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AGED-CARE & RETIREMENT

June - July 2013 | Vol. 7 Issue 5 | $10.95

WE’VE GOT YOUR INDUSTRY COVERED I www.insitemagazine.co.nz

21 I REGULARS

ON THE SOAP-BOX:

RAY LIND ON UNLEASHING

THE POTENTIAL OF AN “UNREGULATED” WORKFORCE

4 I FOCUS ON

DESIGN AND

2 I NEWS

BUDGET 2013:

IS IT ENOUGH?

INNOVATION A FIERY SUBJECT:

NEW FIRE SAFETY CLAUSES SPARK AN UPROAR


We’re here to help protect your aged care facility With elderly, disabled and less mobile residents, the aged care sector requires specialised fire protection solutions. With Wormald, you have an organisation that is always right behind you when you need us most. We’ve helped prevent and protect against fires for over 120 years. From emergency evacuation plans and tailored fire protection systems, to fire equipment and fire safety training, Wormald’s specialist teams can design, install and maintain fire protection systems to match your needs and budget. So, you can get on with providing care, confident that your residents, patients, staff and facilities are supported by one of the world’s fire safety leaders. That’s peace of mind. Trust the aged care fire safety experts. Call 0800 4 WORMALD, email wormaldnz.ads@tycoint.com or visit wormald.co.nz/healthcare

A Tyco Business


In this issue...

www.insitemagazine.co.nz AGED-CARE & RETIREMENT

INsite Magazine Vol.7 Issue 5

Editor: Jude Barback @INsite_NZ T: 07 575 8493 E: editor@insitemagazine.co.nz Advertising: Belle Hanrahan T: 04 915 9783 E: belle@apn-ed.co.nz Production: Barbara la Grange Aaron Morey Editor-in-chief: Shane Cummings @ShaneJCummings General manager/publisher: Bronwen Wilkins Subscriptions: T: 04 471 1600 F: 04 471 1080 E: subscriptions@apn-ed.co.nz Publisher’s note: © Copyright 2013. 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 T: (04) 471 1600 F: (04) 471 1080 ISSN 2324-4755 INsite is distributed to key decision makers in the aged care sector and its distribution is audited by New Zealand Audit Bureau of Circulation (ABC).

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The challenge of providing care in an environment that suits everyone.

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Uproar over new fire safety clauses

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Kapiti Retirement Trust shares the highs and lows of renovating its aged care facility

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Are we friendly with dementia-friendly design?

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Technology’s role in “ageing in place”

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Telehealth in aged care

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ED LETTER WHENEVER I VISIT a retirement village or rest home, I’m always struck by the challenge that must confront operators of providing care and a lifestyle to suit every resident; particularly larger villages, which cater for everyone from the healthy, independent sixty-somethings, right through to those requiring end-of-life care. When building a new facility, or altering an existing one, how do operators design a place that meets everyone’s needs? How is the right balance to be achieved, and within budget constraints? And beyond the provision of care delivery, the somewhat more frivolous decisions of what colours and fabrics to use also requires careful consideration, bearing in mind the varying and changing demographic being catered for. In this issue we look at this notion of being all things to everyone, and consider some of the ways that various operators are trying to do just that. We are lucky to have a brilliant case study to share with you. Kapiti Retirement Trust gives us a rare glimpse into the inner workings of renovating its aged care facility. They show us the importance of remaining flexible throughout a project and of taking a creative approach to fundraising to achieve the desired end result. Of course, innovation can take many guises. In this issue, we look in depth at technological innovation in aged care: iPads in dementia, the increasing sophistication of sensor and robotic inventions, the way telehealth is transforming aged care – and it would be churlish not to pick up on the many reader responses we had from our interRAI debate in the last issue; the debate reaches a head in Last Word. Do keep your feedback flowing. Let us know what makes your heart sing and what makes it sink when it comes to working within the New Zealand’s aged care sector. Our next issue is our annual ‘nutrition’ edition – don’t miss it! Also, check out INsite’s super new website (www.insitemagazine.co.nz) with more bells and whistles to help keep you connected with what’s happening in aged care.

6

FOCUS

Uproar over new fire safety clauses

2

REGULARS

NEWS Snippets and updates from the industry

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A TYPICAL DAY IN THE LIFE OF... Annie Schenkel

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UP CLOSE & PERSONAL... Eleanor Bodger and Esther Perriam

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CONFERENCE CORNER: NZHHA report and NZACA preview

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SPOTLIGHT ON... Arthritis

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ON THE SOAP BOX... Ray Lind

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LAST WORD... Peter Mathyssen

Editor, Jude Barback editor@insitemagazine.co.nz Follow us on Twitter: @INsite_NZ

Connect with INsite Magazine on Twitter Follow INsite for breaking news, the latest innovations, and conversations with editor Jude Barback on the professional issues close to your heart. Find us on Twitter@INsite_NZ

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UP CLOSE & PERSONAL...

Eleanor Bodger and Esther Perriam

www.insitemagazine.co.nz | June / July 2013

1


News

HAEDER

BUDGET 2013: WELCOME, BUT STILL NOT ENOUGH Aged care and dementia services will receive an extra $70 million over the next four years, as a result of this year’s Budget. The Budget 2013 package is providing $20 million additional funding over four years for home support services, $12 million increase in funding for dementia bed subsidies over four years, $3.2 million over three years for dementia related training and to support dementia awareness, and a $1.5 million contribution to costs for training aged care staff in the use of interRAI. District health boards have also been funded to invest an additional $33.2 million on aged residential care subsidies over four years. The funding increases in these areas were largely met with appreciation from the sector. Age Concern President, Evelyn Weir, said she welcomed the additional funding but felt that the Budget did not touch upon other serious aspects of ageing. “The new money will help in some parts, but not others in desperate need, such as elder abuse and neglect prevention and addressing social isolation,” she said. Many also felt that while the money flagged for home support services was very welcome, much more was needed to resolve the level of underfunding in this area. There was some concern raised that funding for home support services might be diverted to prop up District Health Board budgets. “It is critical that this funding injection goes where it is most needed, to support and train this valuable workforce,” said Julie Haggie, chief executive of New Zealand Home Health Association. Budget 2013 is also allocating $100 million to helping meet population changes and cost pressures in disability support services. In response to the Court of Appeal’s decision in Ministry of Health v Atkinson and others, the Government also announced it will provide $92 million over four years to pay family members who care for their disabled adult children. However, the New Zealand Carers Alliance says the Government’s move will only help a limited number of families. The Budget has also allocated $35.5 million for diabetes and heart disease, $48 million for more elective operations such as hip replacements and cataracts, and $14 million extra towards the SuperGold Card off-peak public transport concession scheme.

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June / July 2013 | www.insitemagazine.co.nz

Christchurch aged care nurses on the inaugural GAP course (from left): Ruth Cahutay (BUPA), Gene Ruiz (Ultimate Care Group), Vivienne Erickson (CDHB), Grace Amoafo (CDHB), Kathryn Stewart (CDHB) and Wedzerai Matsheza (CDHB)

‘Job swap’ programme to train next generation of nursing leaders

THE LOOMING WORKFORCE crisis in aged care nursing has prompted Canterbury to create a ‘fast track’ programme to build future nurse leaders for the sector. Six nurses – two from Christchurch residential aged care facilities and four from Canterbury District Health Board (DHB) older people’s health related wards – have been selected for the inaugural programme which got underway in late May. The one year programme includes postgraduate study and “job swapping” between workplaces so the rest home nurses experience working in DHB services and the DHB nurses experience nursing in a rest home. Kate Gibb, the DHB’s older people’s health nursing director, said the idea for the scheme grew out of a committee formed in mid-2011 look at post-quake issues for older people’s health, particularly workforce issues. She said even before the quakes there was a real sense of a looming workforce crisis, with half the nurses working in residential aged care in Canterbury over the age of 50 and 20 per cent over 60. The result has been the Gerontology Acceleration Programme (GAP), which supports the development – both professional and academic – of motivated registered nurses already working in older people’s health who have the potential to be future clinical leaders or managers. Gibb said the GAP scheme was not only a first for Canterbury but also a first across New Zealand for gerontology nursing and was being followed with interest by the Chief Nurse’s Office. Jenny Gardner, the DHB’s coordinator of postgraduate nursing education, said a similar nursing ‘exchange’ programme had been carried out in-house, but this was the

first time the job swaps had been between DHB and non-DHB workplaces. Each of the six nurses will have two 12-week clinical rotations where they will step in and fill the shoes of their fellow GAP nurse while staying on the payroll and pay conditions of their home employer. During each rotation they will have an orientation period where they will be supernumerary and be assigned a preceptor at that workplace. The GAP nurses have also all been allocated a mentor for the programme, a gerontology clinical nurse specialist, to assist them in setting goals and helping them advance their gerontology nursing practice. Gardner said the programme was also working very closely with the University of Otago’s Centre for Postgraduate Nursing Studies. Each of the GAP nurses would be expected to complete Otago’s postgraduate gerontology paper in the first half of the programme and then (during the third and final 12 week rotation when they are back with their home employer) the advanced health assessment paper. Two of the nurses have already done some of the papers and will complete related postgraduate papers. One of the GAP nurses, Ruth Cahutay, is a Philippines-trained nurse who has been working as an RN on nightshift at BUPA’s Parklands aged care facility since 2009 after completing her competency assessment programme at CPIT. Having already completed her postgraduate health assessment paper last year, Cahutay thought the GAP scheme would be a good experience and a good chance to get out and meet other people working in the same field. “There’s a whole big world out there of gerontology, and I don’t think there’s a lot of nurses who are going down that path.”


NEWS

IN VILLAGE NEWS

☛ GOT AN OPINION? Have your say online at www.insitemagazine.co.nz Capital raising, sell-downs, record profits for big three All three listed New Zealand retirement village operators have been in the media spotlight in recent weeks.

Metlifecare’s capital raising successful

Metlifecare has successfully raised $70 million of capital to help fund its plans for future growth and settle debt resulting from the acquisition of Vision Senior Living and Private Life Care Holdings last year. The placement price has been set at $3.10 per share. Metlifecare is also offering a Share Purchase Plan to eligible shareholders, expected to raise up to $10 million. According to chairman Peter Brown, the capital raising is intended to ensure there is more capacity to progress consents and developments on existing sites, and to further expand the company’s greenfield land bank and fund the development of aged care facilities and services. Metlifecare is aiming for a build rate of at least 200 new units a year by 2015. Goldman Sachs acted as sole lead manager, placement agent, underwriter and bookrunner for the offer. Trading on Metlifecare shares was suspended during the placement.

Quadrant sell more Summerset shares

Trading was also halted for Summerset shares to allow Australian firm Quadrant Private Equity to sell 30.7 million of its remaining shares in the retirement village operator. The sell-down follows Quadrant’s initial divestment of 40 million shares in March, upon the expiry of the escrow period which required the firm to keep its 56 per cent majority stake in Summerset.

Quadrant now holds 49.1 million shares, or 22.7 per cent, of Summerset. Summerset chairman, Rob Campbell, said the shares had been distributed to a range of Australian and New Zealand investors. “The sale has been supported strongly by existing and new shareholders,” he said.

Record profits for Ryman

Meanwhile, Ryman Healthcare’s annual profit rose 13 per cent, largely due to an increase in fee income and the rising value of its property portfolio. Net profit increased to $136.7 million, or 27.5 cents per share, in the 12 months ended March 31, from $120.8 million, or 24.3 cents, a year earlier. Ryman’s revenue climbed 17 per cent to $181.3 million, with care fees and management fees both increasing by 17 per cent, yielding $148.4 million and $32 million respectively. New unit sales rose by 35 per cent to 506 and existing unit resales increased by 18 per cent to 479, worth $345.6 million in total. Depending on the success of its new village in Wheelers Hill in Melbourne, Ryman is likely to increase its build rate in Victoria over the next five years. James Beale, head of investment management at Craig’s Investment Partners says that the market is gaining more confidence in the ability of Ryman to roll out in Australia, which is being reflected in current share prices. “Whilst that approach does come with risk – they still do have to successfully deliver on their first village there – the market is

Careerforce leading qualification review

NEW ZEALAND QUALIFICATION AUTHORITY’S national review of all level 1–6 qualifications will result in a smaller number of relevant qualifications that meet industry needs. Before the review, there were too many qualifications and some of them were not relevant or up to date. Employers wanted to know that qualifications contain the right skills and knowledge for the future workforce, employees and clients. Industry Training Organisation Careerforce is leading the review of all qualifications for health, aged care, disability, and social services sectors. “This is a big job and a really important one,” says Gill Genet, Careerforce’s General Manager Business Development. “To get this right, we are working with employers and other parties from right across the sectors. They know what works and what is needed.” “Through February and March we conducted over 30 meetings across New Zealand with a great range of people involved from across the sectors. A significant theme has been the call for qualifications to take a more person-centered approach. And to have a suite of qualifications based on the needs of the client and their whānau, which also connect the sectors with common competencies.” A message Careerforce wants to make clear throughout the review is: do not stop training. “Definitely do not stop training and do not wait for the new qualifications as they won’t be available until late 2014 at the earliest,” says Genet. “Part of the work includes identifying how current qualifications fit into the new qualifications, so workers with existing qualifications are not disadvantaged.” Careerforce will continue to work with industry through advisory groups and ongoing consultation. “We want to encourage everyone who is interested to get involved and have your say.”

giving them credit given the strong history of sensible, staged rollout, and delivering results.”

