June – July 2012 | Vol. 6 Issue 5
AGED-CARE & RETIREMENT
WE’VE GOT YOUR INDUSTRY COVERED I www.insitemagazine.co.nz
6 I FOCUS ON:
IN AGED CARE
25 I INTERVIEW
RESIDENT SPEAKS OUT:
WHEN DISABILITY HINDERS CHOICE 2 I NEWS
HUMAN RIGHTS COMMISSION REPORT CAUSES A STIR 27 I CONFERENCES
RVA AND NZACA CONFERENCE PREVIEWS
17 I EDUCATION & TRAINING
MORE THAN TREADING WATER
developed to meet the challenges presented by the increasing diversity of the elderly in terms of their care needs, preferences and affluence. It is critical that the aged care sector is able to meet these challenges in ways that promote the wellbeing of the oldest generation, while remaining cost effective for the community. Aged Care facilities will be under mounting pressure to manage more residents, with a decreased level of funding, on a per capita basis. Human resources costs will continue to rise, so the only option is to invest in technologies that can increase efficiency. Nurse Call is certainly one field, but equally so; community outreach programmes, telemedicine, IT Systems, Mr. Robert Grey Workflow management and mobile Chief Executive Officer technologies are all areas to embrace. Austco If an Aged Care provider is not investing obert Grey has been involved in into technologies to increase efficiencies Aged Care for a long time - last today, then they simply will not be year marked the 25th anniversary of competitive in the years to come. Austco, the company he founded in 1986. Which provides the best solution for an With 5,500 nursecall installations around aged care site; hardwired, structured the globe, it must have provided you a cabled, wireless or a hybrid approach very unique insight into the issues facing such as a medical dialer? aged care facilities worldwide - what are It entirely depends upon the application some of these issues? as differing levels of care (Nursing Homes, As New Zealand’s population continues Hostels and Retirement Villages) require to age, it will call for the provision different solutions. of services to much larger numbers In my opinion, a hardwired nurse call of people. Services will need to be solution still provides the highest level
Excellence in Emergency Call Systems
of reliability and the lowest cost option when considering the “whole of life” cost. What trends have you noticed in Nursecall, are there any leading edge technologies emerging ? Over the past 25 years that I have been involved in nurse call, I have never seen the rate of change like I have seen today. Like all technologies, there are ‘trends’ and ‘fads’ and trying to distinguish between the two is more of an art than a science. Integration continues to plays a pivotal role in more and more of our installations. Specifically, integration into Access Control, Fire Alarms and Security Systems is very commonplace. I suspect that community outreach programmes, dementia management and integration into resident databases will become increasingly important to be integrated into. On the flip side; I have seen companies create nurse call systems based on WiFi (802.11). I feel that this is more a fad than a trend. WiFi was developed to provide wireless internet and its utilization within a nurse call system, whilst novel, seems overly expensive and inheritably unreliable. I admire the technical ingenuity, I just harbour reservations over deploying solutions designed for Life & Safety over a wireless LAN.
Selecting a Nursecall system is a daunting task, with so many technologies involved how do you choose the right product and the right supplier? At Austco, we understand aged care. Over the past twenty five years, 5,500 healthcare facilities have chosen Austco as their trusted supplier. Our range of Nursecall Systems provide; • Compliance with the Australian/New Zealand Standards for “Alarm systems for the elderly” (AS2999) and “Patient Alarm Systems” (AS3811) • Comprehensive reporting for risk and cost reduction, as well as effective and efficient resource management
TING 25 Y E RA
Special: Nursecall Communications
• Enhances the care delivery process, improving resident satisfaction • Audio and Non Audio Nursecall Systems • A network of trained resellers able to provide local support and servicing ABOUT AUSTCO Austco is a wholly owned subsidiary of Azure Healthcare Limited, an international provider of healthcare communication and clinical workflow management solutions.
(09) 271 3712
AGED-CARE & RETIREMENT
www.insitemagazine.co.nz INsite Magazine Vol. 6 Issue 5 EDITOR: Jude Barback T: 07 575 8493 E: email@example.com ADVERTISING: Belle Hanrahan T: 04 915 9783 E: firstname.lastname@example.org PRODUCTION MANAGER: Barbara la Grange EDITOR-IN-CHIEF Shane Cummings GENERAL MANAGER/ PUBLISHER: Bronwen Wilkins SUBSCRIPTIONS: T: 04 471 1600 F: 04 471 1080 E: email@example.com PUBLISHER’S NOTE: © Copyright 2012. No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media (NZ) Ltd.
EDITORIAL & BUSINESS ADDRESS Level 1, Saatchi & Saatchi Building, 101-103 Courtenay Place, PO Box 200, Wellington 6140, New Zealand Ph (04) 471 1600 Fax (04) 471 1080 ISSN 1177-9268
In this issue... 6
Design and innovation in retirement villages: important considerations for operators as they expand
Which features do residents love and hate in their villas and apartments?
Dementia-friendly design features in the innovative new dementia units emerging around New Zealand.
MAX ROBINS of CHT shares his experiences of developing residential care facilities
CAROLINE BARTLE says dementia care training should enable progressive care that looks beyond just maintenance
Design for design’s sake?
INNOVATION STARTS HERE The aged care sector has been in the limelight these past few weeks. A report from the Human Rights Commission concerning the unfair and low levels of pay for aged care workers has grabbed the headlines, as has the Metlifecare merger deal and Ryman’s record profit. Careerforce and Health Ed Trust have worked through their differences and signed an agreement, which will no doubt be news well-received by the sector. We look at all these and more in an effort to keep you up to date. Don’t forget to check the INsite website for breaking news alerts. Beyond the news, we focus on design and innovation in this issue of INsite . There is so much happening in this area of aged care. In this issue, we consider the ‘renovate vs rebuild’ debate. We look at the emerging research and trends in dementia-friendly design. We take a nosey at brand new villages, rest homes, and hospitals. We ask what residents like and dislike about their villas and apartments. We explore the notions of future-proofing and sustainable design. We consider the importance of accessibility and features to aid people with disabilities. In this issue, we also hear from RVA’s John Collyns and Age Concern’s Ann Martin among others. We talk to the finalists of the INsite /RVA Manager of the Year award; the winner will be announced at the RVA conference in June – see you there! Our next issue will look at nutrition and diet in aged care. Any submissions or topics will gladly be considered. Jude Barback, Editor firstname.lastname@example.org
Snippets and updates from the industry
Which features do residents love and hate in their villas and apartments?
NEWS Snippets and updates from the industry
UP CLOSE AND PERSONAL WITH... the 2012 INsite/RVA Manager of the Year Finalists
ON THE SOAP-BOX... John Collyns
LET'S SNOOP AROUND... Bethlehem Views
SPOTLIGHT ON... flu vaccine for the elderly
RESIDENT CHITCHAT... with Alan Jamieson and Cathy Egan
CONFERENCE CORNER... including NZCCSS report, RVA and NZACA previews
FOR THE BOOKSHELF... Generational Intelligence
A TYPICAL DAY IN THE LIFE OF.... Ngarie Cowley
LAST WORD... Ann Martin
LET’S SNOOP AROUND... Bethlehem Views
www.insitemagazine.co.nz | June/July 2012 1
News NEWS IN BRIEF »» A REPORT BY the Human Rights Commission about unfair pay for aged care workers is met with concern from the sector. »» CAREERFORCE AND HEALTH ED TRUST have turned a corner, resolving their differences and signing a new agreement aimed to provide better training for the aged care sector. »» THE PROPOSED MERGER between Metlifecare, Vision Senior Living, and Private Life Care creates a village operator big enough to rival Ryman Healthcare. »» MEANWHILE, RYMAN ANNOUNCES record net profits and share prices soar as a result. »» IWI NGĀI TAHU has sold 10 million shares in Ryman Healthcare in preparation for Christchurch’s rebuild. »» AUSTRALIAN AGED CARE reforms include a AU$3.7 billion package aimed to keep older Australians in their homes longer and make the cost of care fairer. »» THE LAUNCH OF the new First, Do No Harm website is aimed to connect staff from multiple organisations to find ways of working together to minimise harm to patients during care.
HRC report causes a stir
A REPORT BY the Human Rights Commission about equal employment opportunities for the thousands of care workers in aged residential facilities and at home has created waves in the aged care sector. The report, which was leaked several weeks prior to its official release, describes the low rate of pay as an “indignity” that “can no longer be condoned”. It acknowledges many carers are working for barely above the minimum wage and proposes solutions to address the inequitable pay and conditions. Among these is a stepped increase in rates to achieve pay parity between support workers and hospital assistants. The Government funds aged care through District Health Boards (DHBs), which give money to hospitals and private providers. Martin Taylor, chief executive of the New Zealand Aged Care Association (NZACA), says the Government is not providing enough. “One of the reasons we have a low wage economy is because the funding that the Government gives is inherently low,” Taylor told ONE News . It is estimated $140 million a year will plug the gap between private and public providers. However, Prime Minister John Key said it is money the Government cannot afford. “I don’t think we’re in a position to meet that at this point, but we recognise there’s a disparity there,” says Key. The New Zealand Home Health Association (NZHHA) welcomes the report and also points to an urgent need to look at travel reimbursement, describing travel as “essential to
a service that supports people to live at home.” The NZHHA’s recent newsletter states that current DHB rates include only a fraction of travel reimbursement. According to the NZHHA, home support providers are having to make decisions to cut training, and then supervision, which they know will further undermine workforce retention and put the quality of services at risk. The NZHHA suggests a comprehensive review of the pricing and workforce model for home support is needed in the longer term. “In the short term, we can’t guarantee the sustainability of the services in several regions of New Zealand,” says chief executive, Julie Haggie.
It acknowledges many carers are working for barely above the minimum wage and proposes solutions to address the inequitable pay and conditions.
NGAI TĀHU SELLS RYMAN SHARES TO REBUILD CHRISTCHURCH Iwi Ngāi Tahu has sold 10 million shares in Ryman Healthcare in preparation for Christchurch’s rebuild. According to NBR ONLINE, Ngāi Tahu sold a two per cent stake of the retirement village developer and operator to generate $31.7 million. Following the sale, Ngai Tahu intends to reinvest elsewhere, including in the “agricultural sector and Christchurch residential section market”, according to Ngāi Tahu Holdings Corporation chief executive Greg Campbell. Campbell says the sale is also in line with the tribe’s strategic allocation framework, as due to Ryman’s increasing value, their portfolio was skewed towards the retirement market.
“We continue to be long-term investors in Ryman, of course, due to our high confidence in the company, board, and management,” says Campbell. Ngāi Tahu still owns approximately 30 million Ryman shares. Canterbury Employers’ Chamber of Commerce is backing the tribe to lead both housing and commercial property developments in the city’s recovery from the earthquakes. Chief executive Peter Townsend says Ngāi Tahu is a key player in property ownership and development in Christchurch. “They are well positioned to lead the rebuild of Christchurch both in housing and commercial property arenas.”
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June/July 2012 | www.insitemagazine.co.nz
Associate health minister, Jo Goodhew, says the Government will carefully consider the Human Rights Commission’s report on their inquiry into equal employment opportunities in aged care. Goodhew says many of the recommendations in the report are consistent with the current initiatives and directions already set by the Government, including the areas of training, safety standards, consumer information, auditing, and home-based support services. “The challenge for the Government is how best to balance the many competing demands for additional funding in the aged care sector as the population ages,” says Goodhew.
THE PROPOSED MERGER between retirement village operators, Metlifecare, Vision Senior Living, and Private Life Care has left the retirement village industry and investors buzzing. The parties have signed off on a deal whereby Vision shareholders will receive 21 million Metlifecare shares in exchange for 100 per cent of Vision Senior Living, which is currently 68 per cent owned by Goldman Sachs. Vision shareholders have also agreed to subscribe for 4.2million Metlifecare shares at $2.405 each, with the proceeds used to repay debt. Metlifecare investors, who include AMP, Fisher Funds, and Devon Funds Management, are reportedly surprised at the proposed deal and are said to be considering it. The merger has also received mixed reviews from other investment experts. Macquarie Equities Research analyst Stephen Ridgewell has described the deal as “a merger made in heaven”, while UBS analyst Wade Gardiner was more critical of the mounting levels of debt. The merger news comes after a major structural and ownership shake-up for Metlifecare last year, when the company raised just under $100 million from a share issue and placement and $40 million in fresh capital. The Retirement Village Group also sold down its stake from 82 per cent to 51 per cent. Retirement Village Group, which also owns 100 per cent of PLC, will exchange PLC for 30.5 million Metlifecare shares. Vision Senior Living general manager for sales and marketing, Aidan Craig, said the company’s decision to merge with NZX-listed Metlifecare, was one of a few potential directions under consideration. “The merger was one of a few strategies on the cards for Vision,” says Craig. Vision was last year touted as a possible initial public offer and share float. However, Craig confirms shareholders perceived the merger with Metlifecare to be the best option going forward. “Vision Senior Living has a very good synergy with Metlifecare,” says Craig. “There are really strong reasons for both parties to merge. Vision brings development expertise and a growth pipeline to the relationship, and Metlifecare brings grunt and stability.” Certainly, Metlifecare’s mature cash flows will enable both PLC and Vision to further expand their horizons. There will be opportunities for eventually merging aspects of the overall operation between the companies, but Craig says there is a strong desire from both parties to not make changes for changes sake as the villages are very successful in their own right. “One of the beauties of the merger is that the majority of our villages don’t directly compete with each other,” says Craig. Vision doesn’t foresee any competition with PLC villages either. Papamoa is the area where a Vision village is geographically close to a Metlifecare village, yet even in this instance, there are substantial differences between Metlifecare Bayswater and Vision Papamoa. One thing is certain, with their combined portfolios and skills, the merged operator will firmly cement themselves as one of the giants of the retirement village industry.
SURPRISE COLLABORATION BETWEEN CAREERFORCE AND HEALTH ED TRUST A LANDMARK agreement signed between industry training organisation (ITO) Careerforce and training provider Health Ed Trust (HET) comes as a welcome surprise following the fall out between the two parties earlier this year. Careerforce chief executive, Ray Lind, says the Memorandum of Understanding (MoU) will have widespread benefits for employers and trainees in the aged care sector. “We are delighted to have reached this agreement with Health Ed Trust,” says Lind. “Having a positive working relationship will create clarity and consistency in the sector, and it will promote and increase workforce training.” Careerforce is the ITO for the aged care, health, disability, and social services sectors. Health Ed Trust is a private training establishment, delivering education and training
arrangement because it puts focus on industry education rather than the separate activities of each organisation.” “Together, we can improve support for our ageing population,” says Lind. “Aged care workers have a big responsibility, and elderly people need quality care. Ensuring more of our workers have the skills they need to do their jobs well has huge health and safety implications. “Workers themselves gain skills, confidence, and qualifications. Their employers can be confident they are providing quality care for their clients.” The agreement takes effect immediately. Careerforce will register all the credits currently being held by HET. A transition plan is being developed and the new processes will take effect from 1 July 2012.
