INsite September 2016 by NZME. Educational Media

September-November 2016 | $10.95

AGED care & retirement

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clinical

special woundcare focus -- wounds and co-morbidities -- why use iodine? -- how to take a swab

education and training

Dealing with diversity technology

robotic rest homes the rise of assistive

technologies management

intergenerational activities why your facility should get involved

infection control

Havoc in havelock north lessons learned from water crisis

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In this issue... Ed’s LETTER

In compiling this issue I became preoccupied with the notion of generations – what defines them and how they interact with each other. As someone who just scrapes into Generation Y – the Millennials – I was intrigued to see that my Millennial contemporaries are regarded as “entitled”. According to some research on this topic, Millennials “have been told over and over again that they are special, and they expect the world to treat them that way”. We apparently expect fast and immediate processing. But if you think we sound awful, then take a peek at Generation Z, a generation of impatient, tech-savvy, brandconscious consumers. I have two Gen Zers in my household and I can vouch for this trait summary! The residents of our rest homes and retirement villages are currently members of the Silent generation (also known as the Veterans generation). While they tinkered at the edges of feminism, civil rights and rock’n’roll, this generation is disciplined, selfsacrificing and cautious – a throwback to the suffocating conformity of their formative years. They were loyal to their employers; they are committed in their marriages. ‘Retirement’ for this generation typically means to live your final years in peace. The thought of throwing members of this generation together with Generation Zers is an interesting prospect and one that is at the heart of many intergenerational initiatives, like Metlifecare’s partnership with the Auckland Kindergarten Association that sees residents engaging in storytelling and craft activities with preschoolers. Such activities are designed to encourage understanding, empathy and curiosity about people much older or younger than themselves. Will these intergenerational programmes suit the next generation about to enter our facilities and villages? That’s right, the Baby Boomers, the “me” generation, the hippies, the yuppies, the first generation to accept divorce and homosexuality. They see retirement as a time to enjoy all that life has to offer rather than a time to sit back and accept the ageing process. They’ll almost certainly change the way we run our facilities and deliver our care to suit their needs and preferences. Regardless of when you were born, there is something very humanising about the interaction of generations. Intergenerational initiatives are important in developing a healthy respect for each other and what we each can contribute to this funny old game we call life. Editor, Jude Barback editor@insitemagazine.co.nz

For aged care news, views, trends and analysis visit: www.insitemagazine.co.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

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).

Clinical focus in aged care

Hawke’s Bay water crisis: lessons learned

Six top tips for infection control

Talkin’ ‘bout my generation: intergenerational activities

What does the interRAI data show?

How can an older person’s co-morbidities impact on wound care?

Assistive technology: how can it help in an ageing world?

Adapting to changing media needs

Recognising the value of informal caregivers

Wound care in older adults

Dealing with dementia: the need for education and support

Removing cultural barriers to palliative care

Easing culture shock: helping new migrant staff get settled

Indian nurses as caregivers in New Zealand: “I would not have come”

On the soapbox... Brien Cree

Let’s snoop around... Malyon house

Up close and personal with Gabby Clezy

Case study: Falls Prevention Programme

Upcoming new programme to reduce risk of falls

A day in the life of... Karla Gounder

Upcoming conferences

Last word... Paul Rea

Editor Jude Barback 07 542 3013 editor@insitemagazine.co.nz Advertising & Marketing Manager Belle Hanrahan 04 915 9783 belle@nzme-ed.co.nz

Commercial Manager Fiona Reid Production Aaron Morey

Subscriptions Gunvor Carlson 04 915 9780 gunvor.carlson@nzme-ed.co.nz Images iStock

September–November 2016 Volume 10/Issue 4 NZME. Educational Media, Level 2, NZME. House, 190 Taranaki Street, Wellington 6011, New Zealand PO Box 200, Wellington 6140 © 2016. All rights reserved. No part of this publication may be copied or reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopy, recording or otherwise without the prior written permission of the publisher. ISSN: 2324-4755

Errors and omissions: Whilst the publisher has attempted to ensure the accuracy and completeness of the information, no responsibility can be accepted by the publisher for any errors or omissions. www.insitemagazine.co.nz | September–November 2016 1

Infection control

Hawke’s Bay water crisis: lessons learned The Hawke’s Bay water crisis unleashed a severe gastro bug that took its toll on the care homes and retirement villages of Havelock North. JUDE BARBACK talks to three facilities about how they coped and lessons learned from the experience. 2 September–November 2016 | www.insitemagazine.co.nz

he team at Mary Doyle Lifecare Complex in Havelock North didn’t discover that their water was contaminated until they saw news of it on social media on the night of Friday 12 August this year. It was a similar story at nearby Summerset in the Vines. “How we found out was someone knocked on the care centre door at 8pm on the Friday night. The afternoon RN hopped on Google and sure enough, we had a challenging situation on our hands,” says nurse manager Jocelyn Pack.

