studies of medication-related hospitalisations suggest between one-quarter and three-quarters may be preventable if appropriate primary care is received. Many of these studies have been highlighted in a literature review by the Australian Commission on Safety and Quality in Health Care. A key factor in helping to prevent some of these hospitalisations is for the elderly to talk to their community pharmacist about their medicines regimen and the medicines they are taking. There are a number of services that pharmacists can offer to help older people manage their medicines:
MedsCheck This is an in-pharmacy medicine review between a client, their carer (if the client wishes), and their pharmacist that is focused on education and self-management. The service is aimed to identify problems that clients may be experiencing with their medicines, help them learn more about their medicines, improve their effective use of medicines and provide education on how best to store their medicines.
Dose administration aid A dose administration aid (DAA) is a regularly-filled compartmentalised box used to aid the administration of medicines. The DAA is checked by the pharmacist who must comply with the relevant guidelines and standards.
Prescription reminder service A service that enables the pharmacy to contact clients, either via phone, SMS or email to remind them to have their prescriptions filled so they don’t run out of their medicines
Keep prescriptions safe A client’s local pharmacy can safely store their prescriptions and repeats, allowing a client to request their prescriptions be filled ahead of time and ready for them at the pharmacy to collect. The pharmacist can remind them to visit their doctor when they are due for a prescription renewal and manage their Safety Net and tax records. ■ Community pharmacists are among the most accessible of all healthcare professionals In Australia there are more than 5500 community pharmacies providing older Australians and their families with essential medicines and healthcare support, helping them remain well and active and able to live in their own home. They also provide essential pharmacy services to residential aged care facilities. Their services extend well beyond the provision of healthcare and include, among other services:
• providing aids and equipment to enhance independent living • delivery services to people in need • health screening and monitoring services • referrals to other allied healthcare professionals. The Australian Government funds a number of community pharmacy services that may benefit older Australians. These include: • home medicines reviews • residential medication management reviews • MedsCheck • diabetes MedsCheck
EMBRACING TECHNOLOGY TO EXPAND THE TRADITIONAL MODELS OF AGED CARE
A commitment to ‘over-the-horizon’ planning has helped one aged care provider break new ground in integrating new technologies with their service model.
new integrated technology model that has lifted staff efficiencies, sped up care responses, and reduced medication errors up to 90 per cent at a seniors’ living ‘resort style’ community has garnered multiple industry awards, including the ITAC 2016 award for Best Workforce Efficiency or Quality Improvement Solution. Good Shepherd Lodge (GSL) Mackay’s sister property, Kerrisdale Gardens opened in 2015. From the outset it was developed with a focus on ‘future proofing’ the technological landscape. GSL CEO Raelene Phillips engaged IT Integrity to assist with the project before the building plans were finalised which ensured that the company could examine the building design from an information and communications technology perspective. It meant that IT Integrity’s proposed roll out would support GSL’s aspirations now, but also provide a foundation infrastructure that would be sufficiently flexible and scalable to meet whatever needs may arise for years to come. “We wanted to ensure the facility had a technological foundation built to sustain the changes and advances in this industry which tends to rely on multiple solutions being integrated and fast connectivity,” Integrity CEO Scott Lawson said. This led to IT Integrity facilitating several workshops where board members, executive management and key stakeholders reviewed and discussed business goals, operational gaps and challenges and technologies that were currently in the market while also exploring potential future technologies and related strategies. The outcome of these sessions was a confirmed IT strategy and road map for both the existing business and the new Kerrisdale Gardens facility. The award-winning Kerrisdale Gardens complex in Mackay.
L to R: Rod Young – Chair of ITAC Organising Committee, Scott Lawton – CEO IT Integrity, Raelene Phillips – CEO Good Shepperd Lodge, Jimmy Arteaga and Erin Smolenski - IT Integrity and Graeme Wickenden –Chair of ITAC Awards.
With the foundation requirements agreed upon, IT Integrity constructed and commissioned a new server room, which included designing the infrastructure cabling for the new facility; managed implementation of new technologies such as IP nurse call, Vocera communication solution, new IP phone system, the medication management platform, and the paperless clinical care system, among others. Having a robust and reliable IP communications solution across each facility, GSL and Kerrisdale Gardens are able to operate under a single management team spread across the two sites. With the facilities just 11 kilometres apart, staff can contact any staff members despite being physically located in a different facility. This has enabled GSL and Kerrisdale Garden staff to work collaboratively in multiple scenarios. Aged care funding reforms and a transition to consumer directed care is challenging the traditional models of care delivery and related services throughout the industry. The Kerrisdale Gardens project has been marked as a huge success based on the feedback from the residents living at the facility. In addition, Kerrisdale Gardens has received numerous industry awards for the level of service and efficiency that is provided. It is a shining example of what is possible in the new world of integrated housing and is a model that embraces technology and expands beyond the traditional parameters of aged care. ■ Erin Smolenski is Marketing and Communications Coordinator at IT Integrity.