Is the sector peaking?

Beale believes the sector appears to be fully valued at present and warns that investors’ expectations of short-term returns from the sector need to be moderate from here. However the very efficient use of capital in the sector, the track record of performance and the strong demographics need to be considered too, says Beale. “Part of the share price strength is that New Zealand investors understand the sector and its prospects, and are loyal to the businesses. So other investors are having to pay up to get access to what still is a good long term investment story. “In many ways, the growth is still in front of the sector, with significant increases in the 75 plus population coming through in the next 15 – 20 years. So all three retirement village businesses have a strong tail wind, and all have seen share price increases.”

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FOCUS

BEING ALL THINGS TO EVERYONE Retirement villages and aged care providers face the predictable challenge of providing an environment that will appeal to a group of people with diverse backgrounds, varying tastes, and differing care needs.

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etirement villages and rest homes, by their very nature, must cater for a range of residents. Each has come from his or her own unique lifestyle, each with different needs. Matthew Hutchinson, Director of Seniors Living at Australian design firm ThomsonAdsett, says catering for this diversity remains a significant challenge for designers and facilities. “[Residents] have come into an establishment that by default has the effect of streamlining them into a common way of living for better or for worse. Their needs will differ and care providers will aim to cater for those differences. The challenge becomes considering opportunities to provide destination options for residents, as much as possible within the prevailing operating model of care and building budget,” says Hutchinson in an interview with Australia’s Hospital and Aged Care. Striking a balance between homeliness and providing adequate care and safety is a tricky business, especially considering the various levels of care that are offered. A large retirement village, for example, needs to heed its hospital-level facilities as much as its social facilities. While the pool, gym, and bowling green are bound to appeal to its younger, healthier residents, as calendar pages turn and health wanes, the same residents will inevitably find themselves unable to join in the bowls tournament and increasingly relying on other services on offer, usually those related to their care and health needs. “Facility design must facilitate the various levels of care that will be offered as invariably new facilities are being designed as ageing in place,” says Hutchinson. “This means they will facilitate care for residents with modest needs as well as those with very high needs within the same basic setting. “Additional consideration must also be given to ensuring these spaces are safe, stimulating, and secure environments for all residents, particularly those with dementia. Residents will spend a large part of their remaining lives in these environments, thus they need to work well for all involved.”

HYBRID ACCOMMODATION

Hybrid accommodation – residences which allow residents to live independently while receiving the appropriate level of care as required – appears to be the way forward for retirement villages, echoing the Government’s emphasis on ageing in place. The concept was developed in the early 1990s by the village industry, but in the past five years, village operators have been able to 4

June / July 2013 | www.insitemagazine.co.nz

certify these apartments to deliver rest home level care. Martin Taylor, chief executive of New Zealand Aged Care Association says many drivers, including the increasing expectations of older people, will push design, innovation, and funding models within aged care. Taylor says at present this is manifesting itself in the growth of serviced apartments. “This outcome alone is likely to become a significant feature of the aged residential care market – and it should, as it fundamentally supports the often-repeated ‘ageing in place’ mantra,” says Taylor. “Up until the serviced apartment innovation, successive governments just focused on keeping people at home in the wider community – and ignored the reality that this outcome doesn’t fit for over 20 per cent of the over-80s. True ageing in place is having your rest home and hospital-level care delivered into a space you call your own.” Simon Challies, managing director of Ryman Healthcare, says hybrid accommodation in the form of serviced apartments or studios where care is delivered has been an essential part of Ryman villages since 1993. Oceania’s Assisted Living Suites is another example. The suites, offered by a number of Oceania villages, feature a living environment, bedroom and ensuite as well as the necessary design features to allow for delivery of resthome and hospital level care. The suites are equipped with nurse call buttons in the bedroom and ensuite areas. Summerset’s care apartments also showcase hybrid accommodation in action. Norah Barlow, chief executive of Summerset says residents typically come into a care apartment through one of two ways. “Either you already have a need, you have been looking at a rest home, and you see this as a better option, or you have very low level needs, such as house cleaning, assistance with showering, or meal delivery, but you can see that your health is deteriorating. In the first case, we need to cover right from the start at rest home level care, whereas in the second, we need to keep increasing the care delivery as their needs slowly increase.” In terms of design, the care apartments are more set up for the delivery of care than more traditional village apartments or villas. “Many villages do not have flat access or bathrooms where hoists can easily go. Our care apartments are designed so that these aids are able to be used and so that the resident can maintain as full and independent life as is possible,” says Barlow. However, Ryman takes a different approach to design and strategy. Challies says that

Ryman purposefully doesn’t provide the sorts of design features to aid delivery of care in its apartments because this would be encroaching on hospital-level care. At the point residents need specialist equipment, they would need to be admitted to a hospital-level care facility, says Challies. Challies is noticing an increasing number of couples seeking hybrid accommodation. In these circumstances, typically the healthier partner tends to take care of the other. This has had an effect on the type of residence offered. He says studio apartments are a thing of the past, with a tendancy towards one-bedroom apartments now. Summerset is also finding that its care apartments appeal to couples. In order to meet the needs of couples where the health of one partner is at a different level to the other’s, twobedroom care apartments are now provided. Barlow does admit that providing hybrid accommodation brings its own challenges. A group of care apartments are occupied by a diverse range of people makes staffing more difficult. “Staffing is not only about occupancy, it is about the individual needs of each resident. Not easy for the manager to manage,” says Barlow. Challies says it is more expensive to operate this sort of model as there is more area for staff to look after. “Residents know it is more expensive – they are paying for the luxury to age in place for longer,” he says. Barlow says there is also an issue with funding when a resident is subsidised. “The product is not yet fully understood, and so the funding for those that qualify is not so easy.” However, despite the challenges, Barlow believes the extra effort is well worth it, given the clear desirability for this type of ‘home’ rather than a ‘room’. “I see this as a growing trend in New Zealand. Think of the clear choice now able to be made by a resident. I can have my own small kitchen, my own lounge, I can have visitors, I can have people stay, and yet I can have a large well set up bedroom and bathroom. I can lock my door if I wish. We are also often the target for overseas visitors looking to replicate this.”

CATERING FOR DIFFERENT BUDGETS

Of course not everyone has the means to approach retirement living with the funds needed to buy into this sort of care and lifestyle setup. Almost one million New Zealanders will be over 65 by 2026 and around two-thirds will be in lower income brackets, many struggling to keep up with living costs, home repairs and maintenance.


FOCUS FOCUS considered, as do the practicalities; the need for more frequent laundering, for example. The suitability for older people is another consideration; for instance, big heavy blinds are often difficult for older people to operate easily. However, at the same time, thought also needs to be given to the fact that occupancy changes, and one resident’s taste is bound to differ from another’s. “The incoming residents will all have varying tastes when it comes to décor and whatever paint, carpet, and window furnishing colours are used need to work with their bedspreads and lounge suites. To this end, the colours are kept reasonably neutral.”

SUPPORTING STAFF AND FAMILY

Oceania, in addition to offering its Assisted Living Suites at some villages, has also set out to provide an affordable retirement villa solution at other villages. Oceania Living has developed the Nikau villas – a concept to provide affordable housing that meets the needs of older people. Six Nikau villas are being completed at Stoke Retirement Village, with nine scheduled for Hutt Gables Retirement Village and 10 at Heretaunga Rest Home & Village. An affordable option with the perks of village life is obviously appealing to many New Zealanders as the concept appears to be taking off. Rather than scrimping on quality design and fixtures and fittings, the focus has been on providing a modular, flexible, and energy efficient design. The villas have no corridors, which coupled with mono-pitch roofs and high ceilings, provide a sense of spaciousness. Thought has been given to the increasing care needs of older people too, with bedrooms and bathrooms providing room for manoeuvring a wheelchair and carer assistance. Prices range from $189,000 for a onebedroom villa to $270,000 for two bedrooms and a full garage. Of course, residents must also factor in the village fees.

many people are involved in decision making, often with different agendas. “There are also many more people involved in the process, all with a particular point of view or emphasis. To some the finish or décor is all important while to others the budget is most important. Merging the architect’s and designer’s emotive view with the manager’s more practical view with the owner’s budget can be a challenge. But it does work. In fact it is vital to have these people involved with different accents to be sure the finished product does not look boring or cheap!” Thomsen has noticed much change in décor trends over the years. “Having completed many large aged care projects in New Zealand over the years, it is clear there are many changes in how the décor is now considered. Once it was solely about what elderly people were used to: traditional floral fabrics, curtains off the floor so they can clean/sweep under them, café curtains in the kitchen with a spring operated Holland blind, heavily laced net curtains with a scalloped frill or cross-overs! Catering for the ‘baby boomers’ has changed all this, with much higher expectation given to their own retirement and that of their parents.” Thomsen believes the decor is important, as it A MATTER OF TASTE sets the tone about the purpose of the building. The luxury of retirement village living – or “We have most recently completed installing indeed of owning your own residence wherever window furnishings in the new Meadowbank it may be – is that you can furnish and decorate Village and about to begin with the new as you please. Remuera Rise behind Newmarket shops. It is For care facilities, fabrics, and colours are plain to see the amazing change in quality and usually foisted onto residents by the operator. the attention given to detail. It’s no longer about Many factors come into play when deciding “housing” people but rather about creating a which materials and products to use – provision lifestyle and community for people who happen of care, safety, durability, look and feel, comfort, to be retired.” and of course, cost. When it comes to selecting the appropriate Based on his experience with window window furnishing, Thomsen says thought furnishing projects for many aged care needs to be given to the needs of the facility facilities, Ken Thomsen of New Zealand Drape and the end users – both residents and staff. Company says it can be a tricky process when so Safety aspects, like fabric fire ratings need to be

A village or aged care facility needs to factor in the needs of its staff and visiting family members as well. Resident’s rooms should lend themselves to family visits and ideally a home-like environment should be included in a design to allow family members to join the resident in everyday activities. Small dining rooms, recreation rooms, even activity kitchens all work well. Cafés and gardens also serve the same purpose. The inclusion of a children’s indoor and outdoor play area will encourage families with children to visit more often. Access to technology is becoming increasingly important as older people become more comfortable with Skype and other web-based tools to stay in touch. Involving local business and community organisations, schools, and churches in the planning stages of the facility is a good way of welcoming future community involvement. When it comes to staff needs, walking distances need to be considered and the design needs to be such that staff can easily move about to complete their tasks. For example, ensuites need to visible and accessible to staff and large enough for them to move around in. Storage is important and often an area many neglect in their planning. Storage space for equipment and personal belongings needs to be factored in. Instead of traditional nurse stations, many facilities are now including areas where staff can see and communicate with people with dementia and their families while working. Staff need a quiet, comfortable area for rest and relaxation. A work area with internet access and document storage is also essential. Ideally, an area for in-house training with space for interactive sessions could be included, too. Parking, both for staff and visitors, needs to be considered. Of course, the checklist could go on and on. Everything must be prioritised in terms of budget, space, and need. A village or rest home needs to serve many different purposes for many different people and its design needs to reflect this. Careful planning and managing the input of many interested parties, as well as keeping the end users in mind, is certain to help with what can be a tricky process. www.insitemagazine.co.nz | June / July 2013

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FOCUS

A FIERY SUBJECT The new Protection from Fire clauses have got the residential aged care sector hot under the collar about the likelihood of extra costs resulting from expansion or refurbishment.