Together, we can improve support for our ageing population,” says Lind. “Aged-care workers have a big responsibility, and elderly people need quality care.
programmes predominantly to the aged residential care sector. Barriers to the working relationship between Careerforce and HET have spanned a number of years and came to a head a few months ago when HET announced its decision not to amalgamate with Careerforce. Those issues included misunderstandings about role differentiation and training provision, which has created some confusion in the sector. Careerforce and HET will now cooperatively support workplaces and trainees. “Employers will have our support and guidance,” says Lind. “They will also be able to access the services and benefits provided by both Careerforce and HET, regardless of which training resources they are utilising.” HET Chairman, John Ryder, says, “I am pleased with the new
The MoU specifies that Careerforce and HET will: »» work together to support learning and assessment in the workplace to build the capability and capacity of the aged care workforce, »» jointly support workplaces using ACE resources, clarifying respective roles, »» co-operate and communicate effectively and clearly, »» encourage employers to enrol their staff in the applicable national certificates, »» work with employers to establish training plans that align with Tertiary Education Commission rules, and »» ensure all employers can access the services and benefits provided by Careerforce and HET.
www.insitemagazine.co.nz | June/July 2012 3
Mixed reaction to Aussie aged care reforms THE AUSTRALIAN GOVERNMENT recently released a $3.7 billion package of aged care reforms called ‘Living Longer, Living Better’. Prime Minister Julia Gillard says the reforms will help keep older Australians in their homes longer and make the cost of care fairer. The package, which will only apply to new people entering care from 1 July, 2014, includes: »» home care assistance packages will be doubled from $59,876 to almost $100,000; »» home care and residential care fees will be capped at $60,000 for a person's lifetime; »» $660 million to provide more residential aged care facilities; »» $268 million to fight what the Government calls the nation's dementia epidemic;»» $1.2 billion to help employers improve working conditions for staff. “For too long, pensioners have had to subsidise those who are much better off than themselves,” says Gillard. “This recognises a simple reality that those who can support themselves and contribute a bit more, should, and that we must look after the needs of those who can't.” The reforms have been welcomed by many who work in the Australian aged care system. The (Australian) Aged Care Association spokesman, Rod Young, says it is desperately needed because of the enormous growth expected in the industry. “Our difficulty is that we have 300,000 workers at the moment in the industry. By
about 2030, we have to increase that number to about 600,000, and by 2045, numbers will increase by about another 200,000,” said Young. Martin Laverty from Catholic Care Australia says the changes will make the sector more sustainable. He says the package delivers on what aged care providers and consumers were looking for, but there is still a lot of work to be done. “The implementation council [the Government is] going to establish is going to have a lot of work to do to make sure that today's announcement actually leads to
For too long, pensioners have had to subsidise those who are much better off than themselves,” says Gillard.
improvement in quality for older Australians.” Back in New Zealand, the reforms have received a mixed review from New Zealand Aged Care Association (NZACA). Martin Taylor, chief executive of NZACA, points out that the $3.7 billion package comes from a $1.6 billion ‘redirection’ (a cumulative total over five years) away from the aged residential care market to the homecare market, which also receives an additional $880 million boost over five years.
FIRST DO NO HARM safer care together
First, Do No Harm campaign launches
he First, Do No Harm patient safety campaign has taken a step forward with the launch of its new website – www.firstdonoharm.org.nz. The campaign aims to share information and experiences between the age-related residential care sector, DHBs, and primary care across the Northern Region in the name of reducing
June/July 2012 | www.insitemagazine.co.nz
preventable patient harm. Under the Northern Region Health Plan, the First, Do No Harm and Health of Older People work streams will be working closely to help address important patient safety areas such as falls, pressure injuries, transfer of care, medication management, and reducing healthcare-acquired infections.
Taylor also notes these reforms were undertaken without a cost of care exercise, which makes the potential reductions in the care subsidy even more surprising. However, NZACA is pleased to see that the reforms have marginally improved the split between what residents and government pay, which should save an additional $378 million over five years. The association is also heartened by the increase to the accommodation supplement, which should encourage the building of new aged residential care beds. However, as Taylor points out, the new rate only applies to facilities built or significantly refurbished after April 2012. Taylor also praises the proposed $1.2 billion over four years to be spent improving wages and conditions of workers, although he questions the proposed methods of distribution to the workforce. NZACA will watch with interest to see whether the reforms will encourage more investment in the Australian aged care sector. Involving the aged care sector is considered a priority because of its lead role in caring for people who are at high risk of suffering major harm from falls. First, Do No Harm seeks to find ways of working together to minimise harm to patients during care and to connect staff from multiple organisations while fostering a new sense of regional cooperation. This will allow the sharing of experiences so the region can work and learn together while reducing duplication of effort and waste of limited resources. The campaign’s new website has been launched to raise the profile of patient safety activities being developed and to provide consistent information and messaging to staff. Signing up as a member of the site will allow access to secure discussion forums for the sharing of information and opinions. There is also the option of subscribing to regular e-newsletters that provide the latest news on First, Do No Harm initiatives. First, Do No Harm is part of the Northern Region Health Plan developed by the Northland, Waitemata, Auckland, and Counties Manukau DHBs, along with the National Māori PHO Coalition, Alliance Health +, and Greater Auckland Integrated Health Network. For further information, contact First, Do No Harm clinical lead Karen O’Keeffe: Karen.O’Keefe@northlanddhb.org.nz
HealtH ed trust and CareerforCe
Working togetHer to inCrease training in aged residential Care
RYMAN’S RECORD NET PROFITS RYMAN’S NET PROFIT before revaluations hit a record $84 million in the year to 31 March, with unrealised valuation gains lifting the reported profit after tax to $121 million. This is up 20.6 per cent on the last year’s results. As a result, Ryman’s shares have soared to their highest point in the last year, reaching $3.42, a jump of 5.2 per cent. A 4.5c per share dividend was announced, taking the total dividend for the year to 8.4c, which is up 17 per cent on last year. The results reflect Ryman’s rapid growth. In spite of challenges presented by the Christchurch earthquakes, the company has built 710 retirement units and aged care beds during the year – up 24 per cent on the previous year – and is well ahead of its target build rate of 550 units and beds per year. New villages were opened in Gisborne and Tauranga, and the operator is now looking to expand into Australia. “The lift in build rate reflected the significant investment we made in hospital and dementia facilities this year, and our decision to fast-track new Christchurch facilities post-earthquake,” said chairman David Kerr in a recent statement. Ryman is not the only player in the village industry experiencing growth. Metlifecare’s $216 million announcement to buy Private Life Care Holdings and Vision Senior Living indicates a bold move to challenge Ryman’s position in the market. The other village going from strength to strength is Summerset, which listed on the stock exchange just last year. Shares debuted at $1.45 per share. The company, like its bigger cousins on the NZX, is also reporting rapid growth and development. It has won best retirement village operator in Australasia for two years running. Is there room for another village operator on the stock exchange? Some investment banking sources say ‘no’, claiming that Ryman, Metlifecare, and Summerset fulfil investors’ needs, as collectively, they will be developing enough units to satisfy the current levels of demand.
ADVANCED AGE RESEARCH NEEDS SPONSOR RESEARCH UNDERWAY AT The University of Auckland is attracting attention after initial findings were recently released. ‘Life and Living in Advanced Age: a Cohort Study in New Zealand; Te Puwaitanga o Nga Tapuwae Kia Ora Tonu’ (LILAC study) aims to better understand the biological, social, health, mobility, and quality of life changes for both Māori and non-Māori in their eighties and older. The study involves just under 1000 participants in the Bay of Plenty region. Taking into account the growing ageing population, the study will determine whether the common instruments currently used for health and clinical assessments are appropriate and reliable in predicting and planning for future health, economic, and social services for those of advanced years. The results gathered so far reveal that 44.3 per cent of participants are male, over a third are still married or partnered, 44.5 per cent live alone, and only 3.3 per cent are in residential care. Almost a third are involved in voluntary work and 5.1 per cent are still employed. Almost all are taking prescribed medication, and 60 per cent are still driving. The research team, led by Professor Ngaire Kerse and Dr Lorna Dyall, is looking for sponsorship for their study. They claim there is currently little information available in New Zealand for appropriate planning for people in advanced age. Time is also of the essence. “Our participants cannot wait for HRC or government funding as at least 10 per cent die each year,” says Dyall.
a landmark agreement to work together to support training means employers can now access both Careerforce and Health ed trust resources, services and benefits to support their trainees to complete their national certificates. Employers can choose the resources their trainees will use, including the ACE Manuals, DVDs and assessments, or Careerforce workbooks and assessments or a combination of both.
tHere Will be tWo options option one Continue with the HET subscription-based model, with a payment of $95 + GST at the end of training. HET will arrange for the credits and National Certificates to be registered with NZQA
option tWo HET will also support the Careerforce model which has a $200 + GST fee upfront. On a quarterly basis Careerforce then pays employers $8 for every registered level 3 credit that meets the criteria. Careerforce registers the national certificate with NZQA.
trainees with credits held by Het will soon see their results, as Careerforce will register these credits for Het. Het and Careerforce staff will be in touch Het and Careerforce staff will be in touch soon
Ray Lind CEO Careerforce Juile Sparks GM Health Ed Trust
CONTACT US HET on 03 379 8519 Careerforce on 0800 277 486 www.insitemagazine.co.nz | June/July 2012 5
Only the best for the
baby boomers JUDE BARBACK looks at what is happening in design and innovation of New Zealand retirement villages.
any believe 1948 was the perfect year to be born. With their teenage years untrammelled by the threat of war and defined by an era of free love and Beatlemania, 1948 babies came to expect life to be somewhat rosier than those born a decade earlier. Leading the baby boomer generation, they bought their homes at a time when housing was cheap but set to sky-rocket, leaving them with plenty of money and an expectation for the good things in life. This year, 1948 babies turn 64. They are the next purchasers of retirement villas and their expectations are unlikely to wane now. With money in their pockets and discerning tastes, it comes as no surprise that the retirement village industry is growing. Statistics New Zealand estimates the number of New Zealanders aged 75 and over will more than double from 250,000 to 516,000 over the next twenty years. John Collyns, executive director of the Retirement Villages Association (RVA), says there are currently just over five per cent of people aged over 65 living in a retirement village. It is, as he puts it, a “boutique market”. However, RVA members are reportedly building units at a rate of five to six per cent each year, which given these recessionary times is a clear indication that retirement villages is a growth market.
UNDERSTANDING THE MARKET
Retirement village operators are faced with a demand to build more villas, but in an effort to remain competitive, must also meet demands for quality. Consequently, the architects and design companies working with village operators need to be well informed of what older people need and want in their accommodation. Lifetime Design Ltd, a not-for profit organisation established by CCS Disability Action and supported by the Government, is a design company that prides itself on knowing its market. General manager, Andrew Olsen, says it is important to understand the end-user. “Baby Boomers are the ‘me’ generation,” says Olsen. “They have spent their lives improving their world, they have high demands of their
In 1986, the first retirement village of Masonic Villages Trust was opened in Masterton. At the time of construction, space was allocated within the village for a residential care facility. However, the residents at the time, who were mainly in their mid- to late-sixties and in good health, declared they didn’t want such a facility on-site, such was their keenness to sustain a perception of long-term independence.
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Fast-forward 25 years and perceptions have changed. The sixty-somethings are now in their eighties and nineties, and the prospect of an aged care facility next door has much more appeal, as they begin to recognise their declining independence. Couples, particularly, were quick to see the merits of having a continuum of care in place for them. The trust set about acquiring an existing aged care provider in Masterton in order to meet the emerging demands of residents, as well as to stake out a larger presence in aged care with the district health board. As the acquired facility was over 100 years old, questions began to arise about whether it should be modernised or rebuilt on land purchased next to the retirement village. The residents and staff were overwhelmingly in favour of the latter, and consequently, construction began in 2008 for a new care facility next to the existing village. The new facility officially opened in June 2010. Choosing to rebuild gave the trust the opportunity to provide a range of different accommodation options. In addition to care rooms (all with ensuite bathrooms), six care suites, including kitchenette, lounge, and ensuite, were included in the design as well. Warick Dunn, who has been chief executive
of the trust since 2004, says as an existing provider, they were able to draw on their own experience when it came to the planning and design phases of the build. “We had a fairly good idea what intending residents wanted from a new care facility,” he says. A number of meetings with staff and architects also proved to be useful in informing practical design elements. It was from these meetings that important details were incorporated, such as allowing adequate room in the toilets and shower rooms for greater accessibility. Consultation with staff helped with the design of staff facilities, including rest rooms and common areas, ensuring they were well appointed, with plenty of storage space. A new-build approach also provided the opportunity to incorporate technological advances, such as ceiling-mounted hoists in some bathrooms. Dunn says the project went very smoothly. He puts this largely down to the decision to contract a project manager to oversee the build. The trust also refrained from making any adjustments during construction, which also helped to keep the project on time and on budget.
FOCUS environment, and often, more so than any other group, they have the means to make it happen.” “The ageing population is growing at an alarming rate, and as a large influential demographic, they will continue to seek innovative means to live out their retirements. This will provide the opportunity for niche developments that cater to very specific needs, from resort-type facilities through to lifestyle-specific communities,” says Olsen. He gives the example of Lifetime Care services, which are accessed in small communities of purpose-built, high-quality homes for people in search of an easier lifestyle or on-site support services. Lifetime Design is best known for Lifemark, its set of design standards used to help inform those involved with the provision of housing for New Zealand’s ageing population, such as architects, retirement village operators, developers, and homeowners. The Lifemark design standards, in adhering to the principles of accessibility, adaptability, usability, safety, and lifetime value, deliver what is needed by residents and village operators. Olsen believes Lifemark is making an important contribution to the way our lives are lived in the future. Taking into account the number of home injuries, which will only increase as the population ages, Olsen says changing the design standards of New Zealand’s housing stock will make a dramatic difference to the bottom line. Olsen says they encourage Lifemark design standards to be used by retirement village developers to ensure ease of use by residents at all stages and ages. This is just one way of ensuring the environment is safe to minimise trips, slips, and falls. The aim is to be able to care for an individual within a facility for the rest of their life. This is achieved by creating adaptable and accessible residences with features such as a level threshold, reinforced walls for support rails, and power points and light switches that can be easily reached. Lifemark standards look to exclude steps or provide alternative access if steps are necessary.
Factoring adaptability into design, or ‘future proofing’, is becoming an important consideration for architects. A recent survey of 2000 industry professionals found seven per cent of respondents were designing housing projects for the 50+ age group. Of these, 85 per cent are already including specific design features that will accommodate their clients as they age, in accordance with client requests. Bell Kelly Beaumont (BKB) Team Architects are among those who look to build flexibility into their designs in order to make them adaptable for future generations of the facilities. It is, after all, about looking forward to the next step in design, innovation, As the care facility was built at the very heart of the recession, Dunn says local trades people and suppliers were grateful to have their services enlisted in the build. There were very few other major building projects taking place at the time in the area. The end result has been the source of much praise from the wider community as well. Over 200 people attended an open day of the facility prior to its official opening, with much positive feedback emerging. Two years later, Dunn says the care facility enjoys good occupancy. While preference is given to village residents where possible, the facility is used by the wider community. Dunn says the care facility has increased the village’s competitiveness with another village in the area that also has a care facility. He is pleased the trust had the forethought to set aside money to develop the surrounding landscaped gardens, which are starting to come into their own. “We wouldn’t do anything differently,” he says. The trust’s good experience will allow it to use its Masterton care facility as a prototype for future upgrades to its other facilities.
and consumer expectations. Assuming no cost constraints, Warwick Bell, director of BKB, says bedrooms in a facility would be slightly larger – more in keeping with those in a modern house. There would be a separate lounge, possibly connected to another bedroom for a spouse or partner, and more outdoor space. There would be greater use of ‘green’ technology. BKB is exploring variations of the care-suite concept for several providers, encompassing a different style of unit for couples where one partner requires stage III care. Surprisingly, ‘future proofing’ is a cost-effective option for retirement village operators. Olsen says it has been proven that incorporating the Lifemark design dtandards saves money in the long term, as occupants are able to live out their full lives in the residence because it has been built to adapt to any stage and age.
With money in their pockets and discerning tastes, it comes as no surprise that the retirement village industry is growing.
From a commercial perspective, looking beyond ‘best practice’ to ‘next practice’ is a powerful marketing tool for village operators. The Summerset Group, which has entered a three-year deal with Lifemark, believes that being the first retirement village operator in New Zealand to use the Lifemark design standards in their developments gives them a competitive advantage. Summerset residents appear to be appreciative of efforts made to future proof their homes, as they acknowledge that their mobility may decrease as they get older. “If I need to adapt things, it’s not going to take much to do it,” says resident Dianne. “Should I need to go into a walker or a wheelchair, it already provides access for that. There is room in the hallway to turn,” says Helen, another resident. Summerset chief executive, Norah Barlow, also credits Lifemark for providing functionality without sacrificing aesthetics. “It made something not look like it was built for disability; it made it look like it was built for living,” says Barlow of the Lifetime Design.