How events unfolded Hawke’s Bay District Health Board chief executive Dr Kevin Snee says the DHB became aware of a number of cases of gastroenteritis in the Hastings suburb on the Friday. The nature of disease distribution and the fact that campylobacter was detected in patients suggested the Havelock North suburb’s water supply was the source. The decision was made to chlorinate the Havelock North water supply from two bores, one of which tested positive for E. coli.

Infection control By the time news reached the rest homes on the Friday night, some had already drawn their own conclusions that they were dealing with the dreaded norovirus. However, given that the sick residents were dispersed around the rest home and the village, staff at Mary Doyle felt something didn’t quite stack up. It wasn’t until Friday morning that testing revealed it was campylobacter. “We’d heard earlier in the week other rest homes in the area were grappling with some kind of gastro so we automatically assumed it was norovirus,” says Pack of the situation at Summerset. While bacterial and viral infections often share the same symptoms – typically diarrhoea, nausea and flu-like symptoms – they are two very different types of pathogen. Campylobacter is a food-borne illness so is usually spread through water or food. Unlike viruses, bacteria can grow on the food they contaminate. Symptoms for people affected by campylobacter can last up to 10 days, but will usually abate without antibiotics. By contrast, norovirus is a very contagious virus that can quickly pass from person to person through shared food or utensils, by shaking hands or through other close contact. The virus can survive temperature extremes in water and on surfaces. Mary Doyle’s infection prevention and control coordinator Jo Miller says that while the campylobacter outbreak was challenging to deal with as it was so widespread, a norovirus outbreak would have been worse. “Norovirus is an airborne virus, whereas campylobacter is passed by contact and only lives for one to four hours on hard surfaces and fabric.” On the Saturday morning, aged care facilities went into crisis mode, working hard to control the infection. Being a weekend made things a little tougher – staff came in on their day off; facilities made use of their emergency supplies. At Mary Doyle, Miller knocked on the door of every one of their 135 villas and reception rang all 89 apartments to let the residents know what was going on and to check if each of the 400 residents was okay and knew to boil their water. “Thirty-five per cent hadn’t even heard about it, so it was a useful exercise,” she says. Some facilities were hit hard by the virus, while others escaped unscathed, including Oceania Healthcare’s Duart Care facility. Nine residents in the care facility and 40 in the village at Summerset were affected, plus a handful of staff. Mary Doyle had 118 residents (out of 400) and 21 staff (out of 250) affected. A resident who was unwell with campylobacter passed away (although the coroner’s report revealed she had other significant underlying health issues), and two more became seriously ill

with the infection. Surprisingly, the village was hit worse than the care facility. Miller is not sure why. She speculates that it may have been because villa residents take their tablets with tap water, while some care residents have them crushed with food or water from the purifier. As the window for infection is up to 10 days, facilities at the time of writing were still coping with rolling illnesses. As at the end of the first week, some residents were getting better, while some were just beginning to feel unwell. By the second week some had relapsed. At this stage the decision was made at Mary Doyle to close the rest home to visitors as they were uncertain what else was in the water that could have been causing illness. As a result they are now testing faecal specimens for everything, including cryptosporidium, giardia and norovirus, in an effort to fully understand the bugs they are battling. Fortunately, a wave of community support has helped them get through it.

“

The main lesson learned is that it is so important to have good, robust systems in place.

”

The DHB’s Infection Control team arrived at the facilities on the Saturday afternoon and worked with nurses and staff to isolate people who were showing signs that they were affected. Summerset kept their village residents informed via a mailbox drop and supplied them with bottled water. The district nurses completed follow-up visits to check on them. The district nurses were “fantastic” according to Miller, helping to relieve their care staff and working well with the Mary Doyle team. Mary Doyle manager Diana Triplow says they received great support from the community. A delivery of a pallet of 10-litre containers of water was followed by another delivery from Coca-Cola New Zealand of two pallets of bottled water. The local pharmacy also stepped up to help and delivered boxes of electrolyte ice-blocks. A kindly lady from the community brought in lots of daffodils to brighten everyone up. The New Zealand Aged Care Association was in touch to show its support. Clinical nurse specialist for gerontology Lorraine Price accompanied Miller around the village again.

Challenges Despite community support, the nature of the illness provided the facilities with myriad challenges. There are all sorts of unexpected complications to deal with, given that the water was affected and couldn’t be used.