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he New Zealand Aged Care Association (NZACA) is fighting new New Zealand Building Code Protection from Fire clauses which look set to have an impact on aged residential care providers who wish to refurbish or expand. The previous building code fire safety clauses were replaced by six new fire safety clauses (NZBC C1 – C6) from 10 April 2013. The single fire safety compliance document has also been replaced with eight new compliance documents, Acceptable Solutions, and a new verification method. The NZACA is questioning why the changes have been made in the first place, as there does not appear to be any evidence to suggest that the previous standards and fire safety clauses were inadequate. The association has placed an official information request to glean what is driving the new legislation. “Are fires hotter now? Are fire engines slower? Have there been lots of fires in health facilities? Have sprinkler systems been failing across the country? Unless there is an evidenced-based ‘yes’ to these questions, then the changes cannot be justified on the basis of an increase in risk,” states the NZACA in its weekly In Touch newsletter. However, Building and Construction Minister Maurice Williamson told INsite the main reason for changing the fire safety clauses was to clarify the basic performance criteria that designers and fire engineers needed to meet to ensure Building Code compliance. “The previous fire safety clauses did not do this clearly enough, which led to delays in the construction and occupation of buildings, increased construction and capital costs for developers, and a longer consenting process.” The Ministry developed the new Protection from Fire clauses with a working group of highly-qualified fire engineers following a statutory review in 2007. In 2010, the proposals underwent an extensive 12-week public consultation process and were also tested at a number of international conferences, with positive results. However, the association’s main concerns have arisen from an OPUS report commissioned by the association to investigate the potential effect of the new clauses on aged care facilities. The report shows that the new clauses are likely to make it too costly for aged care operators to expand and refurbish existing facilities. In a letter to Ministers Ryall and Williamson, the NZACA states that as a Building Consent Authority is likely to require 6

June / July 2013 | www.insitemagazine.co.nz

compliance with the new regulations for the entire building, not just the part that has been refurbished or expanded, the expense of re-lining, plastering, painting existing rooms, combined with the loss of income during the retrofit, is likely to be financially damaging to facilities. However, Minister Williamson confirms that compliance with the new clauses does not necessarily mean that a full upgrade of a building’s fire safety system is required when an alteration or addition is undertaken. “Owners of affected buildings need to work with the relevant Building Consent Authority (BCA) to understand what is required in their specific circumstances. “The law hasn’t changed but the new clauses are intended to make it clearer for designers and engineers to understand. The Building Act 2004 calls for compliance as nearly as reasonably practicable with regards to the means of escape from fire. This requirement is not new and has not changed as a result of the new Protection from Fire clauses. “The intent of this requirement is that existing buildings are upgraded to protect people from injury or illness caused by fire, as well as to protect other property from damage. However, the extent to which

compliance is required depends on the characteristics of each individual project and should be discussed and agreed upon with the local Building Consent Authority (BCA). “BCAs have discretion to allow alterations to an existing building without the whole building complying (fully or in part) with the Protection from Fire clauses of the Building Code.” There appear to be three circumstances when this could occur: firstly, if requiring compliance would mean that the alteration would not take place; secondly, if the alteration will result in improvements to means of escape from fire; and thirdly, if those improvements to means of escape from fire would outweigh any negative effects of the building not complying with the Protection from Fire provisions. However, Martin Taylor, is not convinced by the Minister’s statement that the new clauses won’t affect facilities that expand or renovate. Taylor says although the association agrees with the Minister around the intent of the changes to protect people and property, his statement confirms the association’s advice that it is possible for a provider to be forced to undertake a full upgrade of a building’s fire safety when an alteration is undertaken. “The words he uses are ‘does not necessarily mean’ which can be read as ‘it could be required’. This uncertainty in itself increases the risks for operators and will prevent many from undertaking refurbishments,” says Taylor. “As we said in our letter to the Minister, we hope our advice is wrong and we look forward to the Government’s assurance that no operator will be made to upgrade an entire building’s fire safety system if they undertake a refurbishment. We note no such assurance has yet been given. “We are interested in the statement that the law hasn’t changed and is about clarification for designers and engineers. This is a little disingenuous as while the primary law has not changed, the fore code that is set under that law has changed, which is why designers and engineers are telling us the new clauses will have a material impact. So we need to sort this situation out as soon as possible. “The Minister also confirms our advice that it will be up to each individual Building Consent Authority on what takes place when and how. This alone creates uncertainty and why the Minister will be reluctant to give the assurances we have asked for. It may also mean the playing field could be tipped in the favour of larger operators who have the means to hire powerful fire consultants, which may result in them negotiating more favourable outcomes than the outcomes negotiated by individual owner operators or religious and welfare operators.” So it appears that while the intention of the new Protection from Fire clauses was a step to clarify performance criteria to meet Building Code compliance, the NZACA is still waiting for answers and clarification on exactly what affect the changes may have on aged care providers.


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NO ROOM FOR COMPLACENCY WITH FIRE PROTECTION Lessons learned from deadly fires show that fire protection products and services are a vital aspect for aged care facilities to consider. ALTHOUGH IT IS the technical details that are currently under scrutiny, few would dispute the importance of adequate fire safety protection in aged care facilities. Sydney rest home Principal Quakers Hill suffered a devastating fire in November 2011, killing 10 people. The incident sparked cries in New South Wales for a legal requirement for aged care facilities to be equipped with emergency sprinkler systems. Auckland Fire Safety Officer Terry Castle, who wrote to the Herald soon after the incident, believes the damage and loss of life caused by the fire could have been prevented. “Automatic sprinkler systems have been in existence for over 130 years and it is an indisputable fact that when functioning correctly, an operative and compliant system will provide the highest level of life and property protection that can be achieved in the event of a fire eventuating in a building.” However, the consideration of retrofitting older facilities with improved fire safety systems brought up the same arguments of expense. “No one is opposed to sprinklers ... but there is concern at the question of cost and unintended consequences of mandating, especially in the light of the growing demand for residential services,” said Cynthia Payne to Australia’s Aged Care INsite. Payne also questioned whether sprinklers were the best way forward. A reconstruction burn of the Quakers Hill home showed that sprinklers would have helped to limit the heat and damage caused, but couldn’t rule out loss of life, especially as most deaths come from smoke rather than heat. Certainly, sprinklers are not necessarily the only option in fire protection. Fire protection specialist Wormald favours a more bespoke approach for aged care facilities and suggests that fire protection solutions should

be aligned to the needs and the budget of the facility, in addition to complying with the relevant legislative requirements. These solutions may encompass a combination of fire protection products and systems such as fire detection and occupant warning systems, fire sprinkler systems, and portable fire equipment such as fire hose reels, fire blankets, and fire extinguishers. Peter Fermor, Wormald’s managing director says, “With infirm and often immobile residents, as well as supporting intricate medical equipment housed in such

understanding of the needs and fire hazards specific to the facility. Fermor advises that aged care facility managers should check that their building has a current Building Warrant of Fitness and that the specified systems listed on the compliance schedule accurately reflect what is actually installed within the building. “While a fire protection specialist can assist in providing information, it is advisable that every facility manager be fully aware of what is applicable to their particular facility,” he says.

When developing a fire protection solution for an aged care facility, it’s useful for fire protection specialists to consult with facility management and staff as it helps gain an understanding of the needs and fire hazards specific to the facility. facilities, fire protection in the aged care sector requires both careful planning and technical knowledge. “While it is not always possible to prevent a fire, inadequate or improper fire protection can expose residents and staff to dangers, lead to potential injury, or in a worst case scenario, loss of life. Aged care facility managers must be fully aware of any fire risks on site and it is their responsibility to actively work towards minimising these risks.” According to Wormald, design, installation, maintenance, and technical support are all key components of an effective fire protection solution. Consideration should be given not only to the levels of fire protection required but also to compliance, usability, logistics, and the financial investment involved. When developing a fire protection solution for an aged care facility, it’s useful for fire protection specialists to consult with facility management and staff as it helps gain an

Fermor is also an advocate for fire safety training. “Fire safety training is also extremely important as it can help ensure that staff and occupants are aware of the building’s emergency management and evacuation plan and procedures. In the event of a fire, elderly and immobile residents will require special assistance to evacuate the building. Having trained staff that are proficient in evacuation procedures will provide the best possibility for this to happen in a methodical and efficient manner.” It is clear that a ‘one size fits all’ approach isn’t necessary; instead, facilities should be thinking about what they need and what they can afford in order to get the most appropriate fire protection programme for them. The horrific Quakers Hill incident, in addition to other deadly examples in New Zealand’s history, make it clear that fire safety is one area in which we can’t be complacent.

edward@activerehabequipment.co.nz

www.insitemagazine.co.nz | June / July 2013

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Renovating the Lodge: A LESSON IN INNOVATION The Kapiti Retirement Trust gives INsite an insight into its inspiring major refurbishment project, providing a glimpse of the challenges associated with making decisions, sticking to budget, and ensuring continuity for residents.

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y 2006, Kapiti Retirement Trust’s aged care hospital, The Lodge, was in need of expansion and refurbishment. The Lodge was originally built in the mid-1990s, consisting of 37 beds, including a secure 11 bed dementia unit, the Kauri Wing. Continuing care beds were spread over the Kowhai and Rata wings at one end of the building, and the Matai wing at the other end, adjacent to the dementia wing. A block of 42 apartments offering independent living was attached. The building also included the main administration area of the Trust and other associated service areas, such as the activities room, staff room, offices, laundry and dining rooms for both continuing care, and the apartments. Over the next decade, the Trust went on to expand its retirement village onto another site – Midlands Gardens, on which 90 villas were built. In 2006, after largely completing the new village development, the Board made the decision to use funds accumulated from Midlands Gardens to expand and refurbish The Lodge. A total budget of around $3 million was available to complete this over the following five years.

CLOCKWISE FROM ABOVE: Kauri garden, bedroom fittings in the new wing, the new dining room and the refurbishment in progress.

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June / July 2013 | www.insitemagazine.co.nz

THE PLAN

With the money in hand, the Trust set about making decisions about what they wanted to achieve with the renovation project. It was agreed that an additional 12-roomed continuing care wing – to be named the Rimu Wing – with rooms sized 4m x 4m, should be added. They also decided to refurbish the existing three continuing care wings and enlarge the rooms from 3m x 3.75m to 3m x 4.4m. A corridor, or ‘the gallery’ as it would be known, would be added to connect the Rimu, Rata, and Kowhai wings and also serve as an additional lounge for residents. The dementia wing would be refurbished and reconfigured to create a 12th room. The main Lodge dining room was also to be refurbished and expanded. Two additional sluice rooms were to be added, the staff room reconfigured, double-glazed central skylights added, and a ventilation system installed. The Trust also decided to reconfigure and refurbish the main entrance lobby and administration area, as well as upgrade the commercial laundry and refurbish all corridors, bathrooms, and common areas including the activities room and the main dining room for the apartments.

THE ENSUITE DILEMMA

With plans agreed, the project began with building the new Rimu wing. Going against current trends, the Trust made the decision not to include ensuites. Trust chief executive, Wendy Huston, said that their decision was guided by the research, which shows that a significant number of falls occurred when residents at this level of care tried to self toilet or families tried to assist in toileting. Statistics indicated that falls in bathrooms were more likely to result in injury. “This is understandable given the very limited mobility the majority of the residents have. It was decided that as residents mostly needed staff help with toileting and this is what we wished to encourage, then it was better use of space and finances to put the space used into additional general room space.” Accordingly, the rooms were increased to 4m x 4m providing greater room for specialist equipments, such as hoists. Customised storage units with basins and water filters were installed. Sensor taps were also included for infection control purposes, at significant cost. Huston says they proved to “expensive, inefficient, and unnecessary” and provided constant, unresolvable problems with the taps turning on at the wrong time due to overly sensitive sensors. They were replaced two years later with traditional taps. The taps weren’t the only problem faced with the Rimu Wing build. “As they say, ‘the devil is in the detail’”, says Huston. She says they learned to assume nothing, even when employing ‘experts’ to manage the job. For example, the toilets were installed at standard height, not disability height, and had to be refitted.


FOCUS Close attention was paid to future proofing. The wing was wired for television, internet, and VOIP phones. Wireless was investigated but the concrete fire walls between wings meant that wireless access couldn’t be guaranteed. Provision was also made for wall-mounted televisions to eventually take the place of the large floor TVs families frequently brought in.

ESCALATING COSTS

Building the new Rimu wing provided an opportunity to upgrade the other wings without causing too much distraction to ‘business as usual’. The original intention in refurbishing the other wings was to push out the rooms to the edge of the eves giving an additional 0.65sqm to each room. However, after this was completed for the Rata wing, it was apparent that prices were escalating beyond expectations. New building regulations meant the existing French doors in the rooms couldn’t be reused and replacement windows had to be double glazed as well. There was also significant additional carpentry work needed. This led to a full review of costs before proceeding any further. To complete the work within budget meant the decision was made to leave the rooms in the last two wings at their original size and take advantage of the French doors giving access to the gardens; these rooms were to be used by residents still ambulant or semi ambulant. The result was three different types of room used to provide for the differing physical needs of residents. On completion of the extensions to the rooms in the Rata Wing, it was decided that as there would no longer be any major structural changes to the other wings, the Trust felt confident they could take on the refurbishments making use of their in-house expertise. This

Eventually it was decided the focus of the wing would be a central area incorporating different spaces for different uses – a TV corner and a dining area, for example. Semi partitioning and different flooring allowed the space to be used for a range of purposes, such as quiet time, or for music. resulted in significant savings for the Trust. The quality of the refurbishments was high, too, says Huston, due to constant supervision of the project on site.