IMPORTANCE OF A CARE FACILITY
The presence of an aged care facility in a retirement village is increasingly becoming a ‘must have’ for people considering the long-term possibilities of their retirement accommodation. >>
Northbridge, a not-for-profit retirement complex comprising village, serviced apartments, rest home, and hospital was built some 35 years ago. Its ethos, according to director of Northbridge Lifecare Trust, Heather Dixon, is “to provide affordable housing and nursing to average New Zealanders”. However, affordable needn’t mean outdated, so when Northbridge began to look a little “tired”, Dixon said they set about upgrading the facilities. Renovations on the rest home began four years ago, and in 2010, the hospital followed suit. Dixon said she and fellow staff members put themselves in the proverbial shoes of their patients and decided they would want single bedrooms with ensuite bathrooms. Informal discussions with residents and their families confirmed this notion. The hospital was expanded in size but the number of beds remained approximately the same, thereby increasing the space and quality of life for each individual. Northbridge’s community facilities were the next to receive attention, with the lounge,
restaurant, library, and administration area receiving a complete overhaul. Such renovations are rather rare for not-for-profit organisations. Dixon says Northbridge’s charity status means it isn’t taxed, allowing the profits to be put back into the facility. “We thought it was time to give something back to the residents,” says Dixon. Boasting waiting lists for up to 14 years for two-bed apartments, Northbridge is a successful village. Dixon says no scrimping was required for construction of the community facilities. A gallery connects the administration area to a vast modern lounge, equipped to handle every one of the 220 residents for a function. The library is a beautiful space, fitted with a double-sided gas fire to provide ambience and warmth to library users and the people playing snooker on the other side. The revamped Cafe 45 is a popular spot that capitalises on the views overlooking Auckland city. A barbecue area is enjoyed on warmer days. The new community facilities, which officially opened 30 March this year, took just under a year to be completed. Staff and residents coped extremely well with the upheaval, and the vast majority are thrilled with the result.
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.code. Architectural Design Consultants Code Design have over 30 years experience in design of Retirement living, Geriatric and Respite care facilities We offer Master Planning, Design Development Detailed Construction Documentation Project Administration.
<< continued from page 7 Investment experts are certainly witnessing this trend. Jeremy Simpson, director of Forsyth Barr’s research, says a retirement model that is integrated with aged healthcare is going to become really important and drive the need for the product as people won’t want to move again to gain access to highquality care. Indeed, many operators are now offering the full continuum of accommodation and care, from independent retirement living options to assisted living in serviced apartments, to rest home, hospital, and dementia care. Tauranga’s Bob Owens Retirement Village, one of Ryman Healthcare’s newest additions, is a perfect example of a new village that wants for nothing. Many village operators, who have not previously felt the need for an aged care facility within their retirement villages, are now reconsidering. Masonic Villages Trust is one such operator. Masonic’s decision to build a new care facility on land next to their Masterton village (see side article) came after their residents – who had initially rejected the idea – began to see the need for a care facility on site, as they started to acknowledge their waning health and independence.
NEW BUILD OR RENOVATE? John Latimer
Principal Directors With a variety of projects constructed and proposed we offer Innovation in modern Design for Geriatric Care and Retirement Living in a changing and challenging industry.
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Whitianga Village Project 275 TI RAKAU DRIVE - EAST TAMAKI. BOX 38 589 - HOWICK - AUCKLAND 2145 T. 0064 09 273 9712 F. 0064 09 273 9719. E. email@example.com
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With a new build comes the benefit of a blank canvas. Compromise is usually dictated by budget but rarely by architectural design. Consumer preferences for things like ensuite bathrooms, accessibility needs such as adequate room to manoeuvre chairs and walkers in bathrooms, modern technologies, and plenty of space for staff can all be incorporated into a new design. A new build allows designers to adopt best practice according to modern research. Aspects such as lighting and colour are often subject to the scrutiny of architectural researchers. Victoria’s Centre for Building Performance Research recently produced an interesting student project that surveyed the adequacy of light levels in homes for the elderly. Director, Michael Donn, says the project grew from the suspicions voiced by an external optometrist supervisor that New Zealand’s building code minima are adequate for people in the prime of their lives but insufficient for people suffering from the normal yellowing of the eye with age. He proposed the law was making people think they were incapable of reading and seeing clearly because it specified lighting levels sufficient for the nursing staff to read but insufficient for the people in their care. More challenges are usually presented when existing care facilities need to be updated. In such a renovation project, design elements often need to work in with the idiosyncrasies of the building. However, a renovation project allows the benefit of knowing what has and has not worked well in the past for serving the particular needs of their residents. Northbridge retirement complex in Auckland (see side article) recently updated its 35-year-old facilities, including its hospital. The main objective with the hospital alteration was to create more space and privacy for residents – again, in order to reflect their changing preferences and expectations. The renovation also gave the opportunity to better accommodate staff needs – such as more space in shower rooms and toilets for greater manoeuvrability when helping patients were welcome addition. Presbyterian Support Central (PSC) Enliven’s Chalmers rest home and hospital on New Plymouth’s waterfront was another where the decision was made to rebuild. Nicola Turner, general manager of PSC Enliven services, says the decision to rebuild on the existing site was not an easy one. After exploring alternative sites, considering the funding issues and many years of discussion, the decision was finally made to redevelop the existing building. The Eden Alternative model – a shift away from institutionalised, routinedriven care to a resident-centred philosophy where residents “call the shots” – was adopted for the project. This approach saw the disappearance of long, institutional corridors, multi-bedded rooms, and communal bathrooms, and in their place, seven 12-bed ‘cottages’ – each with their own kitchen/lounge/ dining space. Following the Eden model has come at the expense of features from other models. For example, some staff requests – like for nursing stations – have not been taken up as they were considered part of the medical model. Other issues that cropped up were due to budget constraints and adherence to building and fire regulations, which saw the initial design revised several times. Turner says it was also a “nightmare” for architects and the construction firm having the residents still on site, but moving residents out for redevelopment was not feasible. The residents took a keen interest in the build, with peepholes at wheelchair height allowing them the opportunity to watch the work in progress.
WHAT DO RESIDENTS WANT?
Canvassing opinion on design features from residents in a variety of villages revealed some interesting insights. Room by room, residents give an idea of what they like, what they don’t, and what would be good to have. BEDROOMS
A resident with mild mobility issues appreciates the layout of her villa, especially at night. With the journey from bedroom to bathroom, she has three doorways at arm’s length from each other, so she is able to hold one and take a few steps, grasp the second, and proceed until able to grasp the third – feeling safe in doing so.
Light switches or emergency buttons that are too far to reach from the bed.
Ideally, an emergency alarm should be situated 450mm (18”) from the floor for easy access.
Access into the ceiling needs to be in a hallway or garage – not the wardrobe.
A resident likes that the living area is spacious. It is more important than spaciousness in the bedroom.
One village has all its villas facing the sun, so that on one side of a street, the villas have patios facing the street, while the other side has the villas facing “out back” to catch the sun.
Long windows with fasteners near floor level in apartments can affect balance for older people.
Good lighting would prevent tripping over reading lamps with cords.
There should be level, flat access for entry to unit.
Unit should be positioned to achieve maximum sun in living areas.
Round door handles are not good for arthritic hands.
Under-bench drawers are preferable to cupboards. Boxed-in, overhead cupboards are preferable to “open” cupboards. The kitchen pantry, with doors and shelves above-bench height, but with drawers for storage below-bench height. Above kitchen cupboards are fluorescent tube lights, giving a soft glow and sufficient light to make cups of tea by. Can’t access back of corner cupboards. Corner cupboards should have “lazy Susan” revolving shelves. Both floor-level cupboards and overhead/high cupboards are not accessible.
Hand-held shower heads allow for assistance in showering when needed.
Shower head with three spray options is appreciated – especially for the option of two strong jets of water, with the shower hand-held and directed on toes – good for post-op as no bending!
Three-way ceiling heater/light/exhaust fan appreciated.
Common complaint that toilets in the villas, apartments, and common areas of retirement villages are too low for older people.
Vanity cupboard should not be under hand basin – alongside is better, especially for those in wheelchairs.
Handrails in shower and beside toilet are required.
There should be sufficient space in bathrooms to allow easy transfer to toilet from wheelchair.
There should be level floor access into the shower for wheelchair/bath chair.
Recognising that people enter retirement villages and drive cars for a number of years but subsequently give up driving, garages attached to villas should have carpet, windows, and the sectional, remote-controlled garage doors insulated. This allows the garage to be used as an extra living room, hobby room, or temporary extra bedroom.
Internal-access garages has insufficient room to manoeuvre the car in and for driver and passenger to alight inside garage.
Residents considered it poor planning to have ambulance (and furniture mover) access to apartments through common areas, as it is humiliating for the patient and can be upsetting for other residents in the vicinity. It would be traumatic for all concerned should cardiac arrest occur and resuscitation be required.
Some taps are not ideal for arthritic hands. Kitchen workbench is too deep for shorter people to reach the back of the bench.
Swivel taps in bathroom appreciated.
Power points accessible to sink for use of blenders or beaters.
Microwaves at bench height for safety.
Better acoustics in common areas are needed to absorb noise for village functions – not everyone is deaf!
Deeper kitchen drawers for larger/heavier items to be stored.
Several different rooms or areas to allow different activities simultaneously.
Two waste bins fitted in one drawer under sink bench.
Light fittings needed to illuminate stove hob, oven, sink bench.
The comments are from residents (who did not wish to be identified) at Hamilton’s Alandale, Hilda Ross, Tamahere Eventide Village, and Vision Forest Lake, Tauranga’s Bethlehem Country Club, and New Plymouth’s Telford Village.
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Dementia-friendly design JUDE BARBACK considers the research behind an innovative, virtual, dementia-friendly home and talks to architect, Warwick Bell of BKB Team Architects, about applying the research to New Zealand dementia units.
s I ‘walk’ through the rooms of the virtual home online, I am blown away by the number of features that could potentially make life easier for someone with dementia. I am also struck by the sheer simplicity of some of these features. There are clocks with symbols for night or day, shower controls that are easy to use, drawers labelled with text and images, fish tanks to provide an alternative focus to television, and many more.
The virtual home design online guide, launched in March this year, is a Scottish initiative, based at the University of Stirling’s Dementia Services Development Centre (DSDC), created by Edinburgh architects firm Burnett Pollock Associates and funded by the Nominet Trust. By
CASE STUDY: TUARANGI REST HOME AND HOSPITAL Tuarangi rest home and hospital, in Ashburton, has re-opened its doors after extensive expansion and redevelopment. Associate Minister of Health Hon Jo Goodhew and Canterbury District Health Board (CDHB) chief executive David Meates officially re-opened the rest home in late April. The new and improved facilities now offer more options for patients requiring dementia care. Originally built as ‘Tuarangi Old Men’s Home’ in 1902, the rest home previously provided only hospital and specialised psychogeriatric (Dementia /D6) hospital care for the elderly. However, the Twigger Wing, which provides secure hospital-level dementia care, was described by Meates as “less than ideal” and required significant refurbishment to bring
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its online nature, it is able to inform people all around the world on how design can help those with dementia. The designs hinge on the premise that people with dementia need buildings that do not cause them unnecessary disability. In the same way a building should compensate for the needs of someone in a wheelchair with ramps, lifts, and space for turning, a building should compensate for the impairments of someone with dementia in its design. What makes dementia-friendly design challenging is that no two dementia sufferers are the same, differing in age, type and degree of impairment, attitude, and background. Those with dementia can experience sensory, mobility, or cognitive impairments, and sometimes a combination of these, which can affect functioning, behaviour, independence, and ultimately, quality of life. In addition to the virtual home, the Stirling DSDC offers pointers to those aiming to create a dementia-friendly environment, stemming from its research. Given the many differences between people with dementia, the suggestion is to design communal areas to cater for the most impaired residents, which means they will be suitable for everyone. In order to take into account the different interests of residents, the lounge of a dementia unit should ideally make it possible for people
it up to standard. CDHB made the decision to demolish and replace the Twigger Wing, deeming this to be the most cost-effective and beneficial option for patients and staff. The redevelopment project also saw the addition of the new Moule Wing, giving the rest home an additional 10 beds to provide secure rest home-level care for dementia patients. Thanks to the extensive refurbishment and the additional beds of the Moule Wing, Tuarangi rest home has been transformed into a modern 37-bed facility, that, as Meates says, will allow more people to access dementia and hospitallevel care in their own community. The lower level dementia (D3) care now catered for at Tuarangi is certainly a welcome addition for mid-Canterbury. “The expansion will avoid the need for people with dementia requiring rest home level of care to move away from the district for long-term residential care,” says Meates. The Havelock Wing, which provides hospitallevel rest home care to all other residents has also been refurbished and upgraded. Construction began in August 2010 and
to do different activities, whether it be to sit and read, do jigsaws, or watch television, and so on. If people with dementia are going to feel confident in any space, that space has to tell them what is expected of them. Stirling’s virtual home is, therefore, just one example of how a dementia-friendly environment would look. However, it does present a comprehensive inventory of design features that would aid people, whatever their type and stage of dementia. The virtual home is aimed to keep people safe from falls, give them confidence to use their abilities to the fullest extent, aid their memory in day-to-day living, and reinforce personal identity. Hovering over each design feature included in the virtual rooms reveals the rationale behind its presence or positioning. It is suggested for the wardrobe, for example, that it should have an open or non-reflective glazed section to allow visibility of clothes. The door should include a free swing-door closer to allow for easy opening. Clicking on the ensuite toilet reveals that it should be positioned so that it can be seen from the bed. Lighting is a key component, featuring in every room of the virtual home. The Stirling research shows that poor lighting can increase anxiety and may lead to falls if people cannot make sense of what is ahead of them. Age is a key factor in the deterioration of
proceeded well, with the Moule Wing occupied in March 2011. However, the Christchurch earthquake in February 2011 brought the project to a halt. The decision was made to postpone the demolishing of the old Twigger Wing in case it was needed to house displaced patients from Christchurch. The extra beds weren’t needed after all, and construction restarted in May 2011. The old Twigger Wing was demolished and a new wing built in its place, reaching completion in mid-December 2011. The more minor refurbishment work was then carried out on the Havelock Wing. The project was finished in March 2012. The Tuarangi home redevelopment was a collaborative effort, a “true community project,” according to Meates. “Not only did the Ashburton community identify the need for these upgrades, but they also came up with the nearly $5 million needed for the redevelopment,” says Meates. The end result is a modern, stylish, and comfortable rest home and hospital, offering high-quality and comprehensive dementia care to the people of Ashburton.
eyesight. Research shows that by the time people are about 75 years old, they need twice as much light as normal lighting standards recommend in order to see satisfactorily. Older people with dementia are further disadvantaged as the ability of the brain affected by dementia to process visual signals is greatly diminished. Ideally, care environments should deliver higher light levels than ‘normal’. Reflection and contrast, as important factors of vision, should be carefully considered. Sudden changes in lighting levels should be avoided, as should glare from lights. Diffuse lighting helps faces seem less aggressive than spotlighting. ‘Domestic’ style lighting creates a homely feel. Greater contrast, although contested by some, is said to draw attention to something important. The virtual home suggests a coloured and contrasting toilet seat to help with positioning and a contrasting strip along stair rails. The opposite effect can be achieved by lowering the contrast. Safer floorings can be achieved by keeping to a single colour over different floor finishes, or making changes in the floor colour gradually rather than suddenly. It is the sudden contrast that can make the floor levels look uneven, like a step, and this can cause hesitation and unsteadiness, which can lead to falls. Patterns are best avoided in flooring as they also confuse the eye. Shiny finishes can look unsafe; matte flooring is preferable.
What makes dementiafriendly design challenging is that no two dementia sufferers are the same, differing in age, type and degree of impairment, attitude, and background.
A change in floor colour, appearing as a step, is a common perceptual problem, typical of those experienced by people with Alzheimer’s disease. Disorientation and bewilderment often result from perceptual problems, which are often exacerbated by other sensory impairments. Adjusting to a new space can be difficult for a person with dementia as it relies on memory and learning.