Oceania’s senior clinical and quality manager, Tara Evans, says they had to rethink about how to wash residents. “One thing that we felt worked at Duart to stop the spread of the bug was we stopped showering residents straight away as soon as we heard and washed them instead. It stopped water and the bug getting through mucous membranes,” she says. “It’s not just about dealing with diarrhoea,” says Pack. Chlorinated water had to be used for washing clothes, washing dishes and during food prep. Even ensuring boiled water gets to everyone has its challenges. The Summerset facility sourced some giant urns to boil water. The administrative effort involved with organising these things, as well as communicating with the DHB twice a day to provide information about everyone who is unwell has been huge, says Pack. She is full of praise for their office manager, who has been a great support. It has also been challenging dealing with residents with cognitive decline. “Some don’t have a good understanding of what’s going on,” says Pack. Miller says that cognitive decline has contributed to relapse of a few of their residents. “You tell them not to drink the tap water but then they brush their teeth with it, things like that,” she says.

Lessons learned Clearer communication at the interfaces While it transpires the DHB only realised on the Friday the full extent of what the region was dealing with, notification earlier that day could have been helpful. “We would have appreciated better notice of what was going on,” says Pack. She also feels clearer communication from the DHB in general could have helped to keep the population better informed in the event of a public health situation like this. She felt there needed to be a coordinated response from the DHB and Council. Pack says much of the village’s information about the unfolding crisis was sourced via Google and social media, which is unlikely to be useful for many older people. Radio would have been an effective medium to share updates and advice, she suggests. “Lots of older people listen to the radio,” she said. “Many struggle with even simple things like boiling water.” Miller feels the District Council could have been more forthcoming with information as well. “It would have been nice if the District Council kept us as businesses in the know,” she said. “We did not receive any updates from them apart from what was on the radio, news and social media.” www.insitemagazine.co.nz | September–November 2016 3

Infection control

“

This could happen anywhere.

Visitors Pack says one of the best things they did at Summerset was keeping visitors out of the care centre. A note was placed on the door and staff spoke to visitors at the entrance way. Some were let in on a discretionary basis, but most were encouraged to chat to residents outside their windows of the single-level facility. Summerset also made the decision to operate their village café on a limited basis. “It’s really important to limit the amount of foot traffic,” she says. “Once visitors are in, there is no controlling where they go within the care centre. It’s definitely helped our cross-infection rates.” A softer line was taken at Mary Doyle, although they had three areas of lockdown. Miller feels they contained the outbreak well with their approach. Both Summerset and Mary Doyle have had a lot of unwanted interest from the media as well. Pack says their no-visitor policy has also helped keep the press at bay.

Protocols in place

The delayed notification and lack of updates and information meant the public was unsure of exactly what they were dealing with. In the early stages, before the water contamination was widely known, doctors were telling affected people to drink lots of water. And some were prescribing Imodium to those affected, which only suppresses the bug and increases the likelihood of relapse cases. In terms of lessons learned, Miller thinks it is important to keep in closer communication with affected residents’ GPs. Miller said she and the district nurses were aware of who was affected as they had daily contact with all their residents, but unless they were really unwell and dehydrated they did not notify the residents’ GPs. However, after a week they decided that it was important to let the affected residents’ GPs know and to communicate with them about the medications these residents were taking. For example, those on diuretics needed them stopped to prevent getting really dehydrated; those on Warfarin needed International Normalised Ratios (INRs) as these were elevated; diabetics needed closer monitoring; those on laxatives needed to be warned to stop taking them, and so on. 4 September–November 2016 | www.insitemagazine.co.nz

Mary Doyle, Summerset and Duart all felt they had good protocols in place and experienced staff at the helm, but fear for those that don’t when going through such a crisis. Facilities typically have procedures in place for dealing with norovirus, but the contaminated water issue threw all manner of complications at them. Pack, who has a postgraduate qualification in infection control, says she has really had to rely on her knowledge. Both Pack and Miller felt it was really important that DHBs and facilities didn’t have a reliance on one particular person, and knew the correct channels to convey important information to each other. By way of example, Pack says the infection control person who deals with their portfolio was on holiday at the time of the water crisis. Miller felt the DHB needed to review how they follow emergency plans. All information is listed, but not necessarily followed, she said. There had been some difficulty getting hold of the right person when their main contact was unavailable and this had also been the case in the aftermath of a bad storm a few weeks prior, which caused power outage to the area. Despite that, Triplow doesn’t think they would or could have done anything differently at Mary Doyle. “We have such a good team and such good processes in place,” she said. “The main lesson learned is that it is so important to have good, robust systems in place.”

”

Evans agrees. Last year, Oceania put together an outbreak kit for each of its facilities, including all the standard things needed in a situation like this one. Although they haven’t needed it on this occasion, Evans says the water crisis has been a timely reminder of the importance of having the kits assembled and ready to go. She says many years ago a rest home would be besieged by an outbreak for as long as two to three weeks, but since the implementation of the kits they have been able to get outbreaks under control within three to four days. Pack agrees that you can never be too prepared. She points to their civil defence supplies, which have come in handy. “This is an area that some facilities might scrimp on, but it is so important to have water and a good amount of PPE [personal protective equipment] in stock.”