MUSICAL BEDS

The task of moving all residents in a wing to a new wing for the refurbishments to be carried out a wing at a time, had to be carefully handled. Huston said getting the ‘buy in’ and support of families to assist the movement of their family members during the round of ‘musical beds’ was not easy. However, timely and effective communication to all parties involved helped the process and allowed for the Lodge’s complete refurbishment with minimum disruption. Another challenge associated with moving residents was that the final continuing care wing had to be made secure in order to temporarily house the dementia residents while the dementia wing was undergoing refurbishment. All bedrooms had French doors leading to unsecure external gardens – these had to be secured along with the windows. Secure fencing that connected with the outdoor area of the existing dementia wing garden had to be constructed. The small lounge had to be extended so there was room to have all residents in the one dining area – in order to achieve this in a cost-effective way, an exterior wall was knocked out to create a conservatory lounge. The whole process was evaluated by a DHB audit. Following the successful audit, family of the dementia residents were enlisted to help staff carry out the move in one day. Residents were

taken out on a picnic and family and friends came and moved everything in their rooms. By the time residents returned to their ‘holiday home’ their rooms and familiar things were in place. On completion of the dementia wing refurbishment, the process was reversed – another picnic and when residents returned they were back ‘home’.

DEMENTIA WING

The refurbishment of the dementia, or Kauri, wing provided much opportunity for change. Huston says a lot of research went into investigating the appropriate spaces, colour, fabric, and lighting for people with dementia. Eventually it was decided the focus of the wing would be a central area incorporating different spaces for different uses – a TV corner and a dining area, for example. Semi partitioning and different flooring allowed the space to be used for a range of purposes, such as quiet time, or for music. Bedrooms came off this central area, along with a separate lounge. Bright colours were used for the bathroom doors. “We had to very quickly change the same coloured painted door to the resident lounge when a resident misread the purpose of the room!” says Huston. Walls were covered to waist height with Autex to provide additional warmth and a protective surface. Curtains were made of a custom printed fabric with a blackout core, designed for use in aged care in that they can be laundered in-house as needed. Continued overleaf >>

Committed to the Retirement Villages Industry. We understand how access to knowledge and expertise can make all the difference. 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. Find out how we can help make your vision a reality. Auckland: Richard Hinchliffe, Head of Healthcare 09 252 2952. Reuban Dalzell 09 252 3095. Wellington: Chaitanya Cherukumilli 04 436 4134. Christchurch: Brent Crisp 03 368 2414.

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FOCUS <<Continued from page 9 The nurses’ station featured a one-way mirrored window that allowed the nurses to look out over the common areas, with ‘fish eye’ mirrors for areas more difficult to see. The outdoor area provided plenty of scope for incorporating features to encourage the residents’ involvement. The secure garden, which can be accessed from two sides of the unit, included a henhouse from which the residents can collect eggs for the staff to cook. It also featured vegetable gardens and a gazebo with bright yellow seating to differentiate from the framing. In addition to a new domestic laundry inside, a clothesline was erected. “Residents delight in ‘doing laundry’: hanging it out, getting it in, and folding it,” says Huston. Yet the dementia wing refurbishment was not without its complications. Upon opening up the ceiling, some major hidden problems were exposed. By good fortune the timing of the refurbishment prevented some major repair jobs.

PROVIDING RESPITE

It made sense to leave the refurbishment of the final wing, Matai, until the dementia residents were back in the Kauri Wing. Using the knowledge gained from refurbishing the other continuing care wings, it was expected to be a straightforward process. However, it soon became apparent that the Matai Wing provided an opportunity to pave a new direction for the Trust. The long-term wish of the Trust Group Manager had been to provide block respite care to the community. Respite care is generally only offered by facilities when there is a space available, between a resident exiting and someone new coming into care. The Kapiti Trust wanted to be able to enable people to have planned respite where they could book up to six months in advance so they could go on holidays, share family occasions, and so on, with the sure knowledge that a bed would be available, rather than if a bed was available. Huston says it was decided that if people were to take up respite, they needed to create an environment that didn’t resemble an ‘old people’s home’ but rather more like motel/hotel accommodation, so those coming would feel like they were on holiday at ‘Club Matai’. This led to rooms being furnished individually with flat screen television, fridges, and customised storage suited to short stays. Resident telephones could be accommodated. Budget constraints looked set to prevent the Trust from furnishing the rooms in the style desired, but undeterred, the Trust applied for funding from the local community. In exchange for the funding, businesses and individuals were given naming rights to the rooms and a place on the sponsors’ board at the entrance. The initiative was successful: approximately $80,000 was raised from contributions from the local community and all rooms and the lounge were sponsored. 10

June / July 2013 | www.insitemagazine.co.nz

Lunch under the new awning and the new gallery lounge below.

Huston says customising the rooms took significant time but was greatly helped by the use of two companies who were prepared to deal with the one off room requirements. Auckland-based Materialised Pty Ltd were able to provide cost-effective customisation of drapes, bed covers and chairs, by printing different patterns onto different fabric bases for each room. All fabrics were fully washable which meant in-house laundering was possible – an important consideration given the constant turnaround of users. Specialist aged care furniture manufacturer from Northland, Archer Concepts Ltd, were able to make one-off chairs to match the rooms with the fabric from Materialise Ltd; they did not charge any additional costs for matching the room décor. Archer Concepts also helped the Trust develop customised lazy-boy style mobile chairs, adding improvements such as memory foam, double pushing handles, large casters, and wide foot supports. “Both companies exceeded expectations in terms of the help, advice and final products provided,” says Huston.

FULFILLING A COMMUNITY NEED

Another long-term wish of the Manager was to include end of life palliative care. “While Mary Potter Hospice is strong on the Kapiti Coast, they only provide a day centre. Those needing end of life care have to go into central Wellington – a return trip of over two hours. This is so hard for families at such a time,” says Huston. Consequently the decision was made to include a dedicated end of life suite in the Matai wing for use by the community. A wall was knocked out between two of the rooms, installing a full bathroom and creating the “Peace Suite” complete with kitchenette and couch/bed so that family members can stay. As with the respite rooms, the furnishings for the suite were sponsored completely, with the benefactors naming the room. Although this exercise cost the loss of one room, the importance of fulfilling the community need justified this in the eyes of the Trust Board.

INNOVATIONS AND DONATIONS Although they approached the renovation project with a long shopping list, the Trust prioritised the need for specialist equipment.

They needed to be able to get residents out from their rooms, and to this end they had the aforementioned lazy-boy style chairs developed, working in close partnership with Archer Concepts. The Trust now has over 40 of the chairs, provided at no cost to all who need one. Each chair has been donated, the majority from families and Trust supporters. A number were brought as Christmas presents by resident’s families, others were donated by village residents. Other equipment obtained through donations or fundraising efforts included non-institutional dining table and chairs for cognitively aware residents in the dining room; automated outdoor awning with wind sensors – these were in excess of $10,000 – allowing residents to sit or dine outside in the shade; a barbecue; ‘Tilt n space’ shower commodes; pressure mattresses and overlays; and oxygen concentrators. The Trust took an innovative approach to the project, and the end result features many clever innovations, including the use of Autex tiled flooring to allow carpet squares to be replaced if badly marked. A special run of Autex ‘hobnail’ was also manufactured for the walls and used as an edging insert to give a visual barrier to those with failing eyesight. Autex was also used to cover the walls of the activities room, enabling the walls to be displayed with art work created by the residents. The Trust’s innovative and creative approach to the renovation of The Lodge, not only in terms of design, but in their attitude toward working with the community to raise funds and developing savvy partnerships with commercial designers, is exemplary. The end result is indicative of careful planning and research, but also of not being afraid to change course or ‘think outside the box’ when budget constraints threaten the project’s direction.


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FOCUS

Are we friendly with DEMENTIA-FRIENDLY DESIGN? There is a lot of information out there on dementia-friendly design, but how do we know which advice to follow and which features to focus on? While there is no one-size-fits-all solution, there appears to be a need for more guidance in this area, discovers JUDE BARBACK.

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ementia-friendly design is not a new concept. A lot of international research has gone into revealing what best practice looks like in terms of how a residence that is suited to people with dementia should look and feel. But is it still just research on the pages or is it taking a tangible form in new dementia units? Are our existing rest homes and hospitals suitable for the increasing numbers of people suffering from dementia? Before we can address these questions, we need to ask the obvious one: what is dementiafriendly design?

WHAT IS DEMENTIAFRIENDLY DESIGN?

It is widely recognised that a building and an environment can have a significant effect on a person with dementia. As William McMorran of Architectonicus in the UK says, “architecture won’t solve dementia, but it can help.” McMorran, the architect responsible for the design of Bradbury Court, a new dementia care home in Malvern, UK, says, “If we can build the right environment, people look and feel better [and the] best way of helping people cope [with dementia] is to see the activity right in front of your eyes.” But what is the “right environment”? In the same way that management styles and approaches to care can support or hinder people’s wellbeing, their environment also has the ability to aid or hamper their social connection and sense of self; it can encourage independence or force dependency. Underlying dementia-friendly design are the principles of maintaining good health; supporting individuals’ choices, interests, lifestyles, and need for 12

privacy; making up for any sensory and cognitive impairment; offering choice; and providing safety and security while supporting independence. 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. That said, no two dementia sufferers are the same, each differing in age, type and degree of impairment, attitude, and background, and therefore flexibility should be incorporated into design to acknowledge this as well as the changing needs of individuals.

and ways found to improve the adhering to security features is a exchange of knowledge between common balancing act. the parties. Up-to-date guidelines “The décor and fabric of the should be provided free through facility can be made to be homely, well-respected agencies, and a so it comes down to the entry method for showcasing welland exit from the secure area – designed facilities should be that has to be discreetly handled developed, says Fleming. and not made to feel as if it is It is difficult to gauge whether containment.” Fleming’s findings are reflected in Homeliness is an important New Zealand dementia units, but attribute. Design for people with from the facilities INsite has been dementia should look to engage in touch with over recent years, people, support their needs and it seems apparent that the more capabilities, and give meaning, input and knowledge acquired comfort, and safety. Comfort by the operator and manager, cannot be derived from the the more collaboration with the institutional feel of many hospitals architect, the better the end result. and healthcare facilities with Sprott House provides a their long corridors, stark rooms, good case in point. Prior to and harsh lighting. Instead, a commissioning Duncan Lodge, homely environment is the goal in PUTTING RESEARCH its dementia unit, the general dementia-friendly design, one that INTO PRACTICE manager, the architects, and a adds continuity and familiarity to Certainly, there is a lot to consider. board member went to Australia everyday life and encourages the A study led by Richard Fleming on a fact-finding mission to continued involvement of family found that despite substantial discover what worked – and what and friends. evidence-based information to inform the design of residential At St Josephs, circulation routes have been kept aged care facilities for people wide and continuous to avoid dead-ends, where with dementia, many appear to residents could become confused. ‘Bus stops’, small have been designed without clear application of the evidence base, seating areas along the way, have been included to thus highlighting what Fleming and colleagues describe as “a gap in allow residents to enjoy a view or an activity. the knowledge translation process”. Fleming found that those did not – in Australian dementia Familiar domestic features – like facilities designed with the input units. They also read up on all the sofas and pictures on the wall in the of managers who were fully aware relevant research. This mission lounge – help people with dementia of the evidence-based principles helped inform decisions on many make connections between staff, of dementia design were of aspects of the lodge. families, and residents. Areas that significantly higher design quality are designed for individual use, like than those where the managers THERE’S NO PLACE bedrooms, should be personalised were ill-informed. LIKE HOME so people feel in control and able to His research shows that once Often the difficulty for the maintain their privacy. aged care providers are aware of decision-makers of a new build or Familiarity is an important the principles, they appear to find refurbishment dementia design concept. The research is fairly ways to implement them. The project comes from knowing which consistent: when designing living article suggests that if the next areas to prioritise or compromise, environments for people with generation of residential aged especially when it comes to dealing dementia, care should be taken to care facilities is to be suitable for with a limited budget, limited make sure that rooms and spaces are people with dementia, the facility building space, or factoring in recognisable and familiar to people managers must be made aware existing buildings. with dementia so that their use is of the available design principles, Warwick Bell of BKB Team obvious and unambiguous. While architects encouraged to be more Architects says that achieving modern architecture might favour active in sharing their knowledge a homely feel to a unit while multi-purpose spaces, this may

June / July 2013 | www.insitemagazine.co.nz


FOCUS

As William McMorran of Architectonicus in the UK says, “architecture won’t solve dementia, but it can help.”

not be appropriate in a dementiafriendly design. A separate living room and dining room works better than a single generic shared space. For all the allure of a strikingly innovative design, it is important to remember that older people, and especially those with dementia, may be more comfortable in an environment that they can relate to from their past experiences of ‘home’. Bell agrees. “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.” St Joseph’s Home of Compassion’s dementia unit epitomises homeliness and familiarity with its pitched roofs, the use of a residential gutter profile around the internal courtyard, and the selection of materials such as cedar weatherboards, clear-finished plywood, and timber-look vinyl.