PUTTING RESEARCH INTO PRACTICE
The Stirling DSDC is, of course, just one group informing design solutions for the residences of people with dementia. Similar research communities are dotted around the globe. Warwick Bell, director of Bell Kelly Beaumont (BKB) Team Architects in New Zealand, says that keeping abreast of architectural design in general is being aware of new projects, both nationally and internationally. While the firm prides itself on adhering to current best practice for aged care facilities, Bell says there are few projects and even fewer publications regarding dementia care buildings specifically. What research and information is available is taken carefully into account. Bell agrees that >>
CASE STUDY: ST JOSEPH’S HOME OF COMPASSION, SILVERSTREAM, UPPER HUTT
he Home of Compassion’s new 16-bed dementia care unit has attracted much praise for its design, winning the 2010 NZACA/INsite Excellence in Care Awards and a Resene Colour Award. As a stand-alone unit, it has provided an opportunity to put into practice the most recent advances in stage III dementia care. The staff at the home, in consultation with the architects, Bell Kelly Beaumont (BKB)(featured above), have strived for an environment that, while contained and secure, has as many familiar home elements as possible. Pitched roofs, familiar window shapes, and the use of a residential gutter profile around the internal courtyard help enhance the concept of residential familiarity. The material selection, including cedar weatherboards, clear-finished plywood, and timber-look vinyl helps provide a feeling of warmth, as well as being robust and suitable for high-wear areas. Warwick Bell, director of BKB, stresses the importance of creating a homely environment akin to what they have been brought up in. While it had to be viable, Theresa McGlynn, the home’s manager, says they were keen to achieve a “more homely feel”, and therefore, they opted for 16, rather than 20, beds. These beds are in high demand; some people have been on the waiting list since 2010. “We certainly don’t have a problem with occupancy,” says McGlynn. With easy circulation routes, plenty of natural light and ventilation, and good access to contained outdoor spaces, the dementia unit ticks many of the boxes of best practice dementia-friendly design. Circulation routes have been kept wide and continuous to avoid dead-ends, where residents could become confused. ‘Bus stops’, small seating areas along the way, have been included to allow residents to enjoy a view or
an activity. The views over the adjoining St Patrick’s College playing fields, towards the Hutt River, are played to their best advantage from many different points within the facility. The all-important security aspect has been incorporated unobtrusively. A monitoring system, the latest nurse-call technology, and sensors on the doors and windows all help staff to monitor the comfort and safety of residents. When a resident gets out of bed at night, motion sensors turn the bathroom lights on to remind them of why they woke up, and a further link will alert the staff to where the activity is taking place. Colours have been used carefully throughout the unit, creating cues for familiarity throughout the building. For example, all bathroom doors are the same colour. The use of earthy colour tones creates a calming environment for residents and ties in with the strong use of natural materials within the project. Sustainable design has been a major consideration throughout the development of the project. Site planning, material selections, equipment and services have all been aligned with the applicable green rating standards. Residents and their families are pleased with the new unit. “It’s a real little community there,” says McGlynn. “The abundance of natural light and the outlook make the unit a very welcoming environment to live in and visit.” Staff are thrilled with the end result as well. The rec officers and nursing staff were unanimous in that they wouldn’t change a thing. It isn’t surprising that staff are pleased – they were included in the early stages of the design process. McGlynn says they had a lot of useful feedback from staff. “We displayed the plans for the unit in our entrance way, so that families could also see the design and have their say,” she says.
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FOCUS << continued from page 11 features highlighted by the Stirling DSDC and others, such as lighting, colour, accessibility, communal areas, orientation, and signage, are all important to consider in the design of a new dementia unit. However, care is taken where there is conflicting evidence about certain features. Bell says contrast is one area that they treat cautiously as it can be both a positive and negative. Bell agrees that achieving a homely feel to a unit while adhering to security features is a balancing act. “The décor and fabric of the facility can be made to be homely so it comes down to the entry and exit from the secure area – that has to be discreetly handled and not made to feel as if it is containment.” In virtually all projects, most features can be accommodated with good component design, regardless of the funds available for the project, says Bell. Internal courtyards may be excluded on a particularly tight budget, as such plans are less efficient per square metre. Sustainable features, which typically come at a higher price, are also more likely to be deleted from plans. Each project differs according to the operator’s preferences. Bell says the first step is generally to establish a clear brief that captures the operator’s spatial requirements as well as the overall character desired. “We use our expertise to encourage the brief to reflect what we consider to be best practice. Then we attempt to develop a concept design that achieves the brief. It is important during that process to challenge both our and the operator’s expectations of what the unit could be by thinking ‘outside the square’. Only then can we be sure the most appropriate design for the unit has been established,” says Bell. Bell believes designs should always be innovative but not at the expense of meeting the brief. “One should always remember with design for this age group that one needs to create a homely environment in line with the home environments they have been brought up in. Not all have experienced flash city apartments or international-style architecture – probably over 80 per cent of residents are comfortable in their suburban weatherboard house,” says Bell. BKB also get involved with sourcing materials for their designs. Bell says material and product specification comes from much experience and knowing what works and what does not in aged care facilities. “We have a philosophy that our clients should not be the first to try a new product unless it is very obviously a good one. Trialling products can often result in remedial issues further on in the life of the facility.” BKB aim to future-proof their designs. “Most facilities will have a minimum life of 30 years, which is dealing with at least two generations of occupants, so providing flexibility in use for different care types is most important,” says Bell. More information about the Dementia Services Development Centre based at University of Stirling can be found at http://dementia.stir.ac.uk 12
June/July 2012 | www.insitemagazine.co.nz
CASE STUDY: DUNCAN LODGE, SPROTT HOUSE, WELLINGTON Sprott House’s new dementia unit, Duncan Lodge, has been described as ‘state of the art’. Prior to commissioning the unit, the general manager of Sprott House at the time, the architects, Opus Architecture, and a board member went to Australia on a fact-finding mission. The trip proved very beneficial, as they discovered what worked – and what did not – in Australian dementia units. The team also considered extant literature on dementia care to ensure Duncan Lodge would be relevant to the needs of their potential clientele. This research helped inform decisions on many aspects of the new unit. For instance, black toilet seats were chosen for the unit as these were thought to be better than white seats for people with dementia. After initially intending to include a ‘blokes’ shed’, a common addition in dementia units, they decided not to, after finding that the Australian experience was that these were not used. Residents are actively encouraged to personalise their rooms, all of which have ensuites. One family member of a resident is appreciative of the approach taken at Duncan Lodge. “The modern fixtures and fittings allow easy cleaning, but it’s nice that the environment is softened by knick knacks etc. and that the Lodge’s rooms can be personalised, allowing individuality while still being safe.” General manager of Sprott House, Chris Sanders, says Sprott House has actively moved away from a ‘medical’ view of dementia care and is looking more to lifestyle planning to support their residents, using the Spark of Life approach. In keeping with this philosophy, Duncan Lodge is managed by Lisa Cooke, an occupational therapist. Cooke says her role, as unit manager, is to support staff in the delivery of quality care to residents with dementia, focussing on aspects of the Spark of Life approach. She says they aim to provide person-centred care that promotes choice, independence, and increased self-esteem at every opportunity. Cooke believes it is essential to have a good working relationship with families in order to offer support when required and to assist in the planning of care for their loved one. “Our new lifestyle plans have been very successful with families, as they focus on maintaining a resident’s skills and participation in activities of daily living, including personal tasks, domestic tasks, and leisure interests,” says Cooke. One of the registered nurses at Duncan Lodge says it is easy to build rapport
with residents by utilising information from the lifestyle plan that focuses on individual needs. She also stresses the importance of good communication with families to maintain quality of care. One of the caregivers says that it has been an interesting experience settling into the new dementia unit: “I have got to admit not every day is smooth sailing. We have our bad and sad moments. Now that I’ve settled in this unit, the staff and residents have become one big family.” By all accounts, residents’ families appear very happy with the care that Cooke and her team are providing for residents. One resident’s family member says they were attracted to Duncan Lodge because of the commitment to the Spark of Life programme, as it encourages a care programme based on residents’ individual interests, needs, and reactions rather than expecting behaviour to be a certain way and to conform to institutional routines and requirements. “I greatly appreciate the good care provided for, and respect shown to, my mum by the staff. While for some residents the sense of confinement can’t be avoided completely, the unit’s good level of natural light and garden access hopefully helps. Plus, for those who are walkers, the corridor loop enables uninterrupted roaming.” Indeed, it is often difficult to achieve homeliness when the security aspect is such an important component of dementia care. However, Sanders agrees the security aspect is not a limiting factor. The unit was built so that ‘dead ends’ were minimised; ‘walkers’ have a roundel around which they can walk – or they can walk in a figure of eight using the pavilion so that they do not necessarily have to tread the same path all the time. Sprott House is in the process of developing the outside area of the unit into an area that is relevant for residents to enjoy. Part of this plan will involve a sensory garden with flat access, no obstructions, and raised vegetable and flower beds.
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POINTERS AND PITFALLS:
Lessons learned from developing care facilities MAX ROBINS shares his experiences of developing the residential care facilities of Christian Healthcare Trust.
Left: Royal Oak Court Reception Area at centre of a hub with 4 wings radiating out from reception. Middle: Typical bedroom at Royal oak Court. Right: Royal Oak Vegetable and Flower Garden
hristian Healthcare Trust (CHT), a charitable trust registered under the Charities Act 2005, was established in 1962 to provide residential care for older people and to buy the 35-bed St John’s Hospital. The trust progressively built or bought hospitals and rest homes in Auckland and flats and houses throughout Auckland, Nelson, and Dunedin. By the late 1990s, many of CHT’s facilities were run-down and in need of redevelopment. The trust commenced its redevelopment programme where it started: at St John’s Hospital. A completely innovative design was deployed. The existing building was demolished, and in its place, a new hospital erected – its 40 beds comprising eight separate suites, each with its own lounge, dining area, and kitchenette. After St John’s Hospital was opened, a strategic plan was developed to determine how the trust’s entire portfolio could be modernised. The key components of that strategy were: »» to be a long term provider of residential aged care in Auckland »» to own and operate our facilities »» to sell flats and houses to free up capital for re-investment »» to rebuild or upgrade all existing facilities »» to establish a template for future “standardised” design »» to achieve maximum design flexibility to enable alternate uses »» to design to accommodate small communities of 6 to 10 people with easy access to interior and exterior spaces »» to seek to achieve economies of scale »» to minimise loss of capacity during development »» to obtain a return on investment above the trust’s hurdle rate »» to minimise long term costs of ownership. In order to implement this strategy, Octa Associates project managers were commissioned to complete a high-level study of all sites to establish potential capacity, a logical sequence for development, and indicative budgets. The plan guided us through our redevelopment programme and the underlying principles of the plan have been used as the trust acquired new facilities and subsequently modernised or added capacity to those sites.
A DECADE OF DEVELOPMENT
Following the initial rebuild of St John’s Hospital in 1999, an extra 30 hospital beds were added in 2003. The same year, CHT demolished and rebuilt the 40-bed Royal Oak Court Rest Home. In 2005, the trust built the 50-bed St Margaret’s Hospital to replace the old hospital building, which was then redeveloped the following year to create 20 dementia and 17 rest home beds. Also during 2006, CHT replaced 14
June/July 2012 | www.insitemagazine.co.nz
the old Hillcrest Hospital with a new 40-bed hospital, which was then extended with an additional 20-bed dementia unit three years later. Last year, Hillcrest’s dementia unit was altered so that five double rooms became 10 single rooms. In 2009, one of the trust’s major development projects took place: a complete rebuild of the interior of Lansdowne Hospital and Rest Home, which had been acquired four years earlier, transforming it into a 55-bed hospital and 40-bed rest home. The same year, CHT purchased Waiuku Estuary Village and Onewa Lodge rest home. Both facilities were subsequently redeveloped in the following years to include more hospital-level beds. The most recent development project on the cards for this year is the addition of 20 hospital-level beds to Amberlea, a 50-bed rest home purchased two years ago. CHT has learned much from its many redevelopment projects. Two, in particular, emerge as telling case studies.
ROYAL OAK COURT REST HOME
The planning for Royal Oak Court commenced in the offices of Klein, the architects selected for the project. The design process progressed from the inside, starting with bathrooms, and then bedrooms, to get the room sizes right. A mock-up room was established with moveable walls so that various rooms, door sizes, angles, and entry points could be tested. Clinical staff members were brought in to simulate showering and toileting residents to determine the required sizes and relationships between spaces and the optimal location for toilets, basins, hand rails, shower heads, and nurse call points. The site was very constrained and the trust had to compromise by sharing ensuites between two residents. However, many other design features were included. The trust was, for example, able to maintain its unique design with clusters of bedrooms around residents’ own dining room, lounge, and kitchenette. Future proofing was a key feature of the design, to enable the home to be used as a hospital in the future. This was achieved in a number of ways, such as making provisions for centralised dining for rest home residents, but allowing for decentralised dining for hospital residents. Cabling was also installed to suit future data requirements. Nurse call systems were integrated with fire, security, and resident alarm systems. The main focus of the design was on making the facility homely and pleasant by providing spacious rooms with large window spaces and ranch
FOCUS slider access to the gardens, suitable lighting, heating to provide an ambient temperature, effective and attractive wall protection, and durable floor coverings. Royal Oak Court was developed with operational efficiency in mind.
INITIAL AND FINAL BED CONFIGURATIONS AT LANSDOWNE Initial Configuration Hospital
Final Configuration Total
4 beds per room
3 beds per room
2 beds per room
1 bed per room
Bed multiples were carefully considered to ensure efficient rostering – for example, multiples of 10 beds in blocks of 20 beds. Ultimately, the redeveloped rest home had to fulfil the strategic objective of minimising the long-term cost of ownership. Royal Oak Court has run very successfully since it was opened, with average occupancies of 99 per cent and above. CHT uses Press Ganey Australia and New Zealand to conduct customer and employee satisfaction surveys for all of its sites. Approximately 300 facilities are surveyed by Press Ganey, and in the last four years, Royal Oak Court has scored at the 98th or 99th percentile for customer satisfaction on that survey. Royal Oak was awarded four years’ certification in 2007 and 2011.
RENOVATE OR REBUILD?
It is a difficult decision to determine whether it is better to refit an existing building or to completely rebuild the facility. A refit will inevitably involve compromises, but a rebuild is obviously more expensive. However, if the refit is comprehensive and involves moving walls, interior plumbing, and services, then the cost difference narrows. CHT has encountered a number of problems with some of its renovation projects. A major concern can be that not all structural deficits can be foreseen before the project commences. It is, therefore, necessary to have a suitable contingency sum budgeted to deal with the unexpected. For example, CHT found significant discrepancies between as-built plans for the old facility and the actual construction. There may also be a number of modifications since the initial construction of the building, which will add considerable complexity to the extant building services’ layout and operation. Removing and relocating walls can uncover things such as uneven floors and ceilings or poor alignment of walls and doors, revealing the poor quality of the original workmanship. Another issue is often that the desired new layout will not fit neatly inside the shell of the old layout, resulting in redundant or sub-optimal spaces. The capacity and location of existing services may also create problems for a different design. As experienced with the Lansdowne project, a construction project will have an enormous impact on day-to-day operations of the facility. Similarly, sequencing a project around an operating facility can disrupt the workflow between trades during construction. From the many projects it has completed since it rebuilt St John’s Hospital in 1999, CHT has gained huge experience and expertise in new-build and redevelopment work. The trust will apply its expanding knowledge to new projects in the future and continues to learn what works well and what does not. Max Robins is chief executive of CHT.
LANSDOWNE HOSPITAL AND REST HOME
When CHT acquired Lansdowne, it was very run-down and had many multi-bedded rooms. The site was constrained, with no room to add additional capacity. The main focus of this project was to replace all multi-bedded rooms with individual rooms, although like Royal Oak Court, site constraints meant some ensuites had to be shared. This project was very complex. CHT maintained a fully functioning hospital and rest home throughout the construction period. The project was broken up into a number of discrete stages. There were many challenges, including maintaining water, electricity, fire services, sewerage systems, heating, telephone data lines, and nurse call systems. Despite this complexity, high occupancy was maintained throughout the project. The site started with a nominal 114 beds – although multi-bedded rooms had low occupancy – and after redevelopment, ended with 95 beds.
OCCUPIED BEDS DURING LANSDOWNE REDEVELOPMENT PROJECT
In addition to converting the multi-bedded rooms at Lansdowne into individual rooms, the project also saw the hospital organised into three communities. Courtyards were rejuvenated and an open, welcoming reception area was added. Effective storage for equipment and consumables was also included. Simple shaping of the walls helped to break up sharp angles and minimise the institutional feel.