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AGE SERVICES MANAGEMENT
ATTRACTING YOUNG WORKERS TO AGED CARE: THE NEED TO FOCUS ON CULTURE, PURPOSE, AND IMPACT
With half of the current crop of aged care sector workers soon to reach retirement age, providers are being urged to model what the millennial worker seeks.
ot only is Australia experiencing an increasing demand on the services provided by the aged care sector, there is also a burgeoning workforce supply challenge. Because of the high median age of an employee in the aged care sector (49), half of the aged care workforce will be of retirement age in the next 15 years. There are 350,000 workers in the aged care sector (estimated in 2012), so this equates to an average of 11,667 retirements per year for the next 15 years
Attracting millennials to the aged care sector If we are to keep the current ratio of aged care workers to people aged over 85 we need to add 129,945 workers in the next decade. This equates to recruiting 1,083 new workers per month, in addition to replacing the 972 retiring staff per month. The millennial generation (also known as generation Y, born between the years of 1980 and 1994) are those who lived their formative years or began their careers in the new millennium. Millennials seek leadership involvement and career opportunities rather than job security and a stable work environment. What is important to this generation of emerging workers is CPI – culture, purpose and impact.
Culture The millennial generation is one that thrives on a healthy workplace culture. In addition to training, varied job content, an accessible management style and work/life balance, they seek a sense of community. Workplace cultures that are fun, inviting, inclusive, and provide a sense of community are valued highly by a generation who are delaying traditional life markers such as getting married and starting a family.
Purpose In addition to an engaging workplace culture, millennials are seeking places of employment where they resonate with
the values and purpose of that organisation. If the culture is the ‘how’, the purpose is the ‘why’. When millennials are looking for a job, it is about more than just the survival and security components (remuneration, employment conditions, superannuation, employment stability, worker entitlements, role description, tenure, and job security). The social aspects—such as opportunities for collaboration, social events, co-working spaces and team building—are even more important. What millennials consider most important when looking for a job are the ‘higher-order drivers’, such as the triple-bottom-line (people, profit and planet), volunteer days, organisational values, corporate giving programs, career pathways, further study, training and personal development). Rather than a fair day’s work for a fair day’s pay, millennials are hoping to make a difference with their employment. That is why they give consideration to an organisation’s purpose, and how that aligns with their own, when seeking employment opportunities.
Impact In addition to a positive workplace culture and aligning with the purpose of an organisation, millennials are looking for organisations where the impact of that organisation is measured, and where the millennials themselves can have an impact as well. Millennials want to contribute to something bigger than them. They want to be challenged in their work, make a contribution and then celebrate the wins. As the aged care sector seeks to attract, recruit and retain this emerging generation of employees, remember that millennials are looking for an engaging workplace, inspiring values which connect with their own, and employment opportunities where they can make a difference. In short they are looking for culture, purpose and impact. ■ Ashley Fell is Communications Team Leader at mccrindle social research.
JAPAN LEADING THE WAY IN MANAGING THE WORLD’S MOST RAPIDLY AGEING POPULATION
Delegates on a Studying and Advancing Global Eldercare (SAGE) tour of Japan have discovered the many lessons Australia must learn as its population creeps toward the ‘super-aged’ threshold.
t the turn of this century, Japan became one of the first nations to have a ‘super-aged’ society – where more than 20 per cent of the population is over 65. In the decade since, the nation has established new precedents to cope with an ageing population which is predicted to double again by 2060. The primary issues confronting Japan as its ‘super-aged’ society grows include a shortage of care workers, and a need to find new and improved ways to assist aged consumers. Australian delegates on a SAGE tour to Japan have discovered that the challenge of recruiting new hires has been tackled in many different ways by various aged care service providers. During a visit to the Sawa Honpo franchised day care service run by the Japan Care Welfare Group Company Ltd, they learned that owners are studying ways to tap into human resources overseas, primarily from Vietnam. Meanwhile, at the Zenkoukai Welfare Association’s facilities they found a group that is bucking the average Japanese industry staff turnover rate of around 30%, by keeping its turnover to around 20%. The association—which operates elderly care homes and facilities—has a number of initiatives designed to retain staff. Among them are staff recognition programs including annually choosing model staff against each of 10 code of conduct values (the credo) and rewarding them with an overseas study tour. Average annual wages at association facilities is higher than the industry average. Delegates visited a number of care facilities that are also using robots to aid staff in assisting and stimulating client care. The Elderly Rehabilitation Home Azalea features robotics such as the silhouette ‘minamori’ sensor watchover system which can detect behaviours such as getting up, off and out of the bed and relay sensor information to a central nursing monitoring station. Other robotic assistance includes the