NAVIGATING THE RESEARCH

Most theories around layout and navigation for dementia units appear to be in accord. Facilities should strive for as few corridors as possible and keep them short and wide with no dead-ends or blind bends.

Systems that feature textured handrails and visual cues can help residents navigate their way around. Internal way-finding cues, such as potted plants, ornaments, and artwork are popular. Plenty of windows providing interesting views, natural light, and ventilation help to build a connection with the outside world and also help with orientation. In many cases, facilities may not have the luxury of forgoing corridors or adding windows, especially if they are working under the constraints of an existing building. However, it appears that many are doing their best to make navigation as straightforward as possible. At St Josephs, 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. Dead-ends are also minimised at Duncan Lodge, Sprott House’s dementia unit, and ‘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.

CONTRASTING OPINIONS

Inevitably there are some areas where there is conflicting research

about what constitutes best practice. One contentious area is the effectiveness of signs and colour coding. There is also some debate about the use of contrast. The University of Stirling’s Dementia Services Development Centre (DSDC) suggests that contrast can draw attention to something important, such as a toilet seat or a light switch, however sudden contrast in flooring can make a floor look uneven, like a step, and cause hesitation and unsteadiness. Warwick Bell says his firm takes the available research and information carefully into account and treads cautiously when it comes to contentious features like contrast that can be both a positive and a negative. Marja Steur, Chair of the National Dementia Cooperative, says that various facilities use different philosophies, like The Eden Alternative, for example, which can help inform certain design decisions. The Eden Alternative is all about transforming care environments to promote quality of life for all involved – older people and their carers. The Spark of Life approach, a practical implementation of the Eden Alternative, is adopted by many dementia units and also plays a part in informing design. By actively moving away from a medical view of dementia care, to a lifestyle approach, means that

emphasis is placed on designing an environment focussed on making life comfortable for the person rather than all about catering for their medical needs. Dr Hans Becker, the keynote speaker at the Ageing Asia Workshop held earlier this year, says the design of housing and communities helped create opportunities for happiness, and for people to be able to grow old in their own homes, with services coming to them as they needed them. The Ageing Asia Workshop provided a good opportunity to debate different ideas about care philosophies. Sharing experiences is vital to informing which dementia-friendly design elements are to be adopted. Steur says the Hammond Care international design school has also been recommended by some, as a useful way to learn from the experts and share experiences. The school, which takes the form of a conference with presentations, workshops, and forums, but also has site visits and practical sessions, will be held in Sydney in late June this year and is aimed at architects, designers, commissioners, planners, project managers, decision-makers, dementia specialists, dementia service managers, and other health care professionals involved in dementia care. Continued overleaf >>

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FOCUS <<Continued from page 13

POINTS OF INTEREST

A new or refurbished dementia unit can often carry a price tag that can put some operators off the whole notion. However, certain design elements can be incorporated at little cost but to great effect. Spark of Life advocates generally agree that points of interest are an important aspect of a dementia facility, helping to encourage curiosity and engage people’s interest. Selwyn Wilson Carlile Home features several walls that have been carefully selected as points of interest. Each is covered in an interesting wall paper designed to capture the interest of residents. One displays quotes from all over the world and manager Rachael Hall says, “One man with dementia comes to look at it every day and just stands there and cracks up [with laughter].” Another popular example is memory boxes – frames or boxes displaying certain things from a different era, designed to evoke

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certain memories and capture the interest of residents.

MAKING SENSE OF DEMENTIA

Sensory rooms and gardens are becoming more prevalent in dementia units, as well as rest homes and hospitals, a sign that the research is being heeded by many. A sensory space ultimately serves to manipulate the environment in order to positively affect the way an individual processes and integrates sensory information. Sensory modulation, so the science goes, has the potential to increase self awareness, self esteem, communication, social interaction, and the ability to nurture the self and to cope with life’s challenges. Oceania’s Aspen Rest Home in Tauranga recently opened new sensory rooms and gardens, designed to calm or uplift residents. Inspired by a training session run by Nic Jenkins, an occupational therapist from Mental Health Services, Aspen’s

June / July 2013 | www.insitemagazine.co.nz

Diversional Therapist, Marilyn Liddington, prompted discussions about setting up a sensory room at the home. With much input from Jenkins and a visit to the sensory room at Tauranga Hospital, Aspen gradually got its own sensory room. The room features music and pictures, programmed specifically to help calm or invigorate, a water feature providing soothing sounds. There is aromatherapy with someone providing a hand massage, fidget mats to get rid of stressful energy, weighted lap dogs to provide comfort. There are different types of comfortable chairs to suit different tastes. At the official opening, manager Olwyn Kunz compared the room to a hotel spa, describing it as a “spa with a purpose” as the one-on-one therapy helps to tailor the resident’s experience to their needs. “We have started using the room with residents who demonstrate an immediate need for the therapy. Our goal is to integrate the use of the sensory room in to the personal care plans of every resident, so they can visit the sensory room on a regular basis and gain the benefits even before there’s any obvious need,” said Kunz. “So far we have had great results, whether it’s been to treat depression, confusion and restlessness, or insecurity.” Aspen also intends to extend the concept outdoors, creating a sensory garden.

of the ‘L’-shaped unit, allowing residents the freedom to go in and out of the unit and enjoy use of the garden as they please. Points of interest are a good idea for dementia gardens. Ideally gardens should include different points of interest, such as a bird bath, clothes line, mail box, or a bus stop. Sunny, sheltered seating areas, such as a communal patio or barbecue area, encourage social interaction. Ideally, these should extend from indoor social or communal rooms. A garden plays an important role in providing a place for residents to get fresh air and the necessary vitamin D. It is a place for exercise and activity, particularly for people with dementia who walk a lot, and consequently, should have a circular path rather than a straight path. Residents often value the opportunity to help with planting and many rest homes consequently provided a resident’s green house with access to gardening tools. A men’s shed is a popular variation on this. Peria House in Opotiki won two awards at last year’s NZACA conference for establishing a ‘Bloke’s Shed’ in partnership with Alzheimer’s Eastern Bay of Plenty. The shed was aimed to meet the needs of men with dementia within the rest home as well as those in the community still living at home. Yet, Sprott House made the decision not to include a men’s shed, after they found from their fact-finding mission to Australia that these were seldom used by residents. THE GREAT OUTDOORS It is clear, despite the mounting Many aged care facilities recognise ‘best practice’ literature and the importance of a sensory evidence, that there is, thankfully, outdoor space. Gardens filled no kit-set, one-size-fits-all answer with herbs, highly scented plants, to creating a dementia-friendly textured shrubs can help calm or environment. In addition to uplift residents. following the research out there, Lonsdale dementia unit in operators need to be guided by Foxton, Manawatu has a sensory their care philosophies, their garden that allows residents to residents’ needs, their architect’s step into a comfort zone aimed to knowledge, and their instincts decrease their anxiety and improve about what will work best for their mood, physical health, and them. However, perhaps there is mobility. It includes a beach also a need for more awareness in area, a green for activities such as this area, as Fleming’s research lawn bowls, an aviary, bus stop, suggests – freely available letter box, barbeque, garden bed, dementia design guidelines and and a washing line; all helping the opportunity to showcase good to provide the all-important examples might prove beneficial cognitive and sensory stimulation. to the sector as it continues to The garden extends down one side grow.


Sensors and other technologies are playing an increasingly important role in allowing people to “age in place”. But there’s a fine line between assisting care delivery and fuelling social isolation, says JUDE BARBACK.

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revor’s medic alert button, worn discreetly under his shirt, is there to provide reassurance for himself and his family, allowing him to remain independent in his own home but with the knowledge that medical assistance can be summoned at the push of a button. However, when the 89-year-old fell from a chair in his kitchen, knocking his head on the counter top, he forgot all about the device. Instead, holding a tea-towel to his profusely bleeding forehead, he precariously drove himself to the hospital. When asked why he didn’t use the button or call his son who lives in the same town, he simply replied, “I wasn’t thinking straight.” Given the nasty blow to the head, Trevor can be forgiven for forgetting to use the little device around his neck, but the incident demonstrates the limitations of technology used in the place of person-delivered care. Medic alert or panic buttons like Trevor’s have been around for some time, but they are symbolic of the use of technology to prolong independent living. Things have come a long way since call buttons. Much of the technology out there in this area can be broadly divided into two camps: monitoring and surveillance and assistive technologies. The latter is where robots are beginning to feature in aged care. While countries like Japan appear to be leading the research in this area, having developed robots that can wash hair and spoon-feed meals, New Zealand is also experimenting with robots in aged care. An Auckland University study is using two robots in Selwyn Village’s dementia care unit, one as a “companion bot” that looks like a pet dog and another as a “health bot”, which performs tasks such as reminding people to take their medication. The thought of a dog-like robot roaming around a dementia home providing entertainment to residents and staff brings a smile. Yet the thought of such a robot providing respite from social isolation to a person living independently alone seems more perturbing. This is one of the darker possibilities for the dystopian vision of people being cared for robots. While prolonging independent living is a laudable aim, many feel that it has the potential for abuse. Professor Noel Sharkey, a British expert in the field of robotics warns readers of British Telegraph Magazine of the potential for a future where cutting corners and costs leads to the elderly becoming little more than prisoners in their own homes, socially isolated and tended to largely by machines.

However, all do not share Sharkey’s view; many feel new technologies have an important role to play in assisting aged care. ‘Assisting’ is the key word here; if technology can be used to aid care delivery – and not solely provide – this could provide some of the answers to caring for a rapidly growing older population. Take sensors, for example. Sensors can transmit information about whether a person is in bed, sitting in a chair or if they have fallen on the floor. They can detect when a bed or floor is wet. They can monitor blood pressure or blood sugar levels. This information can be incredibly useful in helping carers or medical assistance when needed, allowing older people to remain independent for longer. It all plays nicely into the Government’s Ageing in Place strategy. However, there is no specific funding provided by the Ministry of Social Development for sensor technologies, but assistance for personal medical alarms and other ongoing disability-related costs is available to older people through the Disability Allowance. The Ministry of Health does not specifically fund sensor technologies either. However, it does offer equipment and modification services (which may include some form of sensor) that are essential for an older person to manage their everyday activities. District Health Boards also offer a range of assistance and home-based support services to assist older people to remain at home for as long as possible. In addition to the obvious appeal of remaining in your own home for longer, the Government’s initiative is ultimately aiming to take pressure off hospital and residential care services, saving funds that can be better spent elsewhere. However, given the expense associated with these sorts of technologies, it is questionable whether it leads to any real savings. Interestingly, the world’s largest trial for telecare and telehealth, carried out by the British Government, showed a reduction of hospital bed days of 14 per cent, emergency admissions of 20 per cent, and mortality rates of 45 per cent. The study showed that the scope for technologies to save public health care money is considerable. NZACA’s Martin Taylor, says that while there are many issues to be sorted out with the

FOCUS

A robotic retirement

‘telehealth’ approach, such as training for all parties and legal liability boundaries, this innovation has the potential to resolve many after-hours issues. It is no surprise that research in the area of telehealth and telecare is progressing at a rapid rate. Taylor points to companies that are offering products that track the movements of all caregivers and residents and record these movements in a central database. Facilities that use these products can determine how many minutes on any particular day a resident sees a nurse or caregiver and how many minutes each caregiver was working, he says. A group of computer scientists from the universities of Adelaide, Queensland, and Washington teamed together to adapt radio-frequency identification (RFID) and sensor technologies to develop a sensor system that incorporates a network of sensors attached to objects that the person is interacting with in the home. Software interprets the collected data, painting a picture of daily life, and allowing the sensors to detect when a person strays from their normal routine. In another example, the University of Manchester’s schools of nursing and engineering collaborated to produce a pressuresensitive carpet underlay that can measure people’s gait. A fibre-optic mid-layer detects the pressure of each footstep and sends data to a computer, which can then detect changes in a person’s gait over time, thereby acting as a predictor of a likelihood of falling. For some, monitoring and surveillance technologies are all a little too “big brother” for their liking. While video surveillance is easily within the realms of technological capabilities, in most cases, people are eager to preserve the privacy of older people. “Clearly there are privacy issues which need to be worked through before this becomes widespread, but the technology is here and the value is clear,” says Taylor. In the case of the carpet underlay invention, Dr Christine Brown Wilson, director of the university’s School of Nursing, Midwifery and Social Work, told Telegraph Magazine, “If somebody goes out of a door, we know that they have gone out of the door. But we are not watching you all the time.” That said, many older people are sceptical about even their movements being monitored. Whether the next generation of older people, emerging from a world of social media, smart phones, and Skype feel the same way remains to be seen. www.insitemagazine.co.nz | June / July 2013

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FOCUS

Telehealth in aged care GARY DENMAN discusses the emerging role of mobile technology in New Zealand’s aged care sector.