Lansdowne Hospital and Rest Home
CHT’S TOP 12 TIPS FOR A SUCCESSFUL PROJECT
1. Top level commitment to the project is required at Board, CEO, and senior management levels. 2. A clearly defined strategy and requirements specifications are needed before engaging consultants to begin planning. 3. A well-defined project structure and decision-making processes should be established. 4. The opportunity cost of involving senior and facility managers in the project should be taken into account. 5. High level of trust and effective working relationships is needed between clients at senior and facility manager level, project manager, architect, engineers, and contractor. 6. Detailed planning must be used throughout the project. 7. Consideration should be given to construction phasing during the design process of any redevelopment project. 8. Redevelopment projects need a much higher contingency budget than new-build projects. 9. Extensive and continuous communication with staff, residents, and families is required throughout the project. 10. Budgets should be based on rational assessment of costs to meet requirements. 11. Allow slack in timescale for delays in consent processes. 12. Involve users in design process. www.insitemagazine.co.nz | June/July 2012 15
Workshops to improve the SAFETY of older road users The New Zealand Transport Agency (NZTA) has a free Staying Safe online toolkit – a suite of older driver education resources to help improve road safety for people over 70 years of age. NZTA’S NETWORK USER Behaviour Manager, Jennie Gianotti, says the Staying Safe course content and supporting material is designed to help organisations provide classroom-based road safety refresher workshops for senior road users. “The Staying Safe guidelines and supporting materials are available to any organisation that wishes to provide a refresher workshop for senior road users. Aged-care and retirement organisations may find benefits in delivering courses to members of their community.” One of the Staying Safe workshop modules covers ‘Intersections and give way rules’ including the two new ones that came into force in March this year. But workshops don’t just have to be about driving. The facilitator can pick and choose from 16 modules. Some of the units that aren’t driving focused include ‘safe alternatives to driving’, ‘walking safely’, and ‘using a mobility scooter safely’. The modules fit comfortably with other activities that groups of older people may
take part in. For example, they are fun and interactive so would fit comfortably within a health and recreation programme, or they can be used to promote participants’ communication and analytical skills. More information for organisations interested in running workshops is available at www.nzta.govt.nz/traffic/senior-road-users/ staying-safe.html. A dedicated online section designed for use by individual older drivers is also available. It provides interactive activities and information to help older drivers improve safety for themselves. “For many older people driving is a key to their independence, and many seniors rely on their car to get around – for shopping, appointments, or visiting friends and family. These resources are designed to help people maintain that independence while also staying safe on the road.” While older drivers don’t have as many crashes as younger drivers, if they do crash
they are more at risk of being seriously injured or killed. This is due to increasing physical fragility. Gianotti said it was important for all drivers, regardless of age, to regularly and honestly assess their own driving capabilities to keep themselves and others safe. “It is important to remember that the ageing process can affect a range of skills essential to driving – including eyesight, memory, decision making and reaction times.”
a refresher workshop for senior road users
Do you want people over the age of 70 to be mobile for as long as possible? Are you interested in improving the road safety of senior road users? If you answered yes to these questions, your organisation may be interested in delivering the Staying Safe refresher workshop for senior road users. Staying Safe is a classroom-based refresher workshop that aims to maintain and improve safe driving practices and increase knowledge of other transport options available to help senior road users remain mobile for as long as possible. For more about delivering Staying Safe workshops, please see www.nzta.govt.nz/traffic/senior-road-users
June/July 2012 | www.insitemagazine.co.nz
EDUCATION & TRAINING
More than treading water CAROLINE BARTLE says dementia care training should enable people to provide care that is progressive and not just about maintenance.
here are over 43,000 people with dementia in New Zealand, and this number is growing. The Dementia Economic Impact Report carried out in 2008 estimated that the economic cost of this was about $712 million per year. This, the largest economic impact study of its kind, informed the development of the dementia strategy – a definitive strategy identifying dementia as a major health priority. The Minister of Health, Hon Tony Ryall, describes the situation as the ‘tsunami of dementia’ and calls for an urgent and strategic response to this national crisis. Within the dementia strategy, there is a clear focus in developing services in a way that will minimise the economic impact of dementia. For example, it aims to invest research into identifying sustainable community care options and develop best practice in dementia care. However, the two are interdependent. In order to achieve a sustainable community care option, the focus has to be on ways to embrace best practice. This will enable people who have dementia to reach their optimum level of functioning through the application of new skills according to best practice.
HOW IS THIS TO BE ACHIEVED?
Should we, as professionals, be thinking in a very different way about dementia? Is it time to start thinking practically about what can be done to sustain abilities, enhance well-being, and
improve longevity in people with dementia? We have come a long way since Tom Kitwood introduced concepts of personcentred care. However, many organisations still struggle to define this in a way that can be clearly explained and replicated. As a concept, it is all-encompassing, as it incorporates a wide range of ideologies, adding to its complexity. Developing this into a sense of something meaningful continues to be a challenge for many service providers, as it is more than systems and techniques and has a value base that provides the context for therapeutic relationships. The VIPS model, as established by Dawn Brooker, provides a useful framework for understanding person-centred care in practice: Values, Individuality, Perspective, and Social Environment. This model highlights the importance of understanding perspectives of the person with dementia, having a real understanding of how changes in memory impact on orientation, self-image, and selfidentity. All these factors play a part in the way the individual interacts with the social environment, as understanding the nature of self is central to wellbeing. The VIPS model also highlights the role of the social environment in the wellbeing of a person with dementia. These perspectives are the foundations of psychosocial interventions that are gaining ground in the area of dementia care, and now sit firmly alongside medical
interventions as valid techniques. Taken together, this is known as a bio-psychosocial framework. The reality for many service providers is that they struggle to make room for this type of intervention in their day-to-day routines. For many, it is easy to dismiss these interventions, considering such activities as requiring a high level of skills, perhaps leading them to consider such activities as being more the domain of the psychologist or occupational therapist. In progressive organisations, diversional therapists and activities organisers are tasked with meeting the social needs of an individual in a focused way. In these organisations, they acknowledge that the role of providing dedicated individuals to deliver activities is, in part, a psychosocial intervention.
IS THIS ENOUGH?
Shouldn’t all caregivers be actively practising this, embedding such activities in their daily tasks? Arguments about an inability to practise in this way as a result of time and resources are not always credible. There is a convincing argument about the quality of the intervention being more paramount than the amount of time available to meet social needs. It’s about doing what is possible within the context of a limited health and social care budget. The challenge is finding ways of embedding these practices into >> the role of the front line staff. www.insitemagazine.co.nz | June/July 2012 17
EDUCATION & TRAINING
This is where a real impact is seen, as consistency is an essential requirement to aid the challenges faced by memory impairment. Inconsistent, ad hoc approaches are unlikely to have a measurable impact. Dementia Care Mapping, which originated from the University of Bradford, is able to identify the impact of positive interventions on the individual. This observational tool is a powerful agent for change and has been developed to observe the impact of the social environment on a person with dementia. These observations can identify the amount of time spent on meaningful activities engaging a person with dementia. Often, the observation indicates that a minimal amount of time is spent meeting important psychological and social needs. The United Kingdom’s Home from Home report,
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June/July 2012 | www.insitemagazine.co.nz
carried out by the Alzheimer’s Society, identified that as little as ten minutes per day were spent in meaningful interaction, over and above basic care tasks. Over the last few years, there has been an explosion in the range of psychosocial interventions, such as music therapy, art therapy, dance therapy, life story work, and reminiscence. Alongside these, there has been a growing body of evidence for the role of rehabilitative approaches to dementia care, particularly as these appear to sit comfortably with political agendas in reducing the economic impact of dementia. There has been much written about how psychological states impact on brain pathology. When individuals are provided with a positive psychosocial environment, ‘rementia’ can take place, increasing wellbeing and skills. The brain has the ability to adapt, which is sometimes called brain ‘plasticity’. A lot of exciting research continues in this area. We know that in healthy brains, neural pathways can change following a trauma – for example, when a person is unable to recall a painful experience, particular pathways are bypassed. Whilst we are a long way from identifying the precise relationship between psychology and pathology, we are beginning to understand the consequences of poor care on physical wellbeing – more specifically, on cognition. For example, the symptom of being ‘withdrawn’ is more likely to be a consequence of poor care than organic changes in the brain. Poor practice can then lead to a reduction in abilities and an increase in the need for care, thereby escalating the economic burden. There are three main types of cognitivefocused approaches, as developed by Linda Clare: cognitive stimulation, cognitive training, and cognitive rehabilitation. Cognitive
alongside their carers. There is a great deal of self-determination and meeting of psychological needs in the development and delivery of this type of intervention. Yet this approach is not widely adopted. Instead, care plans focus on deficits or needs rather than strengths and abilities, failing to identify how to make the most of the remaining skills and abilities. A significant shift in thinking needs to take place before a real impact can be made. It might take a revolution in dementia care to get people thinking differently, as radical shifts need to be made. Services have to define themselves as therapeutic, progressive, and goaloriented. Much can be done within the home care sector to reduce admission to residential care. This needs to be done alongside the appropriate application of medical interventions, relevant multi-disciplinary support, and the effective and ethical use of assistive technologies. Targeted intervention is possible at every stage, although it will differ according to need. For example, cognitive rehabilitation will be targeted at the earlier stages, psychosocial interventions in the middle stages, and a more sensory approach at the later stages.
LOOKING TO THE FUTURE
We can start with high-impact training, which is delivered through a range of techniques: classroom-based, mentoring, and guided reflection. We can appeal to the interpersonal nature of the caregiver, by truly connecting with them through humanistic-type training methods. Changing attitudes starts by understanding the experience of dementia, through guided techniques, to develop empathy. It is also about empowering caregivers in understanding their power of change within the context of the social model of care.
Over the last few years, there has been an explosion in the range of psychosocial interventions, such as music therapy, art therapy, dance therapy, life story work, and reminiscence. stimulation includes techniques such as reality orientation. Reality orientation has its supporters and critics, and as with any technique, none have a global application. Careful assessment needs to identify what is appropriate for that person, particularly with the complex and fluctuating nature of dementia. Cognitive stimulation is often delivered in an ad hoc way, which works well with the fluid nature of a residential or home support service. Cognitive training differs in that it is described as involving a standardised approach, focusing on one aspect of cognitive functioning. Many products are available on the market to support this kind of ‘brain training’. However, in the context of supporting a person with dementia, this approach lacks the ‘personcentred’ context, which limits its application. Cognitive rehabilitation has a much wider application, as it is planned and goal-oriented, specific to the individual. It utilises different strategies to support memory. The goals are identified by the person with dementia,
Developing empathy is a practised skill, which can be achieved in many different ways. Tom Kitwood’s dementia equation suggests that we need to think about the experience of dementia on several domains: the neurological impairment, the physical health, the biography, and the social environment. Taking a broad holistic perspective is how we make real changes. Caregivers need to be given the skills to communicate with people with dementia and strong leadership is required to sustain and build upon changes initiated from training. Caroline Bartle is most well known in the UK for her contribution to the ‘knowledge sets’ and her developing work in the new QCF Dementia Qualifications. Since arriving in New Zealand, Bartle has partnered with Leigh Kelly of Clinical Update Training in a quest to empower people to consider dementia care as ‘therapeutic care’, which is progressive rather than just about maintenance. Bartle has also established a dementia training and consultancy organisation, 3spirit.
Do you have questions about living in a retirement village? The Department of Building and Housing provides free independent advice and information for people living in or thinking about moving into a retirement village. Call us free on: 0800 83 62 62 or visit our website www.dbh.govt.nz The Department of Building and Housing is the government agency responsible for overseeing the Retirement Villages Act.
Up close and personal with...
The 2012 INsite/RVA Manager of the Year Finalists INsite meets the three finalists for the 2012 Manager of the Year Award. The winner will be announced at the RVA Conference in Wellington on Tuesday 26 June at the National Bank Cocktail Party and Gala Dinner. DEBBIE POWELL, SELWYN ST ANDREW’S, CAMBRIDGE
INsite: What led you into retirement village management? Debbie: In 1998, I began work with the St Andrews Village Trust in an accounting role, working six to eight hours a week. I also hold a diploma in Business Studies and Accounting. The manager and I were the only employees, so over the next six years, I gained a very good understanding of all aspects of retirement village living. When the previous manager retired at the end of 2003, I was offered her position. INsite: How would you describe your leadership style? Debbie: My leadership style is of a democratic/ participative nature. I involve all the people I work alongside, as well as my manager and residents. This includes decision making, problem solving, and planning as appropriate. The result is a much more satisfactory outcome, with all parties having a good understanding of why a decision was made. This also reduces the number of concerns and complaints, as residents, in particular, feel that they have been listened to with an element of empathy. We welcome any suggestions, thoughts, concerns from residents, and if possible, act on these. This participative 20
June/July 2012 | www.insitemagazine.co.nz
style also helps build and encourage relationships as all parties have a sense of responsibility for the successful day-to-day running of our village.
INsite: What or who inspires you? Debbie: As you are aware, the Selwyn Foundation is a Christian faith-based organisation. The life and teachings of Jesus Christ are my greatest inspiration. Many of my residents also inspire me. Hearing about their lives and achievements prior to village life, observing their approach and attitudes to various ‘life’ issues and challenges, and seeing how they support each other in their own way is a real source of inspiration. INsite: What do you enjoy most about village management? Debbie: I would have to say the people – both my staff and my residents. It is a very positive and flexible work environment where we all feed off each other. As I am involved with the selling of ORAs, I also meet some interesting people from the community. Our total staff is only 1.5FTE, therefore, my role is very diverse; you never know what a day will bring and that can be exciting – it is never boring! INsite: And the frustrations and challenges? Debbie: We are proud to say we have a very high percentage of “highly satisfied” residents, which means we have a very happy village, with, to quote, “a very peaceful atmosphere”. This feedback comes from both residents and visitors.
My frustrations and challenges tend to be with ‘outside’ parties and most people’s frustrations – people not returning phone calls, emails, contractors not showing up when they say they will, and so on, which means spending a lot of valuable time chasing up people and answers! The St Andrews Village first started in 1975, so one of our biggest challenges is the on-selling of some of our older units. Retirement village living expectations today are very different to what they were even 10 years ago, and being an older village, we have very small and limited community facilities. This has been a challenge both to management and residents. However, I am pleased to say that these issues are being addressed by our head office and board.
INsite: Why should you be the 2012 Manager of the Year? Debbie: Our residents like to see expertise and commitment rewarded. Feedback from residents is that they are happy with the management of the village, and this has been reflected in the results of our internal residents’ satisfaction survey. A resident commented to me that he knew residents hold a lot of respect for me. I felt very honoured to hear that. We have had many positive comments about the smooth running of the village from residents and that is evident in the village atmosphere, participation in activities, and our happy residents. This has also been acknowledged by residents’ families by way of complimentary cards and flowers when residents have left our village.
DIANA TRIPLOW, MARY DOYLE LIFECARE, HAVELOCK NORTH
INsite: What led you into retirement village management? Diana: I have been a registered nurse for 35 years, and in this time, I have held a variety of clinical and management positions, including five years nursing overseas. In 1986, I realised that to further my career or influence national health decisions, I must achieve further tertiary qualifications. I completed my Advanced Nursing Diploma, Bachelor of Health Science, and then commenced postgrad papers in health services management. I was working as the unit manager of the medical services at Taupo Hospital – Lakeland Health at this time. In 1998, I seized an opportunity to set up and manage a new aged care facility: St Johns Wood Trust in Taupo. Three years later, all my objectives had been met and I moved to the next challenge. This opportunity was to manage the new development within Mary Doyle, a position that led shortly after to general manager of Mary Doyle Lifecare. INsite: How would you describe your leadership style? Diana: I am a participative leader, but I am able to adopt other leadership styles to obtain required outcomes. I am people-focused and I engage people with the intention to motivate them and achieve a goal that has positive outcomes. I try to be a role model to my staff in order to gain their respect and confidence in me. I am open and honest, consistent and fair, but I expect a high quality of work in return from my team. I mentor my senior staff and empower them through education, delegation, and support to develop and lead their teams. INsite: What or who inspires you? Diana: My residents are my inspiration – hearing them as they proudly show their friends and family around our facilities or watching and listening to their response to innovations I have instigated is truly inspirational.
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Also, my husband and his support for my work. He works with me and shares my vision for Mary Doyle. Striving to meet the mission statement and values we developed for Mary Doyle motivates me to be a leader of age care services in Hawke's Bay. Finally, the positive feedback I receive about Mary Doyle from the community, primary health team, and staff who have worked in other aged care facilities.