Training and education Events like this always highlight the need for ongoing education and training for the workforce in the area of infection prevention and control. “We’ve stressed things like the importance of being vigilant with hand hygiene, the importance of filling in fluid charts, of placing PPE on the tables directly outside the rooms,” says Pack. She says it comes down to simple things like not wearing long sleeves, which can easily pick up bacteria. Evans says the outbreak has highlighted the importance of having a robust infection control policy in place. At Oceania workers must undergo infection control training as part of their yearly competency assessment. It is also covered in their annual study day. “We use glow-germ lights to really drive home the importance of good hygiene. It makes it real for staff.” The facilities all agree that, following an event like this, it is important to review systems and to evaluate how they coped and to discuss any changes to be made to their procedures. In this case, the facilities of Havelock North all coped admirably, considering the suddenness and severity of the bug. The event serves as a timely reminder to care facilities throughout New Zealand to have their training up to date and their procedures clearly in place – just in case. As Pack says, “This could happen anywhere.”

Infection control

Six top tips for infection control Hawke’s Bay DHB Infection Prevention and Control Advisor MARGARET DRURY shares some standard precautions to help prevent and contain an outbreak in an aged care facility.

Hand hygiene

Gown/plastic apron

»» Hand washing or alcohol gel. »» Perform before and after touching the patient and their surroundings. »» Perform before and after contact with body fluids, e.g. blood, urine or bowel motions.

»» Wear during cares that may cause splashes or sprays of body fluids.

Gloves »» Wear gloves before touching body fluids and broken skin. »» Always perform hand hygiene before and after removal.

Mask and eye protection

Environmental control »» For cleaning of beds, equipment and frequently touched surfaces, follow the facility’s cleaning guidelines.

Used linen »» Discard into linen bins immediately to stop personal contamination and transfer of bugs/germs to other patients.

»» Protect eyes, nose, and mouth during activities that cause splashes or sprays of body fluids.

www.insitemagazine.co.nz | September–November 2016 5

Management

Talkin’ ‘bout my generation JUDE BARBACK looks at the benefits, challenges, practicalities and limitations of intergenerational activities.

Photo coutesy of Group Homes Australia

t was “Poppa Jim” Battersby who inspired the agreement between Metlifecare and the Auckland Kindergarten Association (AKA). Ninety-one-year-old Jim Battersby, a resident at Metlifecare’s Hillsborough Heights, has been a friend of nearby Roskill South Kindergarten for the past four years. He was walking past the kindergarten one day when he heard children laughing over the fence. He asked for an introduction and head teacher Karen Ramsey took him on for a ‘trial’ period. He has been visiting the kindy every Tuesday since then. He is such a special visitor that he even has his own special chair at the kindy, where he reads stories to the children. “Jim’s desire for other residents to experience the friendship and fun that he continues to enjoy inspired us to formalise an agreement and we look forward to a long association with AKA,” says Metlifecare chief executive Glen Sowry. Children from a number of AKA kindergartens meet with residents from various Metlifecare retirement villages around Auckland, where they learn and interact with one another through all manner of planned activities, including craft sessions and storytelling. The partnership between the aged care and early childhood providers is beginning to flourish.

Body of evidence There is nothing especially new about the concept of getting young and old to interact. Most rest homes will from time to time arrange for the local primary school choir to come and sing to their residents, or a visit from the preschool children down the road. But the major benefit of introducing more extended and formalised intergenerational activities is watching the relationships between children and residents grow and witnessing a deeper sense of empathy and understanding emerge on both sides that shows many benefits for both children and elders. She expects the children involved in the Metlifecare initiative to gain a better understanding of older people while enhancing their social skills as they develop friendships in a safe environment. “We also expect Metlifecare residents to benefit from the experience. Developing new friendships with the children will help alleviate loneliness, giving them something to look forward to each 6 September–November 2016 | www.insitemagazine.co.nz

week while providing opportunities to experience fun and laughter, to be young again, to share their skills and expertise and to be more physically active.” It’s no surprise that promoting intergenerational activities like this is one of the Ministry of Social Development’s goals in its Positive Ageing Strategy. Thanks to a growing body of research on this topic, it’s now widely accepted that good things come from intergenerational activity. Intergenerational researcher Professor Matthew Kaplan from Penn State University says the call for increased intergenerational engagement is coming from many directions. “We see it in newspaper editorials providing commentary on the increased sense of social isolation experienced by many young people and older adults. The theme is also finding its way into the publications and meetings conducted by professional societies in a broad range of fields, including education, volunteerism, child development, service learning, and gerontology.” He points to a “growing recognition that these efforts to facilitate meaningful intergenerational engagement will enhance the quality of people’s lives, strengthen communities, and contribute to needed societal-level change”.