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aving entered an era of technological advancement where mobile-based voice and video solutions can now be custombuilt to fit the specific needs of any industry sector, available on any device (smartphones, tablets), there is an enormous opportunity to embrace the full range of capabilities this type of technology affords us, and the aged care and retirement industry is no exception. Within New Zealand, the population aged 65 years and over has increased from 11 per cent of the total population in 1991 to 13 per cent in 2009. It is forecast to reach 21 per cent by 2031. The number of people aged 65 years and over is projected to increase from around 550,000 in 2009 to 1 million in the late 2020s, when they will outnumber children. With figures like these, it’s no surprise that New Zealand’s healthcare system is coming under increased strain. To help address the growing needs of New Zealand’s aged care sector, the Government’s 2013 budget allocated an additional $70 million to be spent on aged care and dementia services over the next four years. Many New Zealanders also choose to live in rural communities, which brings its own challenges when it comes to ensuring retired, rural New Zealanders have access to worldclass aged care services. As the baby boomer generation continues to move toward retirement, aged care providers, and the broader aged care industry as a whole, is increasingly looking at

new and innovative technology solutions, such as remote healthcare monitoring and patient consultations via an e-clinic setup, to help achieve industry excellence and best practice in an increasingly competitive and regulated market. Collectively these technology solutions can be categorised under the term ‘telehealth’. Although telehealth as a concept has permeated the broader healthcare industry in New Zealand for some time, we are seeing increased adoption in the aged care sector. While the definition of telehealth varies greatly depending on its use – diagnostics, on-going patient care, medical training – more broadly, telehealth can be defined as the transfer of electronic medical data (images, sounds, video, records) from one location to another. Telehealth can also be used to support aged care administration as well as increased levels of remote residential care or home care. TELEHEALTH AS A VIABLE SOLUTION The New Zealand Government has committed to accelerating the rollout of Ultra-Fast Broadband (UFB) to ensure 75 per cent of New Zealanders have access to high speed broadband by 2019, with health and education the priority. In fact, the Government aims to

have UFB access available to all health facilities by 2015. With UFB set to become readily available, the healthcare and aged care industries have been provided with an incentivised programme to drive telehealth adoption; helping it to mature into a viable channel for patient and resident care. More and more aged care facilities are seeing the true potential of technology such as video collaboration solutions, to help overcome challenges such as large travel distances between healthcare facilities and hospitals; stringent privacy and security requirements to protect patient and resident health information; a shortage of healthcare providers especially in rural areas; and the ever-increasing costs of delivering resident and patient care. TECHNOLOGICAL INNOVATION – AGED CARE’S FUTURE On the back of government initiatives such as UFB, we are seeing rapid growth in the convergence of mobile devices, applications, and networks. These developments have driven innovation that otherwise might not have been possible. With its intent to make video collaboration ubiquitous, Polycom has developed enterprise-grade video solutions that are accessible via mobile devices such as smartphones and tablets. One scenario that demonstrates this involves follow-up care or outpatient care. Patients released from hospital after a specific procedure can receive continued outpatient care by leveraging mobile devices. Bluetooth-enabled ECG devices connected to a tablet device, for example, can transmit data over the internet and subsequently be used for video consultations between doctors and aged care residents. Ultimately this means that doctors can monitor a resident’s recovery remotely. More specifically, they can monitor a resident’s ECG and react immediately if that person’s heart rate or blood pressure begins to drop, by instantly launching an emergency video

IPAD REVOLUTION IN DEMENTIA CARE LIAM BUTLER learns how

iPads are transforming dementia care at Bupa’s Naomi Courts Specialised Dementia Care Home in Nelson.

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hen Naomi Courts’ diversional therapist Maaike Faber brought her smart phone to work, magic happened. “I wanted to show my manager, Jackie Mackenzie-Howe, some of the applications I thought could help our residents with dementia to communicate,” said Faber. Faber got permission from Mackenzie-Howe to show the applications to the residents, and it quickly became apparent they were onto a winner as residents delighted in playing with the

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June / July 2013 | www.insitemagazine.co.nz

phone. Faber’s next step was to bring her own iPad into work, so the residents could enjoy using some of the more powerful applications on a larger screen. “We wanted to create a communication pathway that breaks through the generations,” Mackenzie-Howe explains. “Too often, we saw grandchildren and young teenagers visit their elderly relative and would hesitate on how to engage or communicate.” The iPad enables the residents to communicate with their younger visitors as they tend virtual koi, paint with neon lights, and play math-based bingo. “I am pretty proud of how the iPad is used,” says Faber. “In fact, I was blown away when one of our residents played maths bingo for the first time. It really opened up the lines of communication for them again.

“I call the iPad the diversional therapist’s instant multi-tool as it can engage the resident quickly when they are in the moment to reminisce. I can show them a street on Google map and they can tell me about who used to live on the street and what they were like. For the person with dementia, these moments of reflection may only last two to three minutes. The iPad can at these moments engage all the resident’s senses as it immediately accesses old newspapers, music and images. So you can capture the moment in time.” Buoyed by such splendid demonstrations, Mackenzie-Howe presented to Grainne Moss, the Managing Director of Bupa Care Services New Zealand, a business proposal introducing touch screen technology into the rest home setting. Moss supported and rewarded Jackie’s determination by providing the financial backing


INTERVIEW

call with the resident using their smartphone or tablet. Aged care facilities with investments in video collaboration solutions or those with dedicated telehealth suites, have the potential to leverage these types of capabilities, which could potentially save a resident’s life. Video collaboration technology – hardware and software-based solutions – provides a unique opportunity to overcome many of the challenges facing the aged care industry today. Examples of how it can be used include: »» Live video collaboration between aged care facilities and community health centres, hospitals, primary care physicians, specialists – even family & friends. »» Remote consultation/monitoring brings aged care residents or elderly citizens receiving home-care face-to-face with healthcare providers for consultations and prescribe treatments from their home office, or on the road via high-definition video applications. »» Physicians can provide their expertise from anywhere to deliver specialty services like TeleStroke, TeleMental Health, and Primary Care. »» Correctional Telehealth helps avoid costly, inconvenient, unnecessary, and risky transports to hospital for elderly patients or residents who are potentially too weak to travel. Extended network availability and new devices such as personal desktop video, tablets, and healthcare phones means video technology is starting to become incorporated as best practice in many aged care facilities throughout New Zealand. Inhibitors to wide-scale adoption have been removed through initiatives like the UFB as we soon will have a network infrastructure in place to ensure reliable, fast, and secure access to video-based communications, regardless of the device you are using. Gary Denman is Managing Director Australia & New Zealand at Polycom. required to install wi-fi throughout the dementia care facility and an iPad for the residents. A wonderful research project had begun. The successes are becoming well documented according to Mackenzie-Howe. “One of our residents is a retired art teacher; using an actual paint brush was becoming difficult for her. The painting applications on the iPad allow her to enjoy sessions of painting again. We are exploring the technological applications for person centred care. We now need to measure the benefits of using iPads to see how residents interact with each other and what impact its use may have on other aspects of care such as aiding the reduction of antipsychotics medications.” A further consideration at Naomi Courts is to use the iPad with communication tools like Skype and other applications to improve communication between families and staff. Often families are unable to attend meetings as they live in different parts of the country or the world. The use of Skype on the iPad will allow them to participate with the person they care for whilst they reside at Naomi Courts.

A typical day in the life of …

Annie Schenkel

ANNIE SCHENKEL shares what she finds rewarding, inspiring, and challenging about being facility manager of Oakland Lifecare in Tauranga.

Annie Schenkel (right) with colleagues graduating at last year’s ITO graduation ceremony.

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have had the pleasure of managing Oakland Lifecare for nearly one year. Oakland is a large aged care facility located in central Tauranga, situated in a park like setting with some very old, beautiful trees, where tuis gather to sing. Prior to managing Oakland, I lived and worked in the Waikato for 10 years, managing aged care facilities during most of that period. My introduction to rest home management was not planned. However, it has been a very enjoyable career move! Prior to being a facility manager, I have had a varied career which included graduating as a hospital-trained registered nurse in 1981, holding operational manager roles in DHBs, and working as a practice nurse in GP surgeries. My introduction to aged care facility management came about when I was visiting my grandmother, who was a resident in a Cambridge aged care facility. During my visit, I was offered the manager’s role. I accepted the offer, then had the privilege of seeing my grandmother daily, as well as working with an aunt who had worked there for more than 20 years as a registered nurse and held the position of clinical coordinator. My aunt’s daughter and my cousin also worked at the facility during my time there. This introduction to aged care management contributed to my philosophy of managing facilities that provide care to some of our most vulnerable citizens, which is creating a family and homely environment. The most enjoyable aspects of my job are leading a great team to deliver great care and services to our residents and their families and assisting families through the often stressful journey of selecting an aged care facility for a family member. It is also a pleasure managing a successful business.

A typical day for me involves whatever it takes to ensure the Oakland team delivers great service. I respond to enquiries via telephone, email, or in person from health professionals and families seeking a bed for an older person (Oakland also provides care to some younger residents). I liaise with senior staff regarding the day-to-day management. Oakland employs over 100 staff, which generates challenges at times. A typical day will often involve completing reports and responding to internal and external requests, facilitating meetings with groups of staff, responding to requests from residents and families, planning staff education, and ensuring our cats are well cared for! The challenges and frustrations I encounter are those which are perhaps shared by many aged care facility managers – they are all due to not having enough hours in the day to meet everyone’s needs and wants as well as trying to achieve a work-life balance! During my decade working in aged care in the Waikato, I was a member of the DHB’s AgeWISE Advisory group for three years, where I learned a great deal about the direction aged care is taking in New Zealand. My main concern for older people in New Zealand is for those who suffer from social isolation – or loneliness in layman’s terms. The loving extended family environment is an ideal one for older people to live in, however that is not available for many. Organisations such as Age Concern, which provides services including an accredited visiting service to older people living in the community, is doing a great job in reducing the social isolation for some. www.insitemagazine.co.nz | June / July 2013

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PROFILE

Up close and personal... Eleanor Bodger and Esther Perriam Eldernet mother-daughter duo shares the joys and frustrations of running Eldernet and Care Publications. ELEANOR:

When you’ve been a nurse, a social worker, and community development worker, and worked in the public health system and for NGOs for most of your working life, then you’d never expect to end up running a business – would you? Well I didn’t. If you’re scared of computers, yet the business you end up establishing is internetbased – well that’s just ridiculous, isn’t it? Then to cap it off – for the last eight years, I’ve worked with my daughter – the one with a similar personality style and the one everyone said I couldn’t possibly work with. Isn’t that courting disaster? In 1997, I was 45 and working as a social worker at Older Persons Health in Christchurch when a colleague sat me down and explained how computers, and in particular, the internet, might be a solution to many of the frustrations we faced in our working environment, such as a lack of access to comprehensive information, transparency issues, and so on. I was sold. We established a partnership, forming Eldernet, an online database directory of services for older people. After a short period, I bought my partner out – which was not easy for either of us – and got down to the job of running the business. The learning I needed to acquire was on an almost vertical trajectory. My computer skills were non-existent – I am self taught; I took a basic accountancy course, attended the very helpful and free Canterbury Development business courses, and picked the brains of every advisor I could find, some of whom very generously gave their time for free. Other courses have been essential along the way. Most recently, Esther and I were lucky enough to attend the exceedingly helpful business growth course at Te Wānanga o Aotearoa (Otautahi). In those early years, life was frantic; our funding model was to charge an annual subscription for listings on our website; some advisors ran the figures and told us it wouldn’t fly, and indeed, the going was tough for many years with long, long hours, little sleep, weeks and months ‘on the road’ explaining the vision, low cost motels and camping ground huts, but heaps of passion and a guiding vision. Another thing that was quite hard to handle, particularly in the early days, was the knowledge that some people in the public and NGO sector thought I had ‘sold out’. I believe a private business model was the only way to achieve what we did when we did. I think, however, that there still needs to be significant 18

June / July 2013 | www.insitemagazine.co.nz

bridge-building between the private and public sectors if we are to better utilise scarce resources. My ‘banker’ was my husband, who was beside me 110 per cent, and my younger brother was the first salesperson. He spent a year or two convincing people that ‘yes, the internet was going to be a big thing’ but in the end, he had to get a ‘real’ job again. If it wasn’t for these two men, Eldernet would never have survived. Eventually the message we were giving finally caught up with reality: ‘the internet was a huge thing’. My first ‘real’ employee was my daughter. The strongest ‘work’ glue that holds us together is probably that she loves the job as much as I do. Most of the time we work very well together. However, occasionally we let the boundaries between us as mother/daughter and work colleagues get blurred. It’s usually during a time of high pressure such as going to print with our print publication (we acquired A Question of Care in 2006 in order to provide for the 50 per cent of older people who still prefer print media).