Power Assist Hand (PAH) which the aged can use to pick up light objects, as well as aid in rehabilitation or to help with cognitive disorders. Azalea team members also help their clients to use the ‘cognibike’ dual-purpose ergometer which helps dementia sufferers by encouraging them to use their body to pedal, and their brain to complete memory tasks and exercises. At elderly care home Fuyoen, staff use PARO, an advanced interactive therapeutic robot designed to stimulate patients with cognitive disorders. The facility also uses Palro, a communication partner that plays with elderly people and is connected to the internet to provide news and information, and Katochan, a doll equipped with various sensors that reacts when you touch it. Meanwhile Japan continues to lead the world in applied research. At Shonan Robo Care Centre, delegates were privileged to learn about HAL®—a cyborg-type robot that helps improve, support and enhance a wearer’s bodily functions—which is available on a lease basis to care facilities and companies. Demonstrators showed how HAL® can be used for medical use, to assist people in walking, standing or sitting down; for living support by helping wearers move and exercise their joints; and for therapy to help patients with cerebral, nervous and muscle disorders. The people behind HAL® have also developed other systems to help the elderly including communication robots and robot-assisted walkers. Fujitsu too, is developing new data-
based technologies to aid elderly care. Among the devices delegates saw were sensor shoes where shoes can gather data on the wearer and may include strides, speed, pressure and others. Similar data could be provided through use of a beacon installed at an elderly person’s home that recognises the arrival of a health care provider and sends the occupant’s health data and activity logs to the provider’s tablet. At the National Rehabilitation Centre for Persons with Disabilities, delegates saw assistive technologies and systems that included a patient wheelchair with a cooling system designed for warm-weather use, and a voice recognition system for the speech impaired. The care robotics industry is expected to be worth around 35 billion yen by the end of the decade, and at Tokyo University, researchers are contributing to that growth by developing and supplying a new generation of muscle suits that give the wearer up to 30 kilograms of extra lifting power. Around 2500 suits have been sold up to March 2017, just 18 months after their market launch.
Delegates also learned that Japan is at the forefront of architectural innovation in elderly care when Tokyo University experts in gerontology and urban engineering spoke to them about the trinity for health and longevity including not only nutrition and physical activity, but social participation. The latter, they said, requires a re-imagining of community, where parks are not just designed for children, but the elderly, and where residences for the elderly are in central areas that mean they are part of buzz of life when they open their doors. The advantages of architecture and design in elderly care had already been demonstrated to delegates earlier in the tour when they visited the Reversible Destiny Lofts designed by Shusaku Arakawa and Madeline Gins. These apartments—which have been well-publicised—have different elements to provide sensory stimulation, including bumps in the floor, sloped ceilings and rings from which everyday items such as handbags and coats can be mounted and hung as art. The apartments are designed to make the body constantly reconfigure itself as it interfaces with the space, and in time, this can strengthen the immune system and sustain and extend life. ■
WHAT’S NEW TOILET SEAT SOLVES PROBLEMS FOR ARTHRITIS SUFFERERS The BIDET SHOP® customer Mabel suffers with arthritis and a painful back condition but has found a bidet has made the everyday task a much simpler. “It’s marvelous! I’ve always wanted a bidet in my bathroom and I wish I found it years ago!” Mabel said. ”The bidet simply replaced the existing toilet seat and automatically cleaned. The friendly staff explained that the bidet toilet seat has many health benefits as well as the comfort factors of a heated seat and other features” she said.
New Frontiers in Dementia Education Do you or your staff work with people living with dementia? In Australia there are more than 400,000 people living with dementia. Those working in aged care would be acutely aware of the growing incidence, and how the impacts are felt community wide. To improve the quality of dementia care through a skilled workforce and to address dementia literacy for formal and informal carers, the Wicking Dementia Research and Education Centre have created the Dementia Care Program. The program is fully online, offers part time or full time options and students can graduate with a Diploma (8 units), Associate Degree (16 units) or Bachelor of Dementia Care (24 units).
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The Wicking Centre is the global leader in dementia research and education and aims to prepare the aged care and health care sectors to address the needs of those living with dementia, whilst providing a qualification that equips graduates for opportunities in a range of career pathways. 2017 is the last opportunity to secure a full HECs/Tuition fee waiver (for Australian citizens and permanent residents) for the duration of the course*. Credit for previous study may be available. All welcome to apply. Semester 2 starts 17 July.
www.utas.edu.au/dementia-care. *see www.utas.edu.au/dementia-care for more information.
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South Pacific Laundry specialises in the provision of quality linen and supplies for the aged care industry.
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South Pacific Laundry (SPL) has been a provider of commercial laundry and linen services to the hospitality industry in Melbourne for the last 20 years.
Currently, the South Pacific Group is establishing a strong network of modern laundry across Victoria, New South Wales, Queensland, Western Australia and South Australia with plans for several more facilities up the East Coast of Australia in 2017. The relocation of our Sydney operations to a new larger facility in Bankstown together with the relocation of our Brunswick plant to Broadmeadows will establish South Pacific Laundry as the single largest privately owned laundry in Australia and in the Southern Hemisphere.
Contact Robert Teoh National PR & Marketing P: (03) 9388 5300 M: 0421 716 888 Coverage Australia wide
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Full Contact Information South Pacific Laundry 9-23 King William St Broadmeadows VIC 3047 P: (03) 9388 5300 F: (03) 9387 2399
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