Intergenerational activities in action Across the Tasman, a KITE (Kids Interacting with the Elderly) programme sees preschoolers from Tasmania’s St Michael’s Collegiate School Early Learning Centre interacting with residents of nearby Bishop Davies Court, an aged care residential centre managed by OneCare. The KITE programme encompasses babes in arms, toddlers, and children up to the age of four. “Babies and the elderly enjoy the experience of being together, of being nursed or nursing, and indeed for the elderly, just watching and enjoying the activity that surrounds young babies as they begin to crawl and explore can bring joy. For older children the experience broadens so that they talk, read, do puzzles, listen, and spend time doing shared activities,” says Dr Julie Rimes, director of the Collegiate Institute in Hobart. Both generations are equally intrigued about using iPads, she says. They delight in the exploration, the games, and the fun contained within this light and easy-to-use technology. The activities that the elderly participate in will depend on their physical, social, emotional, and cognitive abilities. Another Australian success story sees residents at Group Homes Australia sharing a regular 40-minute story time session with Family Day Care children. The residents – who are all living with dementia – and children read their favourite stories, sing nursery rhymes and enjoy conversation together. The carers note how animated, settled and content the residents are during the children’s visit and how happy they are long after the children have gone. Tamar Krebs, CEO of Group Homes Australia, says, “For our residents, for a moment in time they feel needed again, they have a purpose to read to the children and engage in something meaningful.”

Management

“Poppa Jim” reads a story to a child at Roskill South Kindergarten

The benefits extend beyond the old/young participants, with facilities reporting an increase in staff morale. Caregivers enjoy the chance to spend time with children as well, and also the relationships formed with staff from the participating day care or school. As Rimes confirms, she received positive feedback from the aged care staff members participating in the KITE programme about how much they, like their residents, value the opportunities to see young, carefree and happy people in the aged care setting. “The programme brings enjoyment, energy and enthusiasm to their setting,” she says.

Practicalities Back here in New Zealand, Aria Gardens Home and Hospital have established a successful Adopt-a-Grandparent initiative, which sees residents interacting with slightly older children at nearby Albany Primary School. The scheme started with a pilot in 2013, with a group of residents and a class of year 6 (10-year-old) children. Prior to the launch of the initiative, the children had some education around the ageing process, the life cycle, issues around death and dying and barriers to effective communication. The pilot scheme ran until December 2013. Evaluations and feedback were taken from residents, children, parents and teaching staff. The children were asked to write a one-page reflective essay on what they learnt from the experience and the essays showed not only an increased awareness of age-related issues but also increased self-awareness and confidence when meeting older adults and a developing advanced empathy towards the elderly. As part of the programme, the children were also taught about effective communication techniques for those with cognitive or sensory impairment, undertaken by manager Jon Amesbury and the Speech and Language Therapy Department at Massey University. The children were taught the acronym ‘F.I.S.H’, representing: face-toface communicating; introducing the topic; staying on the topic; and helping the other person if they forget what they were saying or became stuck. The initiative saw many fun activities emerge for the residents and school children, including a ‘Pimp My Ride’ session where the students customised residents’ wheelchairs and walking frames according to their favourite activities. It also led to the introduction of ‘Primary Pals’, which involves quarterly correspondence from a group of students to every resident in the facility, irrespective of psychological or physical ability. The correspondence revolves around contemporary issues affecting the younger generation in New Zealand and relating to the past experiences of the older residents. Amesbury said by exposing the older generation to the exuberance and pure enthusiasm of technologically advanced pre-teens and raising awareness and understanding with the children of the salient issues that can affect the elderly through experiential learning, education and positive reinforcement, they are attempting to stop that intergenerational divide becoming a chasm.

Benefits The ‘Neighbors Growing Together’ programme run by Virginia Tech in the United States has been studying the effects of intergenerational activities like these for over seven years. They have discovered that older people are more positive and engaged during intergenerational activities than single generation activities, and activities that encouraged older adults to mentor young children gave them a chance to exercise choice, initiative and autonomy. From the children’s side, the programme found that children were more comfortable around people with disabilities and older people in the community. The children also experienced a sense of purpose when they were able to teach or help older people.

Of course, programmes like KITE make it all sound so easy. Yet working with young children and frail older people can be challenging enough on its own, without combining the two generations. While most intergenerational activities are reportedly successful, it is important to be mindful of the challenges that facilitators face as well. Staff who work with children or older adults are typically trained for caring at one end of the life course or the other and as a result they may be unfamiliar or even uncomfortable with the idea of coordinating an intergenerational activity. Tried and true, a guide from Virginia Tech for running these activities, suggests providing intergenerational “cross-training” that orients staff to the clients, staff members, and care philosophy and practices of the other-generation. The training gives the opportunity to discuss misconceptions, ideas and questions about intergenerational activities. Staff learn how to work with the other organisation’s clients and policies. Intergenerational activities, like many activities launched in aged care facilities, are often initiated by one person with a great idea and a passion for the project. This person may take on the responsibility of creating, coordinating and implementing the programme. But if he or she leaves, the programme stands a high chance of fizzing out. Tried and true says administrative support is critical in helping to institutionalise an activity so that it endures regardless of staff turnover.