INsite: What do you enjoy most about village management? Diana: My residents. We are an extended family, sharing our passion to make our village the best place to live, love, play, and continue learning in. I am in such a privileged situation where my residents choose to leave their homes to come and live with us or families entrust their relatives to us. I love to hear the all-toocommon “I wish I had done this years ago”. I love to provide opportunities to my residents so they can live a full and active life in our supported environment and also to keep couples together when one partner has to go in to care. INsite: And the frustrations and challenges? Diana: Managing personalities is always a challenge, both residents and staff. We have a predominantly female staff of 240 – speaks for itself, really! It is a challenge ensuring we employ good staff who provide the high quality of care we expect for our residents. The length of time it is taking to obtain a contract from the DHB so we can provide subsidised home care services to residents within my village is frustrating. INsite: Why should you be the 2012 Manager of the Year? Diana: I am a general manager with passion for the work I do, and I have humanised the executive position of general manager within our corporate business. I lead from the front and have built effective teams within my village, resulting in a positive reputation within our community and excellent occupancy. My residents and staff support me – I guess their
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nominating me for this award shows this. I have trebled the growth of Mary Doyle, yet maintained a village atmosphere that is friendly and supportive. I am very innovative and always looking for new ideas to improve our village. I meet and exceed my key performance indicators. Becoming Manager of the Year would be the best gift I could give back to my residents.
MARK ROUSE, PARKWOOD RETIREMENT VILLAGE, WAIKANAE
INsite: What led you into retirement village management? Mark: I had worked in a number of different industries in accounting and management roles before entering the retirement village industry. This business background and my love of working with people seemed to be the right mix when I joined Parkwood. INsite: How would you describe your leadership style? Mark: I like to think I lead by example whilst being inclusive all the way. INsite: What or who inspires you? Mark: I am inspired by people who have a real passion for what they do or have done in their lives. INsite: What do you enjoy most about village management? Mark: Seeing residents enjoying their lives and staff feeling fulfilled by, and therefore enjoying, their jobs. INsite: And the frustrations and challenges?* Mark: Dealing with major cost increases that you have no control over, such as rates. INsite: Why should you be the 2012 Manager of the Year? Mark: For the residents and the village.
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www.insitemagazine.co.nz | June/July 2012 21
Each issue, INsite seeks opinion on a contentious issue concerning aged care and retirement.
On the soap-box... John Collyns HOME-BASED SUPPORT SERVICES IN RETIREMENT VILLAGES
Todd Jenkins’ article in the February-March 2012 issue of INsite kicked off an interesting debate – the undoubted benefits to residents if their retirement village operator contracts to their District Health Board (DHB) to provide home-based support services (HBSS) directly. As far as Metlifecare Greenwood Park is concerned, the case is well and truly proven – there are demonstrable benefits to residents, the DHB, and the operator when the operator holds a contract directly with the DHB. Sadly, apart from a few villages in the Bay of Plenty and one or two in Lakes DHB and the Taranaki DHB, the other DHBs seem in some sort of denial on this topic. The RVA has researched member villages in the Hawke’s Bay and Waikato DHB areas to find out who receives HBSS and what the benefits would be for a change of policy. We estimate that around 18 to 20 per cent of residents receive HBSS from a variety of external agencies (six or seven organisations in the Waikato, for example). The majority of visits are made on Mondays, Wednesdays, and Thursdays between 8.30 am and midday. A small number of calls are made in the afternoons and a handful at weekends. Around half those calls are for an hour, with another 20 per cent around two hours. Yet, we all know that assistance is needed at any time of the day or night – not just conveniently on Monday mornings – and is usually for relatively small blocks of time.
BENEFITS TO THE DHB
Just what are the benefits to the DHB if an operator were to provide the HBSS to their residents directly under contract? An obvious one is slowing the move to a rest home and the related cost of subsidy – operators note that they will be able to provide a detailed and consistent level of HBSS as they are on hand 24 hours a day. One village quotes four examples of residents who could have been cared for in their apartments but are now in a rest home – three on a subsidy and one privately. Each resident used to have outside agencycontracted hours, but when they were assessed for a higher needs level, the village was told by the NASC the residents could have more hours added, but the problem was the night care and the times between the carers’ visits. Had the village been allowed to provide the contracted care, they could have managed on a package of, say, four hours a day when their staff are on-site and could have responded to night care, toileting, and so on, as part of the package. This would have been a lot cheaper for the DHB and better for the resident. Another obvious benefit is reduced travel times and related costs. Agency contracts will have an allowance for travel times; their profits are maximised when they are able to manage 22
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the travel times efficiently. If retirement village carers look after the residents receiving care, staff time would be used efficiently and the cost of travel minimised.
BENEFITS TO THE RESIDENT
There are a great many benefits for the resident if their village operator were to provide HBSS under contract to the DHB. Not the least of these is the question of choice – why can’t residents choose to have their village as a provider? They have chosen to live with the village, a decision based on the village’s reputation and the ongoing care they may require, but when they need HBSS care, as one manager put it, “oops, no we can’t provide that service, sorry – you need a stranger to come in!” Residents prefer to be looked after by someone they know, and the village staff members are available and well known to residents. Villages tell us that on “many” occasions, carers have not arrived to provide their personal care or prepare them for bed, etc. Villages have incident forms notifying them of agency carers who have mostly not turned up at all; a few say the carer stayed ten minutes instead of the allocated 30 minutes. As retirement village-based carers will have short distances to travel between residents, their punctuality will also be improved. Not all agency staff members record their visits, what they did, and so on, and as many of the residents have memory loss, they are unable even to advise the village if their carer has been, let alone what they did. A village-maintained central record of individual residents’ care needs would improve the quality and consistency of care. Villages believe that their provision of HBSS will be superior to the status quo, as they have supervising staff on duty to monitor their residents and staff at all times. Currently, there is limited supervision of the care provided by the agency carers – the agencies react to concerns and complaints, like the ambulance at the bottom of the cliff. The village manager, who is on-site, is ultimately responsible for the quality of the residents’ care and can quickly deal with issues should they arise. The village has relationships with their residents’ GPs when they liaise with the village, and as a result, there is no privacy issue. Villages obviously already have a relationship with the residents’ families.
Residents discharged from hospital with a home support package would not ‘fall through the gaps’ during the time it can take for the referral to get to the HBSS provider and for that provider to make the initial care-planning visit. If the HBSS is managed by the village, there are staff on-site who can receive the resident back into the village (even at 5pm on Friday) and arrange for the services to be implemented the same day, as there would already be home support staff on-site providing to other village residents.
BENEFITS TO OPERATORS
The principal benefit for operators is being able to provide a complete package of care to their residents, while the residents continue to benefit from the HBSS provided as of right by the DHB. Operators also note that the issue of security exists as well, with unidentified agency staff coming into the village. In apartment buildings, there are large common areas that are an extension of the residents’ homes. Operators (and residents) are uncomfortable with strangers wandering through these areas. Villages know the capabilities of their staff and residents and can far better match the sometimes very complex needs of the resident to their staff’s skills. We are told that some agency staff are exemployees whom villages would not re-employ because they do not have the honesty, reliability, or work ethic to be on their staff. Yet these people are looking after the village’s residents via an agency and the village cannot supervise or performance manage them, thereby putting the village’s reputation at risk.
WHERE TO NOW?
The pressure on health funding, even at the modest level of HBSS delivery in retirement villages, suggests that a change in policy for many DHBs is long overdue. Direction from the Ministry and Minister of Health would be valuable, and we are slightly encouraged that some DHBs are conducting trials to see if the benefits we’ve identified are justified in reality. It’s time DHBs stopped avoiding the issue and allow contracts to provide HBSS to qualified retirement village operators so they can extend their continuum of care into the village itself. John Collyns is executive director of Retirement Villages Association
RESPONSE FROM HON JO GOODHEW, ASSOCIATE MINISTER OF HEALTH AND MINISTER OF SENIOR CITIZENS I am pleased that some DHBs are conducting trials to see if the benefits of retirement village operators providing home-based support services are a reality. Experimentation with service delivery and assessment of the impact is to be encouraged. Where results are positive, I want other DHBs to learn from that. Mr Collyns has ably set out the potential benefits. DHBs need to weigh those against potential disadvantages, such as extra costs of contracting with many more service providers.
Let’s snoop around... Bethlehem Views JUDE BARBACK gets a chance to snoop around a residential aged care facility in Tauranga.
auranga rest home and hospital, Bethlehem Views, just celebrated its first birthday, complete with birthday cake, singers, and even belly dancers. The latter was a surprise arranged by manager, Diane Rodger. “You should have seen their faces,” she laughs. “Some of the men said they had never seen anything like it in their lives!” There is something heartwarming about the fact that life can still hold surprises for those who are now in rest home care. Indeed, ‘surprising’ is a good word to describe Bethlehem Views, which is part of the Sanderson Group, a family operation, which also developed nearby Bethlehem Country Club, Omokoroa Country Estate, and Cascades rest home in Hamilton. Bethlehem Views occupies the site of the former Southern Cross Hospital. Gone are the narrow corridors, pokey rooms, and institutional feel. In its place is an opulent and luxurious building. The reception area is magnificent. I am in no hurry
but I am also keen to see the residents’ rooms. Each resident’s room is equipped with a hospital-style bed on wheels, a wheeled La-Z-boy, ensuite bathroom, wall-mounted flat-screen television, in-built refrigerator, and ranch-slider onto a terrace. The rooms are spacious, and some are designed to accommodate couples. There are also a small number of interconnecting rooms, although the rooms need to be vacant at the same time to allow residents – possibly a couple or siblings – who wish to make use of the interconnecting door. With a long waiting list, this seems unlikely. Rodger tells me the rooms were designed to meet the expectations of the next generation of residents, who will no longer accept shared bathrooms and peeling wallpaper. Hers is an informed opinion. Now general manager for care services at the Sanderson Group, Rodger has managed rest homes since 1990. “I’ve managed some grotty places,” she says, “This place is an
For all the state-of-the-art architecture and lavish furnishings, it always comes down to the quality of the staff and the care they are able to provide. for Rodger to meet me, as I wait, absorbing the hotel lobby music, plush leather and velvet furniture, chandelier, and gold Sanderson family crest. The message they are sending visitors is clear – no expense has been spared in this development. I know better than to judge a book by its cover. However, I am eager to get a feel for the atmosphere and care beyond the lavish lobby area. Bethlehem Views is a 52-bed rest home and hospital. It has the feel of a new building, and while parts of it are new, it is virtually impossible to tell which parts have been converted from the old Southern Cross hospital. Like the reception, the residents’ lounge is expansive and beautifully furnished, but the eye is drawn immediately to the sweeping views of Tauranga harbour. Some residents sit in their La-Z-boy chairs, all with wheels, taking in the sunny autumn vista. I could happily linger here with them,
absolute delight.” It hasn’t all been plain sailing in the first year. A new rest home requires new residents and new staff. Rodger says it took a little while to get the right staff on board, and the home experienced a fair amount of turnover in the early days. New systems to get used to, a handful of difficult residents, and a need to get experienced staff on board all added to the initial flux. Once the inevitable teething problems settled down, and the core group of staff became established, the home began to find its feet. For all the state-ofthe-art architecture and lavish furnishings, it always comes down to the quality of the staff and the care they are able to provide. Rodger agrees wholeheartedly. She cannot speak highly enough of her staff and gives examples where they have come in on their days off to help residents with particular needs.
The staff members I encounter on my tour of the home seem happy and focused. They support each other in their work. In addition to registered nurses, a diversional therapist, and care assistants who work on site, doctors from a nearby practice visit the home on a regular basis and as needed. The residents appear to relate well to the staff as well. Joyce, who is keen to show me her room, which she has
made very homely with fake flowers and crocheted rugs, is full of praise. “The girls are very nice,” she says warmly. On my way out, Doug, another resident, tells me I am an “attractive girl”. Having resigned myself that my days of being ‘hit on’ were long over, Doug has made my day, and I leave the home finding it hard to fault Bethlehem Views.
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www.insitemagazine.co.nz | June/July 2012 23
Flu vaccine for elderly Every flu season, vaccinations are recommended for older New Zealanders, but just how effective are these vaccines, and which ones are best?
t’s that time of year again when the changing seasons prompt people to get their annual flu vaccination, and with good reason: statistics show that influenza causes three to five million severe cases of illness worldwide, resulting in 250,000 to 350,000 deaths. While some countries, like the US and Canada, advocate universal vaccination for influenza, New Zealand recommends – and provides public funding for – vaccinating those at high risk. Included in the high-risk group are people aged 65 and over, as older people are more prone to illnesses associated with influenza than their younger counterparts. The flu virus changes from year to year and the choice of vaccine formulation is informed each year by the World Health Organization’s Influenza Surveillance Network, of which New Zealand is a member. New Zealand currently uses the TIV (trivalent inactivated influenza virus) vaccine. As recently discussed by Professor Ngaire Kerse and Dr Helen Petousis-Harris in NZ Doctor, the TIV vaccine used here is shown to be more effective in reducing mortality in those at low and intermediate risk than in those at high risk. It is thought that new TIV vaccines, such as Fluad from Novartis, available only overseas, are proving more immunogenic in older people. However, it is difficult to determine exactly how effective vaccines are in elderly patients. Nikki Turner, director of Auckland’s Immunisation Advisory Centre even suggests in the Journal of Primary Health Care that as the current evidence around the effectiveness of influenza vaccines in the elderly remains
uncertain, we should be considering whether offering the vaccine to this group is the right path to take. One of the main reasons it is so difficult to determine the effectiveness of vaccines is the occurrence of immunosenescence – the agerelated decreased ability of the immune system to respond to antigens. Immunosenescence often means that the typical outward clinical signs of influenza, such as fever and cough, are often not observed, leading to delayed recognition and treatment. What is most important, therefore, is getting the flu vaccine to elderly people at an appropriate time. Kerse and PetousisHarris suggest that vaccination has the most protective benefit for those in residential care. Staff should also be vaccinated. Canterbury’s Professor Lance Jennings agrees in the Journal of Primary Health Care that influenza morbidity and mortality is higher in individuals living in rest homes than the non-institutionalised elderly, and therefore, vaccination is important. While outbreaks in rest homes in New Zealand are rare, they can be devastating when they do strike. Two incidents of such outbreaks resulted in clinical influenza attack rates of 48 per cent and 58 per cent respectively. Jennings also suggests elderly people with dementia are particularly vulnerable because of the additional difficulties they have in communicating their symptoms. While it is more difficult to ensure the vaccination is delivered to older people who live independently, experience shows that these people usually respond well to reminders and invitations and also tend to visit their
local GP surgery at the right time of year. That it is free to people over 65, and usually available from around March until the end of July, should make getting the flu vaccine an easy decision for older people. A common misconception is that it is possible to catch influenza from the vaccine. This is not so. However, the vaccine will not prevent other respiratory viruses like the common cold. There are a small number of people who should not be vaccinated without first consulting a doctor, such as those who have had a severe reaction to an influenza vaccine previously, or who have a severe allergy to chicken eggs. Geriatrician Dr Maree Todd offers some sound advice in Family Care to keep older people well during the winter. In addition to getting the influenza vaccine, she advises keeping warm, keeping active, eating well – including lots of colourful fruit and vegetables – and taking a vitamin D supplement. For those who do get sick, Todd suggests seeking advice from a doctor or nurse before symptoms worsen, drinking plenty of fluids, eating regularly, taking paracetamol up to four times a day for headaches and muscle pain, and keeping moving to avoid loss of strength. She says to be mindful of existing illnesses, such as lung, heart, or kidney disease, as these can become unstable under the strain of a respiratory virus.
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June/July 2012 | www.insitemagazine.co.nz
...with Alan Jamieson and Cathy Egan In this column, INsite chats with residents of different retirement and aged care facilities. WHEN DISABILITY HINDERS CHOICE
Cathy Egan suffers from multiple sclerosis. She has progressively lost her mobility since her condition was diagnosed 12 years ago and is now dependent on her power chair to get around. Eventually, in 2007, Cathy and her husband, Alan Jamieson, decided to move from their topfloor apartment in Thorndon, Wellington into retirement village accommodation. “Cathy loved the view of the harbour from Petone around to beyond Eastbourne and I loved the real-life model railway set at the bottom of the hill,” says Alan. “Getting around a Wellington apartment in a power chair and getting away from the building with steep streets in the same power chair was daunting. So we began our search for something that would work for us both and still keep us in touch with our Wellington roots.” But it wasn’t to be that straightforward. Although, as Alan says, the topography of Wellington limits the number of choices, their search included several retirement villages in and around Wellington: Huntleigh in Karori, Village at the Park in Berhampore, Ryman Healthcare’s Malvina Major village in Broadmeadows, and Summerset at Aotea village in Porirua. The apartment building for Village at the Park was, at the time of visiting, unfinished with no plans available, so that narrowed the search even further. Upon visiting Malvina Major village, the couple were astonished to be told by the village’s salesperson that Cathy could not use her power chair in the common areas such as hallways and function rooms. “When the salesperson made that statement, I asked why. Her response was ‘they run people down’,” says Alan. “Having being indirectly involved in construction, I was forming an opinion the buildings – it had grown like Topsy, with many additions over a number of years to the original motel site – were not suitable for anyone with mobility issues. “The refusal to accept a power chair in common areas just added to the overall unfavourable impression of this site.” “Cathy and I visited this site with her in a collapsible wheel chair, which is quite compact. We could not get Cathy (in wheelchair) into the bedroom, bathroom, or toilet. The lift could just take us two and the salesperson with a squeeze – no room for an ambulance stretcher. Door closers were heavy and the impression was they would be almost impossible to use for someone with one working hand. And from memory, doors did not stay open sufficiently long for the wheelchair user to pass through without assistance.