ESTHER:

If someone had asked me what I was going to be when I grew up, I wouldn’t have been able to tell them, but one thing was for sure – I’d NEVER work with my mother and I’d NEVER work in aged care. Yet, here I am, in 2013, doing just that. I was a true “Gen X” employee – flitting from one job to the next (try English language teaching, security, farming, sales, admin, and recruitment, for a start) with no real idea of what I wanted to do. When Mum approached me about working for her, I was hesitant. No one gave us much of a chance. We’re both passionate and that led (and still leads) to all sorts of issues. But what a journey it’s been. I love working for Eldernet and Care Publications, so much so I’m buying into the business. I’ve loved growing the business with Eleanor, and as a result of that, growing the team of great staff we have here in the office. It’s an enjoyable, busy, and fun place to work. I’m really looking forward to putting some of my energy into different projects over the next few months as I’m always up for new challenges and like things to keep moving along. I don’t have a clinical background, so sometimes I find I don’t understand that aspect of things, but that’s not actually a bad thing. Another challenge has been working

in a business while having a young family. Since being here, I’ve had two children; I am extraordinarily lucky that working for their grandmother has allowed flexibility in my hours – and I’m sure many of you will have seen me heavily pregnant or breastfeeding at conferences and events around the country. I wonder if my kids are thinking, “there’s no way I’m working in aged care”... little do they know they’re my little trainees! I think we run a unique service. I sometimes struggle with Eleanor’s mixed business model with a social service ethos thrown in – the fact is, though, everything we do is to support older people. Our aim is to be impartial and even-handed across the whole sector – funder, provider, and service user. I wish there were more ‘young’ people in this sector. It’s sad that ‘ageing’ isn’t sexy. The only time people are really interested in what I do is when something bad hits the news. That’s another thing I struggle with; how the media portray aged care and ageing. There are so many amazing things being done that I rarely hear shouted from the rooftops. We love the fact that we are beginning to provide the sort of information we dreamed about and we love meeting the wide range of people we do (we have visited every single residential care facility in the country, most retirement villages, most home support services, all Age Concerns, many community groups, all public hospitals, and many other older persons’ services in between). Their stories help to inform us so we can pass the information on to you. Networking and helping people make connections gives us a lot of pleasure, too. There are amazing amounts of goodwill and passion for the sector out there and when we meet people who have it, it’s contagious!


CONFERENCES

HOW TO HANDLE THE MEDIA

PETE BURDON discusses why retirement villages and aged care facilities should be prepared with a media policy. What would happen if a TV reporter arrived at your village or facility and started asking sensitive questions of staff with the camera rolling? Would they know what to do? This is one reason why you need a media policy. This does not have to be a huge document that sits in a bookcase gathering dust. But it does need to clearly outline what all staff should do in all potential media scenarios. For example, if there is a serious allegation made against a staff member, what is the policy? This can lead to all sorts of media scrutiny. Reporters may approach carers, the gardener, and anyone else who may give them an interesting comment. It only takes one off-the-cuff comment to turn a relatively minor issue into a full-blown crisis. It must be made clear to all staff how they must deal with scenarios like this. The staff members most at risk of this are receptionists because they are on the front line. Let’s take another scenario. A media crew arrive in the reception area and request an interview with the manager about a complaint from a resident. Whatever the receptionist says may become the TV story, so it’s vital that he or she knows exactly what to do and say. This must be clearly laid out in the media policy. There must be someone specifically designated in the policy to act as a media liaison person and someone to fulfil the role of media spokesperson. The liaison person plays an important role in dealing with all enquiries from journalists and contacting them when good news stories arise that may interest them. This is a wonderful way to grow reputations and profiles. All media calls requesting information or interviews should be directed straight to this person. He or she will liaise closely with the spokesperson. The spokesperson is a separate role. This is the person who fronts for the media interviews and is usually the job of the owner or manager. Sometimes this role and the media liaison officer are played by the same person. The roles of media liaison officer and spokesperson are vital. But as we’ve seen, it’s important that every staff member knows what to do and say around media. In other words, it must be a team effort. For example, if a staff member is approached about a sensitive issue, the policy should outline that the only reply should be “you’ll have to speak to X about that”. Every village and facility will have its own exceptions to these rules. It’s vital that they are spelt out to all staff in the media policy. This will prevent a disaster if you suddenly find yourself in the middle of a crisis. But it must be in place before it’s needed. Often a media training course is a good idea for spokespeople, as media interviews are like no other conversations and can trip up even the best communicators. A course for media liaison officers is also beneficial for those unaware of how the media works and what journalists want. Pete Burdon is Founder and Head Trainer of Media Training NZ. The company trains aged care owners and managers how to master media interviews and grow their media profiles.

CONFERENCE REPORT New Zealand Home Health Association (NZHHA) Conference 2013 - ‘Squeeze, Stretch and Flex’ – 10-12 April, Rendezvous Grand Hotel, Auckland THE NZHHA CONFERENCE, which carried the intriguingly named theme of ‘squeeze, stretch and flex’ focused on how to achieve integration and flexibility, both within the home-based support services sector and with other sectors. It also addressed issues around workforce and future planning and looked at measures, outcomes and responsiveness. The conference featured an interesting and diverse mix of speakers over the two days, including Canadian interRAI expert Prof Jon Hirdes, Assoc Prof Walter Leutz from Brandis University in the US, Healthcare of New Zealand’s Sandra Hamner, Chris Fleming, representing the DHBs, Director-General of Health Dr Kevin Woods, and Hon Jo Goodhew, Minister for Senior Citizens. Julie Haggie, chief executive of the NZHHA, says the conference was a resounding success. “We are very pleased with the conference and have had excellent feedback. The information provided by John Hirdes showed the power of using standardised assessment processes. Another stand out speaker was Nancy Chapman who gave an inspiring presentation on working alongside Māori.” Haggie says attendees were also very impressed with the presentation by support workers Anna Huffstutler and Ngapera Rangiaho. “As noted by Chris Fleming, we look forward to working with the Ministry and the District Health Boards on ways to improve understanding about costing that can then inform decision-making on investment of services.”

Haggie says she is “heartened” by the funding injection for the sector, as announced in the Budget. At the awards dinner, Pacific Homecare narrowly beat Mobilize to win the INsite Service Innovation and Quality Award, with the judging panel finding great merit in both entries and declaring it a “tough decision”. The South Auckland-based organisation was also successful in winning the Workforce Initiative Award for improving service delivery through workforce development. A lifetime achievement award was received by Trish Neal, who was previously the owner and Managing Director of Panacea Healthcare.

CONFERENCE PREVIEW

New Zealand Aged Care Association Conference 2013 – ‘Moving with the times’– 28-30 August; SkyCity Convention Centre, Auckland THROUGHOUT THE ECONOMY many sectors are facing changing consumer expectations, changing regulations, and changing technology. All of these changes have an impact on existing businesses and only those operators who adapt and plan for the future will have successful business models. The aged care sector is no different, which is why the theme of this year’s conference is “Moving with the times”. The aim this year is to focus delegates’ minds on what they need to do in the short and medium term to maintain and grow as aged care operators in the face of rapid and inevitable change.  Keynote speakers will include Stephen Becsi, CEO, Bethanie; Terry Grundy, Managing Director, Press Ganey

Associates; Martin Green, CEO, English Community Care Association; and, Andrew Carle, Executive-in-Residence, Program in Senior Housing Administration, George Mason University, Washington DC.

>> CONFERENCE CORNER DATES FOR THE DIARY: • Retirement Villages

Association Conference: 24–27 June 2013. Marriott Resort & Spa, Surfers’ Paradise, Queensland, Australia

www.insitemagazine.co.nz | June / July 2013

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HEALTH

Spotlight on ... Arthritis In this issue we cast the spotlight on arthritis, a common condition affecting hundreds of thousands of New Zealanders. DARRYL WARD discusses the common types of arthritis, how to cope with it, and where to turn for support.

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re you having difficulty in doing your daily tasks or playing your favourite sport? If you have started to notice swelling, pain, and stiffness in one or more of your joints, it could possibly be arthritis. But to be certain, you need to see your doctor. Arthritis can occur to anyone at any age. And there are 530,000 New Zealanders living with arthritis (including a thousand children). The word ‘arthritis’ means ‘inflammation of the joint’. Swelling, redness, heat, and pain are the signs of inflammation. The word ‘arthritis’ is used to cover diseases that affect the joints and can also involve tendons, muscles, and the bones. And there are over 140 different types of arthritis, the most common being osteoarthritis, gout, and rheumatoid arthritis.

OSTEOARTHRITIS

Osteoarthritis (OA) is the most common form of arthritis. Almost half of all people over the age of 60 and virtually all over the age of 80 will have osteoarthritis. Osteoarthritis has been called ‘wear and tear’ or ‘degenerative’ arthritis. It

occurs as a result of mechanical breakdown of the cartilage, causing pain and weakness of the muscles surrounding the joint. This happens most often in the large weight bearing joints – the knees, hips, and spine.

GOUT

Gout is now the second most common form of arthritis in New Zealand. Gout affects mostly men and is quite rare in women until after menopause. Gout is very common in Māori and Pasifika men. It occurs as an acute attack, often coming overnight with severe pain and swelling in the affected joint. The skin over the joint may also become red and shiny. Gout usually affects only one or two joints at a time – most often in the feet and ankles. The big toe is the most common site. Without treatment, the attack may settle down, but gout is not going away. There may be intervals of many months or even years between attacks. As time goes by, these tend to become more frequent and more severe. Eventually several joints may be involved. Without treatment this can progress to joint damage and disability.

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RHEUMATOID ARTHRITIS

Rheumatoid arthritis (RA) is an inflammatory type of arthritis that affects the joints, and because it is ‘systemic’ (affecting the entire body), it can affect other parts of the body as well. It occurs in about one to two per cent of the population and is more common in women, affecting them three times more often than men. It can begin at any age, but commonly first occurs between the ages of 35 and 45. One person in six affected by rheumatoid arthritis will have a more serious form that if untreated can cause painful, misshapen joints. It is a chronic disease and may last a lifetime. These are the three most common forms of arthritis. Other types include ankylosing spondylitis, psoriatic arthritis, fibromyalgia, polymyalgia rheumatica, lupus, scleroderma, and juvenile idiopathic arthritis.

COPING WITH ARTHRITIS

If you do have arthritis, it is very important to know which type of arthritis you have in order to get the best available treatment. For this reason your doctor will ask you about when and how the problems started, observe your movements and may also organise blood tests and x-rays to assist with the diagnosis. While these tests can be useful, they do not always provide an accurate gauge of the level of pain that you may be experiencing, or the difficulty performing daily tasks.

When you live with arthritis, everyday tasks can be challenging, and the idea of becoming more physically active could be daunting. However studies show that regular and appropriate physical activity help improve pain tolerance, mood and quality of life for people with arthritis. Living arrangements need to be carefully considered. Some previously simple tasks like opening doors may now be more difficult, so adaptations may be required. Bending may now be difficult, so the height of bench tops and even power points may need to be adjusted, and you may need to consider installing access ramps, or frames to assist access to toilets and baths.

GETTING SUPPORT

Arthritis New Zealand offers a range of services designed to assist and support people living with arthritis and our team of Arthritis Educators provide advice, education, and up-to-date information on how to self-manage including physical activity, joint protection, medications and complementary treatments and products. Arthritis New Zealand can also provide information about waterbased exercises and support groups in your area. Darryl Ward is from Arthritis New Zealand. More information about Arthritis New Zealand can be found at www.arthitis.org.nz or by telephone: 0800 663 463.


WORKFORCE

RAY LIND, chief executive of Careerforce, voices his opinions on the need to implement integrated care and unleash the potential of the “unregulated” health workforce.