“

If we can improve the standing of older adults in society and nurture what they can bring through intergenerational connections, then we can achieve a better community with a better quality of life for all ages.

”

It is also important to think carefully about what activities are selected to engage both generations simultaneously. Connecting young and old can highlight generational and developmental differences between participants. For example, not all adults will want to play superheroes with kids, and not every child will be interested in bird watching. But there are plenty of hobbies and interests that are ageappropriate and developmentally appropriate for both groups. Cooking and gardening are just two examples. Tried and true suggests getting to know a bit about the adults’ and children’s social history to help staff develop activities that speak to participants’ interest and expertise. Generational differences can also contribute to how elders think children should behave. For example, an older adult might think it rude for a child to get up from an activity in progress just because she has lost interest in the activity, though this might be acceptable to childcare staff. It might be a good idea to discuss childcare practices and how they differ from older adults’ parenting practices. Developmental differences can contribute to participants’ varied energy levels, attention spans, and tolerance of noise and mess. Intergenerational participation should always be voluntary. www.insitemagazine.co.nz | September–November 2016 7

Management Jim Battersby and AKA’s Karen Ramsey

Intergenerational housing – a stretch too far? Perhaps this is why industry experts don’t expect there to be high demand for intergenerational housing models in New Zealand, which would see older people living together in a community with younger generations, sharing facilities. Cam Ansell of Ansell Strategic says he can’t see it happening. He gives the example of a New Zealand operator who built a range of housing, including expensive units aimed at wealthier people, rental units aimed at the less wealthy and a nursing home – only to find that the wealthy residents didn’t want to mix with the poor or the disabled. “If we can’t see social cohesion in a New Zealand retirement village then what chance have we for an intergenerational village?” ASB’s Ross Currie agrees we’d need to see a significant cultural change before we saw intergenerational villages emerge. “In general Kiwis in their old age don’t want to live with their kids and the kids don’t want their parents living with them. The kids would rather pay for their parents to have quality care if the parents can’t afford to pay for themselves. This is different from other cultures where it is normal to care for the older generation.” That said, Currie believes operators should be future-focused in their thinking and should not discount the possibility of facilities being used by younger generations. “New retirement village developments should contemplate a potentially declining population from around 2060 and include alternate uses in their design, primarily the facility being designed to also accommodate families and working-age couples. That would allow for the family generations to live in close proximity to each other so that the younger generation can look out for their parents without being under the same roof.”

Dylan Kneale and Sally-Marie Bamford from the International Longevity Centre-UK state that pitching generation against generation not only ignores the reality and fluctuations in the housing market, but also masks potential solutions. They believe we need to move away from division and instead consider a more intergenerational approach. In the Guardian, they point to the merits of co-housing – the development of private households with shared facilities that invoke a sense of community. The rationale behind this idea is that older people can benefit from reduced levels of loneliness and isolation and increased levels of civic participation, while younger generations can also benefit in similar ways and through the provision of affordable housing. “If we are to witness greater development of such schemes this will necessitate not only a change in values and attitudes, but a significant reappraisal of housing design and planning.” Susan Bosak of the Legacy Project, which runs its programmes across the US and Canada, believes that life in a multigenerational, interdependent, richly complex community “teaches us how to be human”. “If we can improve the standing of older adults in society and nurture what they can bring through intergenerational connections, then we can achieve a better community with a better quality of life for all ages.” Such ideals, while laudable, are unlikely to gain traction in New Zealand just yet. However, while we may not be ready for intergenerational housing solutions, we should certainly be open to embracing activities and programmes that see our residents interacting and growing relationships with people of all ages. It is clearly worth the effort.

Which generation? Generation Veterans/Silent Baby Boomers Generation X Millennials/Generation Y Generation Z Generation Alpha

Born 1922-1944 1945-1964 1965-1979 1980-1999 2000-2015 2016-

8 September–November 2016 | www.insitemagazine.co.nz

Typical traits Disciplined, self-sacrificing, cautious Hard-working, team players, not adaptable Entrepreneurial, sceptical, wary of commitment, self-reliant Not team players, entitled Impatient, tech-savvy, consumers Who knows?

Technology

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Our population is ageing and one of the ways we can help improve health outcomes is through data analysis, so that healthcare providers can be informed about the trends and outcomes of older people in the South Island.