“As we both did not feel comfortable with what was on offer, we did not take it up with them. But I did think about taking the matter up with a relevant authority.” The couple experienced a similar situation at Huntleigh but on a smaller scale. “Entry into the building was some distance from the car park and was uncovered. [The] lift did not seem to be big enough for a few people, let alone an ambulance stretcher. Access to the apartment was through a door with a closer and immediately down one step. The walkway around to the apartment was uncovered. As the apartments were under construction, we couldn’t test wheelchair access, but we had already lost interest.” Fortunately, Cathy and Alan found what they were looking for at Summerset at Aotea. They were impressed with the service and what was on offer. “I came to visit late one Sunday afternoon. I found later the salesman would normally be gone by that time, but he took an hour to show me around,” says Alan. “I first saw a one-bedroom apartment and was impressed with the internal layout – what appeared to be good access from bedroom directly to the bathroom. “We left that apartment to see some twobedroom units. As we progressed, the salesman pointed out a semi-hidden area that he called the “scooter room” and kept going. I asked him to elaborate. He showed me a large space (3x4 metres) with a lino floor and about six hot-points. He said this was where apartment residents could re-charge their scooters over night. And he confirmed, yes, power chairs were expected within the village.” As a result, Cathy and Alan bought a twobedroom unit at the village. Alan says that not only were they impressed with nearly all the features, but the “apartment at Aotea feels about
twice as big overall as that at Malvina Major and the price was very much lower.” “All the apartments at Aotea I saw then and since have wide internal hallways and wider than normal doorways, but this does not stop the wheelchair “bruising” the paintwork from time to time. We have not needed to make any internal changes to suit Cathy’s equipment (although a third bedroom would be nice). “We wanted to be in the apartment building with café, library, and function rooms all under cover, so we did not look at villas. The lift is large and we could easily get a sevens team with their equipment in it. But not everything is joy unbounded: senior management for Summerset seem totally unwilling to provide a freely available digital Freeview television service to most homes, despite being less than a kilometre from and within sight of a digital transmitter.”
RESPONSE FROM SIMON CHALLIES, MANAGING DIRECTOR, RYMAN HEALTHCARE We are disappointed that our village did not appeal to the Jamiesons. We design our apartments to meet the building code and to meet the needs of our elderly residents, and our design is continually being improved in response to resident feedback. We do not design all of our apartments to suit the needs of a person in a wheelchair, as an apartment designed that way is not necessarily desirable (or suitable) for a nonwheelchair resident. Our approach is to adapt an individual apartment as required to meet the needs of a wheelchair user.
We do restrict the use of electric wheelchairs in the common areas of our villages. Use of a power chair in the common area is only possible if it is used in walk mode and the user is accompanied by an observer (who walks in front). This policy recognises the danger that electric wheelchairs, which are essentially motorised vehicles, present to the other elderly residents. It is not fair to expose other residents to the risk of being injured by an electric wheelchair, as there is a high risk the injury will be a fracture that the resident may never fully recover from. We have mitigated this risk by providing for an observer.
☛ GOT AN OPINION? Have your say online at www.insitemagazine.co.nz www.insitemagazine.co.nz | June/July 2012 25
Design for design’s sake? W
ould you want to live here? After posing this question to a handful of people, both young and old, I struggled to find someone who would be happy to spend their final years in such a care environment. Ultra-modern? Yes. Innovative? Definitely. Edgy? Without a doubt. Homely and cosy? A resounding no. The Residências assistidas em Alcácer do Sal, which translates to ‘Houses for elderly people in Alcácer do Sal’ was completed in 2010. It occupies that curious position somewhere between hotel and hospital for older people. The architects wanted to deliver a new take on providing residents with the opportunity to enjoy a social life, as well as their solitude. However, the architecture speaks so strongly, it is hard to imagine people living in this building at all. Minimalism reigns supreme, with a starkwhite facade and geometric cube-like rooms. In keeping with the minimalist theme, the interiors are white too, tempered with white marble and light grey floors. The lack of contrast draws some criticism from one blogger on the design: “However appealing and modern these white surfaces in the interiors might be for a person my age, I personally believe that the lack of visual contrast between the surfaces and apparent way-finding markers could actually make life pretty difficult if I was a senior, where my vision would probably be impaired. The seniors might face a difficulty in seeing the handrails, and in distinguishing between walls and floors.”
Individual rooms appear like boxes sitting haphazardly on top of each other, with recesses to provide sun shading and balconies. Each has their own private access to the outdoors. While design junkies are full of praise for some of its features, others are more scathing. “I would never be able to put my beloved parents away in a white marble box like this … it is so sterile, cold, and anything but welcoming, inviting, warm, and cosy,” says one blogger. “Ultra modern juxtaposed with the demographic… I’m not feeling it!” says another. Those I spoke and shared the images with tended to share the opinions of those who had taken to their computers to air their views. Neil (30) accepted that while it didn’t look appropriate for an aged care environment, he was impressed with its minimalist appearance. Others felt it could do with more warmth and colour. “It could do with warmer finishings, like wood instead of metal,” says Clare, one person I spoke with. “It needs a bit more colour,” agrees her husband, Alan. “All that white would hurt your eyes after a while.” Both are in their fifties, and while they are not contemplating retirement living yet, they are mindful that they will someday. It doesn’t look like they will be adding their name to the waiting list at this particular home. Neither will Emily (87), who is content with the homeliness and rustic charm of her small rest home, or Trevor (86), who “couldn’t imagine anything worse”.
☛ WHAT DO YOU THINK? Contact the editor, Jude Barback, with your thoughts: email@example.com
For the book shelf... INsite recommends Generational Intelligence
Generational Intelligence: A Critical Approach to Age Relations by Simon Biggs and Ariela Lowenstein (Routledge, 2011)
Professor Simon Biggs, a keynote speaker at the NZCCSS conference in Wellington earlier this year, has a keen interest in generational awareness, one of his main areas of research. As part of this research, Biggs produced a video entitled ‘Age Encounters’. Comprised of a series of recorded interviews that reveal people’s differing perceptions of other generations, the video gives a glimpse of Biggs’ interest in the generational gap. Biggs’ book, Generational Intelligence, co-authored with Ariela Lowenstein, appears to be taking these interviews to the next level, by analysing these perceptions and offering guidance on how we might achieve a better understanding of other generations. ‘It is important that gerontology moves away from exclusively championing the old and that society moves away from championing youth’. This could be considered one of the ‘take home’ messages from the book. 26
June/July 2012 | www.insitemagazine.co.nz
According to the authors, generational intelligence is all about putting yourself in the shoes of the other generation, or as the authors describe, your ‘age-other’. Apparently, our awareness of other generations, built gradually over time, is predisposed to negative connotations about ageing. The authors, through scrutiny of the literature and interpretation of an array of data, show how a new way of thinking about the generational gap can help dispel such negativity. Through closer inspection of the personal, interpersonal, and social factors that affect our perceptions of other generations, the authors encourage, through a series of steps, better understanding and communication between generational groups. Generational Intelligence is concerned with the bigger picture, considering how we might address social issues emerging from ageing populations. It is suggestive of policies for age integration that might lead to ‘a society for all ages’. The authors look critically at age relations within the family, workplace, and community, examining relationships between older adults and their parents when the latter need care, between older and younger adults in workplace settings, and the broad relationship between young and old. Age Encounters can be viewed at http://youtu.be/wdcWZDZ7d-I.
The Nursing home of Aires Mateus Architects through the eyes of Fernando Guerra
Reactions are mixed for a radical new Portuguese rest home, designed by architects Francisco and Manuel Aires Mateus.
NZCCSS’ SERVICES FOR OLDER PEOPLE CONFERENCE 29-30 MARCH 2012, WELLINGTON LAUGHTER A KEY NOTE AT SERVICES FOR OLDER PEOPLE EVENT
One of the many highlights of this year’s Services for Older People conference run by the New Zealand Council of Christian Social Services (NZCCSS) was the hearty laughter provided by keynote speaker Jean-Paul Bell of Australia’s innovative Arts Health Institute. Bell, most well-known for his work as a clown doctor, rounded out an extremely comprehensive range of speakers, from global experts in gerontology, social policy, and systems of health care for older people such as Professor Simon Biggs (Brothers of St Laurence) and Professor Chad Boult (Johns Hopkins Bloomberg School of Public Health) through to a who’s who of New Zealand experts on aged care and wellbeing for kaumatua. Through the Arts Health Institute, Bell has been focusing his work towards older people in residential care and on applying humour therapy to dementia. From this, he has developed a programme called ‘Play Up’, which is a direct continuation of the work
of the SMILE Study conducted by the Dementia Collaborative Research Centre at the University of NSW, funded by National Health and the Medical Research Council. The results of the SMILE Study provided positive evidence of the impact that humour therapy can have on creating a 20 per cent reduction in agitation levels experienced by older people with dementia and generally lifting positive behaviours. In an interview with TVNZ’s Breakfast show host, Petra Bagust, during his time in Wellington, Bell spoke about the “dose effect” of humour and the importance of “keeping up the dose”. He also noted the way that ‘Play Up’ has introduced opportunities for aged care staff to share in and benefit from some additional levity and social engagement at their workplaces. In addition to keynote speakers, the NZCCSS conference, a biannual event, featured a series of workshops that were fronted by a range of organisations: Family Centre Social Policy Research Unit, Mary Potter Hospice, Wellington Tenths Trust, WellElder, the Selwyn Centre for Ageing and Spirituality,
Simon Biggs (left) and Jean-Paul Bell (right), keynote speakers at the conference.
Presbyterian Support Central, New Zealand Aged Care Association, Social Housing Unit, Osteoporosis New Zealand , Careerforce, two leading iwi organisations – the Rauawaawa Kaumatua Charitable Trust and Te Taiwhenua o Heretaunga – and a number of DHBs and tertiary institutions. Further information on the ‘NZCCSS Moving Forward Together’ conference can be found at www.nzccss.org.nz. For more insight into Jean-Paul Bell’s enterprising work, see www.artshealthinstitute.org.au Contributed by Stephen Olsen, Community Scoop
>> >> CONFERENCE CORNER 2012 NEW ZEALAND ASSOCIATION OF GERONTOLOGY CONFERENCE, 13-15 SEPTEMBER, AUCKLAND The conference will focus on the health aspects of an ageing population, presenting up-to-date research and informed discussion about the health needs of an ageing population, how New Zealand can best serve those needs, and the impact of that ageing population on the New Zealand health system. For more information visit: www.nzag2012.co.nz
DATES FOR THE DIARY: • Retirement Villages
Association (RVA) Conference, Wellington, 25–27 June 2012
• New Zealand Aged Care Association (NZACA) Conference, Rotorua, 10 – 12 September 2012 • The New Zealand Home Health Association Conference, 11-12 April 2013, Auckland
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BELLE ON 04 915 9783 OR EMAIL BELLE@APN-ED.CO.NZ www.insitemagazine.co.nz | June/July 2012 27
RVA CONFERENCE 25-27 JUNE 2012, WELLINGTON CELEBS HEAD TO THIS YEAR’S RVA CONFERENCE
It is hard not to name-drop when talking about the upcoming Retirement Villages Association conference in Wellington in June. Following the opening cocktail function, comedians, MPs, broadcasters, and actors will come together for the opening night celebrity debate. Chaired by broadcaster Jeremy Corbett, with teams led by comedians Raybon Kan and Paul Ego, the moot is ‘that age and treachery will always overcome youth and skill’. While not an entirely original topic, Kan, Ego, and company promise to deliver a novel and entertaining take on the familiar argument of age versus youth. More famous names creep into the programme on day two, with 2010 New Zealander of the Year, Sir Ray Avery, taking the stand. The second day will also provide delegates an opportunity to glimpse across the ditch to see what is happening with the Australian retirement living industry, with Andrew Giles,
the chief executive of the Australian Retirement Villages Association, and Jim Hazel, director of Adelaide and Bendigo Bank, looking at the Australian retirement village model going forward and the implications for New Zealand operators. The eagerly awaited INsite /RVA Manager of the Year award builds momentum in the afternoon as each of the finalists have their say (see page 20 to meet the x finalists ). They will be kept in suspense until the Cocktail Party and Gala Dinner that night, when the winner will be announced. The programme for the final day is packed with interesting topics and perspectives, kicking off with one of New Zealand’s top lawyers and business women, Mai Chen. Delegates will hear from experts in dealing with emergencies, which, in light of Christchurch’s bitter experience, will be a timely topic for discussion. A representative from the Association of Residents of Retirement Villages will also
take the stand to give a fresh look at the issues concerning residents. Things are sure to get interesting as Martin Taylor of the New Zealand Aged Care Association, Chris Fleming, DHB Lead CEO Aged Care, and Simon Marks of Anthony Harper Lawyers discuss the issue of Occupation Right Agreements in residential accommodation beds. Sean Plunkett will chair a panel discussion on a retirement village’s value proposition, where residents, operators, market analysts, property experts, and others will question whether the industry offers value for money. In addition to a full and varied programme, the RVA conference also boasts a well-supported trade show and social activities, including the Golf Tournament for those keen to take part. This year’s conference is not to be missed! RVA Conference takes place from 25th to 27th June, 2012 at Te Papa, Wellington.
Your dedicated sponsor for years and years and years.
We’re proud to be sponsoring the Retirement Villages Association conference for the 14th year in a row. Having worked so closely with your industry for many years, we understand how access to knowledge and expertise can make all the difference. Whether you’re in it for profit or not for profit, don’t wait until the conference to talk to us about your plans. If you currently have a Retirement Village, are planning new stages or are considering a new Village altogether, give one of our Healthcare Relationship Managers a call today to discuss how we can help. Auckland: Richard Hinchliffe, Head of Healthcare (09) 252 2952. Reuban Dalzell (09) 252 3095
The National Bank of New Zealand, part of ANZ National Bank Limited.
June/July 2012 | www.insitemagazine.co.nz
Wellington: Rob Snaddon (04) 436 6691. Christchurch: Brent Crisp (03) 368 2414.
KEYNOTE SPEAKER: SIR RAY AVERY, 2010 NEW ZEALANDER OF THE YEAR
Entertaining keynote speaker Sir Ray Avery is a successful pharmaceutical scientist, a founding member of The University of Auckland school of medicine’s department of vlinical pharmacology, and former technical director of Douglas Pharmaceuticals who, over the past thirty years, has made a major contribution in the development of New Zealand’s pharmaceutical industry. He is a compelling motivational speaker with great stories to share.
However, it is Avery’s groundbreaking work in the developing world that has brought him respect and recognition internationally. As technical advisor to the Fred Hollows Foundation, Avery designed and commissioned two state-of-the-art Intraocular Lens Laboratories in Nepal and Eritrea. Today, these laboratories supply 16 per cent of the world’s market for these products, and thanks to Ray’s innovative lens manufacturing technology, the cost of lenses is less than $6, thereby making cataract surgery available to the poorest of the poor. Working throughout Africa and Asia, and exposed to the raw and real shortcomings in healthcare, Avery was determined to use his knowledge of pharmaceuticals, science, project
RVA conference programme Day 1
management, and product design to tackle big health issues throughout the developing world at a practical and sustainable level. His work has been recognised by his peers and Avery has received numerous awards, including a Rotary Paul Harris Medal, The Bayer Research and Development Innovator Award 2008, World Class New Zealand Award for Biotechnology 2009, TBWA Disruption Award 2010, Kiwi Bank New Zealander of the Year 2010, and The Blake Leadership Medal 2010. In 2011, Avery was awarded the New Zealand Order of Merit Knight of the Grand Companion in the New Year Honours for services to philanthropy. His book Rebel with a Cause is on its fourth reprint.