On the soap box... Ray Lind CANTERBURY LEADS THE WAY

A healthier society is happier and more productive. Most people will agree that improved population health is the key to a healthier economy and quality of life. But if we’re serious about population health, we need to change the focus of our health services. Shifting to a more integrated model of care is part of the solution. As our aged population increases, and hospitals are stretched to their limits, there will be a greater need for quality home and community support. Christchurch is a remarkable example of integrated community care meeting pressing health need. I was struck by an interview with David Meates, CEO of Canterbury DHB, on Radio New Zealand last month. While discussing the $500 million rebuild of Christchurch Hospital, he talked about how they have coped with a serious shortage of hospital and residential care beds. “Over the last 12 months, we’ve managed 24,000 people in the community setting. If they were anywhere else in New Zealand, they would’ve largely ended up in hospital. This gives you a sense of how radically we’ve already changed the way we’re delivering care. It’s requiring primary care, community services,

and the hospitals to be working very differently in an integrated way.” Necessity has been the cause of this shift. By stepping up their home and community support services, Canterbury is now a step ahead of the rest of the country. Some suggest around 30 per cent of secondary hospital admissions of over 65 year olds are for medication issues. This is the kind of care, along with the management of chronic disease, that Canterbury is proving can be delivered in the comfort of people’s own homes. However, if hospital managers behaved in a short-termed economically rational way, they would resist moving older people out of their hospital beds. An older person occupying a hospital bed for medication management, for example, is a “cheap” patient. If those patients were not in hospital, then those beds would be filled by “expensive” elective surgery patients. Unless beds are closed, caring for patients in the community increases short term costs. Of course, hospital managers committed to a DHB drive to improve population health would not do this. They know that managing chronic disease in the community is ultimately cheaper and better on every long term scale.

This brings us back to the need to implement integrated care and unleash the potential of the “unregulated” health workforce. Quality community support will help to relieve the ever growing strain on our hospitals. But to successfully roll-out an integrated care model, senior health executives need a shift in focus and priorities. DHBs must have the incentive and the ability to invest in the home and community sector. For example, in Canterbury, home and community providers are able to be paid at a higher rate, and all support workers are trained and qualified. Increased funding will enable community providers to pay their staff enough to improve recruitment, retention, and morale. Crucially, it would enable an increase in training. Trained and qualified workers provide quality support. Training makes a difference to quality. And quality support will make a big difference to the health and wellbeing of our population. Investing in this workforce is an investment in our future. Careerforce is the Industry Training Organisation with coverage for the aged care, health, disability, mental health, social services, and cleaning services sectors.

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LAST WORD

Last word... Peter Mathyssen PETER MATHYSSEN, owner and manager of Glenbrook Rest Home, gives his views on the interRAI debate between Victoria Brown and Martin Taylor, featured in the last issue of INsite.

I

’d like to comment on Victoria Brown’s interRAI article and Martin Taylor’s response to it. I am on Victoria’s side on this. Firstly, and importantly, I’d like Martin Taylor to name the 30 countries where interRAI is being used, presumably in the same way as it is proposed to be used in New Zealand. If interRAI is really used in 30 countries, could one not reasonably expect that teething and implementation problems/issues would have been resolved by now? Why still all the drama and requirement for days and days of training? It does not sound like a particularly user friendly tool. Basic questions on InterRAI have been asked on several occasions, but to date have not been answered, neither by MoH/DHB or NZACA, which is a co-sponsor of the interRAI project. For instance: 1. What consultation with providers, if any, was done prior to the introduction of interRAI? 2. Rumour has it that some interRAI trials were done. Where are the results? 3. What evidence exists that current resident assessment and care practices are improper and how will they improve as a result of interRAI?

4. What commitment has the Government made to fund the system beyond the four year roll-out? For instance: at whose cost will the government supplied dedicated interRAI laptop be replaced at the end of its life? 5. What training and IT support will be available beyond the four year roll-out? 6. Will NZNO include interRAI as part of its general nursing curriculum, now that interRAI has been made compulsory? 7. If interRAI remains “RN only”, what contingency plans have been made so that a facility which cannot find an interRAI trained RN can have data entered? 8. Australia looked at using interRAI but backed away from it. In what way is the New Zealand aged care sector different from Australia for interRAI to be deemed appropriate here, but not over there? 9. Who has access to and who is responsible for the interRAI data? Plenty of questions, but no answers. Government and DHBs insist the aged care sector employs open disclosure policies, but seem unwilling to practice what they preach. It is becoming evident that interRAI is nothing but a data collection tool for government and DHBs, forced onto a

chronically underfunded aged care sector. The already abominable caregiver pay rates will be further eroded, smaller facilities pushed closer to the brink and care for our elderly will suffer. No smooth talking politician, DHB representative or association CEO can gloss this over, no matter how hard they try. Martin Taylor’s comment that, “It is also unreasonable to expect a roll-out such as this to have answered every question before we begin or even to know every issue that may crop up along the way” is particularly unsettling. They still don’t know the answers after having interRAI employed in 30 countries? Aged care providers look after vulnerable members of our society. Audits need to be passed and standards adhered to. When an aged care facility opens a new wing, an audit is done beforehand to ensure all systems are in place. Can we not expect the same diligence when it comes to government/ DHB/NZACA implementing a new, supposedly used-all-over-the-world, assessment tool? Come on, get real. Government/DHB/ NZACA should act cooperatively, not in an underhanded way, trying to sell something that is not wanted or needed.

RESPONSE: MARTIN TAYLOR, CHIEF EXECUTIVE, NZACA All across health clinicians are moving to adopt new technology such as standard assessments in the homecare sector, electronic medications systems and shared care records. All of these initiatives represent progress towards better outcomes for residents, which are, and will always remain, our goal. I will do my best to answer Peter’s questions: Firstly, and importantly, I’d like Martin Taylor to name the 30 countries where interRAI is being used, presumably in the same way as it is proposed to be used in New Zealand. interRAI in one form or another is being used in many countries. The exact countries are shown at the following link: http://www.interRAI. org/worldwide.html. Peter can count all of the icons if he has time. I didn’t try because there are too many. In terms of countries that use interRAI for aged residential care, the best comparisons are Finland and Canada. Both of these countries have shown the value of a standardised assessment tool, both in care planning and in policy development. If InterRAI is really used in 30 countries, could one not reasonably expect that teething and

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implementation problems/issues would have been resolved by now? Every country is different – from how their government agencies are set up through to the IT systems they run, the software they use, their broadband coverage and how everything is funded. Furthermore, staff training and age demographics are different in each country. This all means the roll-out in each country is going to face some unique problems. To expect anything different is somewhat unrealistic. Some common problems in Finland and Canada have been the overall low level of IT ability and the lack of change management knowledge of older RNs. Also, just because another country has adopted or not adopted something should not determine whether New Zealand does it or not. However, looking at the experiences of other countries is helpful in giving guidance on some of the pitfalls, benefits and costs. That is what NZACA and DHBs have done. Why still all the drama and requirement for days and days of training? It does not sound like a particularly user-friendly tool. Assessing the elderly for care is vitally important – if this step isn’t

done right then care delivery will be compromised. That is why the training is so comprehensive and why RNs are required to reach a uniform level of competency. Like anything new, some people will always believe it is not user-friendly – and for some this view may be valid. However, at the end of the day ‘user-friendliness’ not only reflects on the tool but also on the user. For example, if you hand a new smartphone to a six and a sixty-yearold, the six-year-old will probably be able to work it out faster. Basic questions on interRAI have been asked on several occasions, but to date have not been answered, either by MOH/DHBs or NZACA, which is a co-sponsor of the interRAI project. This criticism has been made time and time again and has resulted in newsletters and visits to concerned parties by representatives from the Steering Group. At the end of the day all answers that can be given have been given, in person and/or in writing. What consultation with providers, if any, was done prior to the introduction of interRAI? In 2005, the concept of interRAI was first raised at our Association’s conference. Since that date it has

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LAST WORD

AGED-CARE & RETIREMENT

<<Continued from page 22

make interRAI compulsory. I would not expect so, as they train RNs to do clinical assessments and interRAI is a tool for an RN to record and analyse their clinical judgements in. If interRAI remains ‘RN only’, what contingency plans have been made so that a facility which cannot find an interRAI-trained RN can have data entered? Currently, if a facility cannot find an RN to undertake an assessment, they are in breach of their contract with the DHB. In terms of a situation where they have an RN but they cannot undertake an interRAI assessment and the facility has purposefully ignored interRAI training, then they will be failing to comply with the directive from the Government. What sanctions might follow are as yet unclear. In the situation where through no fault of their own a provider is unable to use interRAI, because of RN supply issues, then we will need to ensure some leeway is given. As yet these details have not been finalised, but they will be over the next year. Australia looked at using interRAI but backed away from it. In what way is the New Zealand aged care sector different from Australia, for interRAI to be deemed appropriate here, but not over there? My understanding is the Australians wanted an assessment system that could also be used to determine funding. That is why they developed their own unique system called ACFI. Broadly speaking, in New Zealand our assessment system is separate from our funding system. Also, Australia doing or not doing something should not determine whether New Zealand does it. Any initiative must stand or fall on its merits, and this was the overwhelming consideration when adopting interRAI. Who has access to and who is responsible for the interRAI data? This is a very important question and one we have been actively discussing at interRAI NZ. At this stage, no one can have access to the information unless they make an application Australia looked at using interRAI but backed to interRAI NZ and any is only away from it. In what way is the New Zealand aged information released following care sector different from Australia, for interRAI to de-identification and ethics approval. Going be deemed appropriate here, but not over there? forward, we are working on establishing a system where providers can receive regular reports on clear there has been a wide range of variability in assessment practices throughout the country. clinical indicators and the acuity of their residents in comparison to other providers. Note all data We also have to accept that we are being paid will be de-identified so no provider will be able to a national fee and we have a national contract – identify another provider. therefore it is not a big leap to agree that every In regards to Peter’s final comments about New Zealander, regardless of location, should be how interRAI is some sort of conspiracy for data assessed using the same assessment tool. collection and that the Government is not acting What commitment has the Government collaboratively – these claims are simply untrue made to fund the system beyond the four year and reflect a view that rational replies will never roll-out? For instance: at whose cost will the Government-supplied dedicated interRAI laptop satisfy. interRAI is not a perfect system and the be replaced at the end of its life? What training and IT support will be available beyond the four roll-out has not been perfect either. However, the benefits of having a national assessment year roll-out? tool outweigh the costs. Just as importantly, it This question is yet to be answered, not will result in more consistent care planning and because it is being ignored but because we delivery and provide a greater understanding on have other decisions to make on the roll-out the increasing clinical requirements of an ageing that are more pressing. I am absolutely sure population. the Government will not put the millions they have paid to date in jeopardy by not supporting Due to a printing error, Last Word was missing training and the IT system. In terms of the laptop question, it was never envisaged that the from the last print issue of INsite. It featured Government would pay the laptop costs forever. Ian Brown’s opinions on changes to the Retirement Villages Code of Practice with It was an incentive to assist providers. responses from RVA executive director, John Will NZNO include interRAI as part of its Collyns, and Building and Construction Minister general nursing curriculum, now that interRAI Maurice Williamson. You can find this interesting has been made compulsory? article online at www.insitemagazine.co.nz. I think Peter means will the nursing schools

been a feature of the dialogue in the aged care sector when NZACA meets with members. In 2008 and 2009 it was discussed in our annual strategy sessions with members. These sessions were attended by 250-300 people each year. In addition to this, when we held branch meetings in 2008, 2009 and 2010, we asked members what they thought of interRAI – setting out the pros and cons. These meetings were well advertised and attended. In addition, the Association has had over 80 per cent membership of the aged care sector since 2005. It is also worth pointing out that the other provider association, which I understand covered around 10 per cent of providers during this time, was aware of the focus on interRAI and what was being discussed. Rumour has it that some interRAI trials were done. Where are the results? It is no rumour. Two trials were run, one led by ourselves and one by Canterbury DHB. The trial run by NZACA (or HCPNZ at the time) was published in June 2009. The trial was funded by Bay of Plenty DHB and run jointly by NZACA and Waitemata DHB. The outcome of this trial was very positive and based on this outcome we continued promoting the idea to our members. The Canterbury DHB trial ran from June 2008 to early 2010. This trial confirmed the benefits of a standardised assessment process but did raise concerns about RN workload if facilities tried to run dual assessment processes. For example, if each resident was assessed twice on entry with different tools, instead of once, the RN workload became unmanageable. What evidence exists that current resident assessment and care practices are improper and how will they improve as a result of interRAI? No one has ever claimed that all current assessment and care practices are improper. However, from those people who consult in the sector and from NZACA’s training sessions, it is

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NEXT ISSUE:

AUGUST/SEPTEMBER FOCUS ON: NUTRITION » What’s on offer for older people at home? Exploring the alternatives to Meals on Wheels. » Changing dietary requirements. Aged care providers need to adapt menus as residents who have food allergies or are gluten-free or lactoseintolerant become more common. » Advantages of a homely dining experience over an institutional feel.

PLUS: THE REGULARS: ‘SPOTLIGHT ON ... ’ A section dedicated to relevant issues including education and training, therapies, falls prevention, infection control, palliative care, dementia and more. ‘A DAY IN THE LIFE ...’ An insight into the lives of everyone from caregivers to chief executives, residents to retirement village managers. ‘LET’S SNOOP AROUND...’ An insight into the operation of a village or aged care facility. ‘LAST WORD’ Giving sector leaders the chance to air their views on the current status and direction of aged care in New Zealand.

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Insite june july 2013