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What does the interRAI data show? Collaborative analysis of the first set of interRAI data with other health data sets from the South Island Alliance and the University of Canterbury has helped to inform health service development.

he findings of a collaboration between the South Island Alliance and the University of Canterbury (UC) to understand and improve the healthcare needs of older people has been presented to the healthcare community. The analysis of interRAI data was carried out by UC statistics and mathematics students as a part of their degree programme, in conjunction with the New Zealand Health and Ageing Group, and the South Island Alliance’s Health of Older People Service Level Alliance (HOPSLA). The students analysed data recorded by the five South Island DHBs between September 2012 and September 2015 and focused on InterRAI Homecare 9.1 data in relation to three key topics: predictors of poor outcomes in dementia; predictors of hip fractures and serious injuries, and end of life issues. Analysis questions were developed in conjunction with clinical supporters and the students completed a minimum of 400 hours on each topic over the summer period, alongside their supervisors.

Dr Hamish Jamieson, geriatrician and senior lecturer in medicine, helped to coordinate students for the project and says the aim was to support effective planning of future health services. “Our population is ageing and one of the ways we can help improve health outcomes is through data analysis, so that healthcare providers can be informed about the trends and outcomes of older people living in the South Island.” InterRAI produces 8,000 standardised assessments on elderly people in the South Island per year, he says. “We receive about 10 million pieces of this electronically recorded information per year, and we would like to analyse this data on a continued basis.” The students presented the review results via video conference to a range of healthcare professionals across the South Island, including DHBs, aged residential care and primary care. “We achieved some really interesting results and attendees were very impressed with the students’ research,” says Jamieson.

“For example, 2,800 people in New Zealand suffer from hip fractures every year, which is a very traumatic and painful experience. “The data showed the predictors for those who have a higher chance of suffering from hip fractures, so they can now be targeted through the health industry.” Professor Jennifer Brown of the UC School of Mathematics and Statistics facilitates project work associated with interRAI. “This is a great way for students to develop their skills and seed their enthusiasm for work in the health sector,” she says. “It opens up a whole range of possibilities for them in future employment, as well as postgraduate studies, which contributes to improving health care in New Zealand. The results from this project have been fantastic and the feedback from health providers was overwhelmingly positive.”

www.insitemagazine.co.nz | September–November 2016 9

Clinical

How can an older person’s co-morbidities impact on wound care? AMANDA PALMER discusses some of the major health issues experienced by our older clients and how these can impact on wound healing.

here once a simple wound from a car door, coffee table or dog claw would heal easily, as a person ages there is an increased risk of delay and potential deterioration. During the initial assessment of an older client with a wound, it is important not only to identify but also to actively consider how the following co-morbidities may impact on the potential progress of the wound.

Diabetes Diabetes affects the ability of the body to manufacture insulin and can also mean it becomes resistant to insulin. This results in the altered ability to take up, store and utilise energy. The impact of diabetes on wound healing is complex and significant. There is an increased likelihood of hyperglycaemia (high blood sugars) in people with significant wounds because the inflammatory response causes an increased rate of glucose production. Antibiotic use will also affect glycaemic control. Tight control of hyperglycaemia will reduce the risk of infection and promote healing. When a person with diabetes has episodes of hyperglycaemia, damage is caused by processing the excess glucose. The result of this is delayed wound healing due to impaired angiogenesis (formation of new blood vessels), damage to nerves (neuropathy) and blood vessels (ischaemia) and poorly regulated cellular functions including phagocytosis (debris clearing) that not only break down 10 September–November 2016 | www.insitemagazine.co.nz

dead tissue but start to damage the new developing tissues.

Neuropathy Nerve damage to the feet causes dry skin on the feet and lower legs increasing the risk of cracking and bacterial infection. It changes foot, toes and foot arch shape and changes the pressure points of the feet as a person walks. This results in movement of the fat pads that normally provide some protection against pressure damage and can lead to callus build up and trauma to areas of the foot not used to the change in weight and function. Sensory nerves alert the body to pain, heat, cold and touch. Damage to these nerves can lead to unrecognised trauma occurring i.e. burns, sharp objects stuck in foot and so on. Altered pain sensations are often described as like burning or tingling, numbness, or like wearing a thin sock, sharp jabbing pain, extreme sensitivity, skin, hair and nail changes. Neuropathy can disguise the symptoms of infection and inflammation or ongoing trauma because the brain does not receive the appropriate nerve triggers.

Ischaemia Ischaemia means a reduced blood supply to the tissues. This results in nerve and tissue damage and ultimately death. A person with ischaemia in the feet and lower legs will experience pain due to lack of oxygen. This is noticeable when demand increases, such as walking, elevating the foot, lying in bed. The

lack of an adequate blood supply will make healing wounds more complex and in extreme cases impossible because of poor oxygen levels and reduced nutrient availability to cells. Ischaemic wounds are at high risk of infection due to the reduced ability of the immune system to respond to bacteria. Gangrene and other rapidly developing infections can quickly become life or limb threatening. Ischaemic feet can be purple when dependent and requires urgent intervention to improve the blood supply. Ischaemic limbs also get pale and cold on elevation; toenails and hairs stop growing. Palpation of the foot pulse is an indication of blood flow, but will not necessarily mean the flow is sufficient for effective wound healing or compression bandages or hosiery.