Retirement Villages Association Conference, 25-27 June 2012, Wellington
Monday 25 June 2012
From 6.00 am Trade show build-up 7.30 am
Registration desk opens, closes after golfers depart
Golfers gather in the Amora Hotel foyer
Coach departs for the Royal Wellington Golf Course, Heretaunga
Programmed Property Services Golf Tournament starts
Buffet lunch in the club house, prizes presented
Depart from the course for the Amora, arriving around 4.45 pm
Trade Me Property Opening Cocktail function in the trade show area, Te Papa
Celebrity debate starts, concludes around 10.00 pm
Tuesday 26 June 2012 Conference welcome - Norah Barlow, President RVA, gives an overview of trends, threats, and opportunities in the industry and then introduces … Hon Maurice Williamson, Minister of Building and Construction, to open conference Sir Ray Avery, 2010 New Zealander of the Year Sponsored by SCA-TENA Ltd Richard Hinchliffe, Head of Healthcare, Commercial & Agri, The National Bank Morning tea Cameron Bagrie, Chief Economist, The National Bank Cameron will provide his views of the current economic climate, discuss developments in the financial markets, and give valuable insight into the key economic issues and opportunities for New Zealand. Sponsored by The National Bank Lunch in the trade show Sponsored by Ernst and Young Speed dating session: 10 x 5-minute appointments for delegates with trade show exhibitors Jim Hazel, Director, Adelaide and Bendigo Bank Jim will be looking at how the Australian retirement village model going forward, the influence of care services requirements and residents’ needs, industry financing and valuation models, and the issues Australian retirement village operators and developers have which are relevant to New Zealand. Sponsored by FMR Risk Ltd Andrew Giles, CEO Retirement Villages Association, Australia Andrew will review the Australian retirement industry regulatory regime, expected regulatory trends, the influence of resident activist groups, and the implications of all this for New Zealand. Andrew will also cover the highlights from a major piece of research commissioned by Australian operators into their residents and retirement villages. Sponsored by Grant Thornton New Zealand Ltd Afternoon tea 2012 Manager of the Year Award – the finalists speak. What’s made these finalists the top in the business? There are going to be some healthy ideas you can use when you get back home – don’t miss this session! Sponsored by INsite magazine RVA Annual General Meeting - See separate agenda Conference closes for the day The National Bank Cocktail Party and Gala Dinner Presentation by the Hon Maurice Williamson to the 2012 Manager of the Year winner The Sound Workshop plays until midnight
8.30 am 8.40 am 9.15 am 10.15am 10.30 am 11.10 am 12.15 pm 1.00 pm
3.40 pm 4.10 pm 4.30 pm 5.00 pm 7.00 pm 8.30 pm
For the full conference programme and speaker bios, visit http://conference.rvanz.org.nz/site/events/conference/2012/ www.insitemagazine.co.nz | June/July 2012 29
NZACA CONFERENCE FUTURE FOCUS OF AGED CARE: DEEPER AND WIDER 25-27 JUNE 2012, WELLINGTON
or aged residential care providers, there are two broad directions in the coming years, going ‘deeper’ and ‘wider’. This will be the focus of this year’s NZACA conference in Rotorua. Going deeper means focusing on doing what is being done now but working towards more efficient operations through changes in existing service mixes, size, and management practices, such as premium charging, implementing quality improvements systems, and introducing IT solutions, such as InterRAI. Going wider means focusing on developing new services, such as ORAs or other mechanisms to release capital through deposit, or payment in advance schemes. Wider also refers to providing more services in the health market, such as operating a local health cluster, and/or developing standalone rehabilitation, step down care, acute care, or community support services, such as meals, remote monitoring, personal care, and emergency care. The decision to go deeper and wider is influenced by each operator’s strategic goals, the market in which they operate, and by changes and innovation in the private and public health sector. For example, increasing acuity has an impact on service delivery, as does the DHBs’ recent attempt to provide residential care in someone’s home, and consumers’ desire for increased choices, a continuum of care, and ownership of their accommodation. This theme – going deeper and wider – will be reflected in many of the sessions and talks of the conference, which will play host to a variety of well-known and entertaining speakers. Among them will be Mike McRoberts and Winston Peters, with both taking the stand on day one. The focus on the first day is predominantly about models for a continuum of care, probing the experience and opinions of Karima Velji from Canada and Ingrid Williams from Australia. The global theme continues with Grant Thornton’s Cam Ansell delivering an international comparison of aged care models. Bringing the focus back home, representatives from DHBs, private hospitals, and retirement villages across the country will lead discussions on new and future care options for New Zealand. The concurrent sessions held over the last two days will aim to penetrate some of the pertinent topics of aged care, including InterRAI, design, legal, financial, auditing, and dementia issues. The public/private interface of aged care will be explored on day three, with Associate Minister of Health, Hon Jo Goodhew, and economist Benje Patterson of Infometrics taking the stand. The meeting will wrap up with a panel discussion addressing the question at the heart of the conference: is it deeper, wider, or both?
June/July 2012 | www.insitemagazine.co.nz
SPEAKER BIOS CAM ANSELL
A chartered accountant and director of Grant Thornton International, one of the world’s largest business advisory groups, Ansell has undertaken comprehensive financial and operational reviews of retirement villages and aged care services in Australia, USA, Asia, and New Zealand. He has also personally managed retirement villages. His most recent research into the cost of delivering care in modern aged care facilities supports the work being done by the Productivity Commission to reform the aged care sector in Australia.
HON JO GOODHEW
Now a Minister in the 2011-2014 National-led Government, Jo Goodhew was elected as the Member of Parliament for Rangitata in 2008, having been elected to Parliament as the MP for Aoraki in 2005. Born and schooled in South Canterbury, where she grew up on a local farm, Goodhew qualified as a registered nurse in 1982 and has practised throughout New Zealand and in London in both hospitals and in general practice. She gained a Bachelor of Nursing degree in 1995. Her professional involvement has extended to tutoring in Health Sciences at the Aoraki Polytechnic, acting as recruitment coordinator for Breastscreen South Ltd., and she was also the founder of the Aorangi Nursing Agency. Her extensive voluntary community involvement has included membership in a large number of organisations, including the South Canterbury DHB Community and Public Health Committee, the Craighead Diocesan School Board of Trustees, and the Timaru Multiple Birth Club.
REJÁNE LE GRANGE
Award-winning aged care manager Rejáne Le Grange draws on almost 20 years of practical experience when she works to moderate the effects of dementia and to improve people’s lives by improving organisational culture and environment at all levels.
As senior dementia consultant at The Dementia Centre, she excels in working together with all those involved, from family members to CEOs, turning cuttingedge research into real life improvements. Her practical skills are helping managers implement person-focused care that saves money by reducing staff turnover, saves time in dealing with complaints, and improves reputations and referrals. Her expertise has been recognised both in Australia and in the UK, as evidenced by several major awards, including winning the Dementia Care category in the 2011 Pinders Healthcare Design Awards in the UK.
Benje Patterson is an economist at Infometrics Ltd, a leading independent economic forecasting and consulting company. At Infometrics, his responsibilities include forecasts for the transport sector, tourism, fiscal policy, the external sector, and the international economy. Patterson studied economics and finance at Otago University before spending two years at the University of Freiburg in Germany on scholarship from the German Academic Exchange Service. In Freiburg, he graduated with a Master of Arts in economics and politics.
Karima Velji is vice president for clinical and residential programs and chief nursing executive at Baycrest, a large geriatric health system in Toronto, Canada, with 1000 beds spanning the full continuum of aged care. Under her leadership, Baycrest was awarded accreditation with exemplary standing – one amongst the top five per cent of organisations in Canada. Velji has led a number of initiatives, including the North American benchmarking exercise for residential seniors care (Seniors Leap Initiative), the development of big dot metrics for seniors care using LEAN methodology, and the implementation of point-of-care performance reporting for quality and safety.
NZACA Conference 2012: Rotorua Energy Events Centre, 10-12 September MC: BRETT TUTHERIDGE
9AM REGISTRATION DESK OPENS
MONDAY 10 September 12.00 pm
Official Opening – Martin Taylor, NZACA CEO
Motivational speaker – Mike McRoberts
Continuum of Care/models - Canada –Karima Velji, Vice President for Clinical and Residential Programs and Chief Nursing Executive, Baycrest, Toronto, Canada
Winston Peters – New Zealand First Leader
Excellence in Care Award Finalists – Training and Staff Development, and Innovative Delivery categories – Judges – Martin Taylor, Bronwen Wilkins, Roy Reid, Grey Power Federation President
NZACA CONFERENCE PROGRAMME
Continuum of Care/models – Australia –Ingrid Williams, CEO, TLC Aged Care, Melbourne, Australia Welcome function amongst the Trade Exhibitors (included in registration)
TUESDAY 11 September 8.30 am
Member only breakfast strategy session and AGM NZACA Members Only
Excellence in Care Award Finalists: Community Connections, and Built and Grown Environment Categories – Judges – Martin Taylor, Bronwen Wilkins, Roy Reid, Grey Power Federation President
International comparison of aged care models Cam Ansell, Grant Thornton International – Sponsored by Grant Thornton
New and future care options in New Zealand To cover three areas: »» Total Care/CREST – Carolyn Gullery, CDHB General Manager of Planning and Funding »» TAC Contracts – Sarah Davey, BOP DHB and Ginni Cashell, Althorp Private Hospital »» Rehab provider – Sue Maney, Horowhenua Masonic Village Session to be Chaired by MC
Lunch Concurrent Session 1
Concurrent Session 2
Concurrent Session 3
Design in aged residential care: what the evidence shows (part 1) Rejáne Le Grange, Senior Dementia Consultant, HammondCare, Australia
Applying to the court for personal and welfare orders when an incompetent elder has no valid power of attorney Wendy Aldred
Design in aged residential care: what the evidence shows (part 2) Rejáne Le Grange, Senior Dementia Consultant, HammondCare, Australia
Collection and disclosure of health information Wendy Aldred
Practical interRAI training session Brigette Meehan, interRAI Project Manager and Cheryl Bowen, interRAI trainer
The Audit Process: Criteria and trends Marion McLauchlan and Heather Harlow – Ministry of Health
A profile of people at risk of entry into aged care (based on interRAI assessment) Michal Boyd, Gerontology Nurse Practitioner, Waitemata DHB interRAI update interRAI Steering Group - Martin Taylor, Chris Fleming, Brigette Meehan, interRAI Project Manager Conference Dinner “An Enchanted Evening” – INsite/NZACA Excellence in Care Awards Ceremony
WEDNESDAY 12 September 8.45 am
Concurrent Session 1
Concurrent Session 2
Concurrent Session 3
The Audit Process: Improvements in the system Heather Harlow, Ministry of Health
Supporting people living with dementia needs when they live in care (part 1) Rejáne Le Grange, Senior Dementia Consultant, HammondCare, Australia
Financial Benchmarking Cam Ansell, Grant Thornton International
Training a 2IC for a 1IC position Rhonda Sherriff and Judith Johnson
Supporting people living with dementia needs when they live in care (part 2) Rejáne Le Grange, Senior Dementia Consultant, HammondCare, Australia
When residents rights come into conflict with our duty of care Lydia Wadsworth Acting Senior Legal Advisor Health and Disability Commission
Hon Jo Goodhew – Associate Minister of Health
The public/private divide in Health – Benje Patterson, Infometrics
Future focus of care – Chai Chuah, National Director, National Health Board
Lunch and Prize Draws
Panel answering the question: “Is it deeper, wider or both?” Chris Fleming, Karima Velji, Ingrid Williams, Martin Taylor, Acute/Rehab provider – Sue Maney , Chaired by Brett Tutheridge
Conference Close – Simon O’Dowd, NZACA Chairman
www.insitemagazine.co.nz | June/July 2012 31
LAST WORD Ngarie Cowley is a caregiver for Home Instead.
A typical day in the life of …
Ngarie Cowley Ann Martin
NGARIE COWLEY IS passionate about her work. She has been a caregiver for Home Instead for four years. Her efforts have been recognised by the National Caregiver of the Year award, for which she has been a finalist two years running, winning the prestigious award in 2010. When asked what a typical working day was like for her, Cowley responds, “Well, no two are the same – but they are. I do anything from house work, to showering, high needs dementia, companionship, and stimulation, to sleepovers and convalescence. I love the mix. While I will happily do 24-hour clients, I prefer having a mix of clients with varying needs.” Every client has different requirements, and Cowley’s mindset changes accordingly as she moves from one client to the next. Some clients are just for an hour, some five hours, and sleepovers vary according to the family needs. “You just change as you move from one client to the next, as they vary in how they like to be approached. Some like a ‘quiet, get on with it’ type attitude, while others like to talk about their day, what’s happened, their life. Some are a bit grumpy and you have to turn that around. You just work with them and make the difference in their day. I love it and can not imagine doing anything else now,” says Cowley. Cowley admits some clients are more trying than others. “I have to be honest – when you have a dementia client and it takes an hour to get them to get out the door for an outing as they have had
to check their handbag 40 times, that everything is locked, etc. Well, that is when I am often working my hardest, but you just work with them patiently. Then we get out that door, their focus changes, you get the stories, and you make the difference to their day and lives. It is just wonderful,” she says. A typical day sees Cowley up at 6.30am and on the road by around 7.30am. “Usually, I am finished by 4.30pm to 5.00pm. Sometimes, I go back for a sleepover, but it just varies on what is happening with clients,” she says. “One of my frustrations is when my hours drop due to losing clients when they have been rehabilitated or passed away. Otherwise, there is no frustration. I would not like to only do housework, or high needs, or any particular kind of client. Personally, I need the variation. “What I know is ‘homecare’ is the best thing that could happen to these people. We change their lives on a daily basis. To see their faces light up when you walk in the door. The majority just do not want to leave their homes. The thought just about kills them. I see them respond so much more to the care in their own environment. They are just happier because they feel they have control. I only help where they need it. I fill the gaps and let them do whatever they can and want to. It is their home, we are there to guide, prompt, and assist. It just amazes me what these people are capable of doing, at times. They don’t mope about; they try to control their day and what happens. While this is not always possible, I truly see this business as being the best thing for them. “I love the elderly, their stories and wisdom. I also enjoy working with their families to relieve them a little and learn from them as well. I couldn’t imagine another job.”
www.insitemagazine.co.nz AGED-CARE & RETIREMENT
NEXT ISSUE: AUGUST/SEPTEMBER
In the next issue we focus on nutrition and diet in aged care, considering: »» expert opinions and latest research »» best practice nutrition and hydration in residential care »» trends in menu planning »» catering for a changing demographic »» dealing with special dietary requirements ... as well as the latest news, interviews, conference reports, and opinions from all corners of the sector.'
June/July 2012 | www.insitemagazine.co.nz
In the build up to Elder Abuse Awareness Day, Age Concern chief executive, Ann Martin, talks about this ‘serious and growing problem’. ELDER ABUSE AWARENESS
Age Concern works through 33 offices around New Zealand to provide information, advice, referral, support and many other services for all older people. We gather grassroots information from the hundreds of older people who use our services about what matters to them and what life is like for older New Zealanders in 2012. Certain themes emerge time and time again. Older people have told us their top four concerns are elder abuse, loneliness, being able to afford the basics, and getting the care they need. We also know the abuse of older people is a very serious and growing problem in this country. It is a hidden problem, as often the very people an older person should be able to trust are the ones responsible for the abuse. This June 15 is Elder Abuse Awareness Day. You can also support the day by wearing purple. Every week, caring people from Age Concern hear of older people who have been abused. The cost can be devastatingly high. We know of older people who have lost their life-savings and security, and worst of all, their sense of wellbeing. This is a serious issue all New Zealanders should care about. Why? Because it harms older people, affects family relationships, impacts an older person’s ability to contribute to our communities, and the health costs are often significant. We also know 40,000 older people are extremely isolated and lonely – that’s the equivalent of a town the size of Nelson. If I could ask you to do one thing today, it would be this. Mark June 15 and resolve to do one thing to make a difference for an older person. Perhaps you could visit an older neighbour? Ann Martin is chief executive of Age Concern
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