Renal or liver disease These affect the homeostasis within the body by affecting nutrient use and metabolism, haemoglobin levels and blood pressure, all of which will have an effect in wound healing. Renal failure in people with diabetes results in a significant rate of lower leg ulceration and amputation due to ischaemia. Even with successful re-vascularisation the amputation rate can be more than one in three people.

Obesity Systemically obesity is associated with the development of heart disease, arthrosclerosis, type 2 diabetes, cancer, hypertension, dyslipidemia, stroke respiratory problems, low

Clinical iron and reduced haemoglobin production resulting in reduced oxygenation of tissues. At a local level there is increased pressure ulcer risk due to hypovascularity (reduced blood supply). Poor perfusion in subcutaneous adipose tissue and reduced mobility increases the risk of pressure injury development and infection. Breakdown of surgical wounds is caused by increased tension on the wound edges causing micro-ischaemia. Skin folds harbour bacteria due to the warm moist environment and allow normal skin flora to become problematic. Friction and shear results in skin breakdown. The adipose tissue secretes adipokines that negatively influence the systemic immune system and therefore wound healing. There is an increased risk of haematoma formation and venous leg ulcer formation. Weight loss can reverse many of these factors.

Age Increasing age is not a risk factor for wound healing but is associated with an increased likelihood of disease processes, multiple medications, malnutrition, reduced mobility and lifestyle issues that could be significant. Age is associated with reduced collagen production that affects skin’s elasticity and structure. Older skin becomes less able to hold moisture and dries more readily, leading to cracking and therefore increased infection risk. Over time sun damage causes thinning of the epidermis, resulting in skin that blisters, tears and grazes more easily. There is also

an increase of pre-cancerous skin changes and skin cancer (basal cell or squamous cell carcinoma) development that can initially appear as areas of dermatitis, eczema or small ulcers.

Autoimmune diseases These include around 80 diseases, including cancer, lupus, scleroderma, rheumatoid arthritis, diabetes, Crohn’s disease, eczema, endometriosis, Grave’s disease, multiple sclerosis, psoriasis, vasculitis and so on. These diseases arise from an abnormal immune response of the body against substances and tissues normally present in the body. Typical treatment is with immunosuppressing medications. These diseases are often complex, with both the disease and its treatment adversely affecting wound healing – the most significant of which is the chronic state of activity of neutrophils and leukocytes that cause tissue damage.

Cardiovascular These diseases include heart attack (MI), stroke (CVA), angina, heart surgery, transischaemic attack (TIA) and congestive heart failure. These result in an inefficient heart pump, compromising pressure in the lower extremities making venous return problematic. This results in oedema and venous ulcers. Arthrosclerosis/ arteriosclerosis/ peripheral vascular disease causes blockages, narrowing and hardening of the arteries and ischaemia.

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Regular exercise of 30 minutes a day, which includes pushing through the pain – i.e. walking a further 10–20 steps beyond when the pain starts – and quitting smoking has been demonstrated to improve the blood supply in around two to three months.

Deep vein thrombosis DVT causes long-term complications including pain, swelling and heaviness, lipodermatosclerosis, venous hypertension and ulceration. At five years post DVT most people will show signs of post-thrombotic syndrome, spider veins, varicose veins, oedema, pigmentation, lipodermatosclerosis or ulceration. There might not be a known episode of DVT but incidents of surgery or significant lower limb injury can result in a DVT forming that resolves without apparent issue at the time. It is not necessarily possible to influence the impact of chronic disease on wound healing, but by recognising it and understanding its influence the management of wounds can be better tailored to the individual’s needs. Attention to factors such as infection, mobility and diet can have a significant impact on the overall outcome.

Amanda Palmer, BA, RN, Dip. Wound Care is a wound consultant at Wound Management Consultancy Ltd. For references to this article, please email editor@insitemagazine.co.nz.

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www.insitemagazine.co.nz | September–November 2016 11

Technology

Assistive technology: how can it help in an ageing world? JUDITH DAVEY discusses the practical and ethical considerations of introducing assistive technology into aged care.

here are all kinds of technology – digital technology seems to be taking over the world. Transport technology can get us where we want to go faster (but also contributes to traffic jams) and, in planning for an ageing world, we often hear talk about ‘assistive’ technology. What is it? And what can it do for us? The World Health Organisation defines assistive technology (AT) as “An umbrella term for any device or system that allows an individual to perform a task which they would otherwise be unable to do or increases the ease and safety with which the task can be performed.” In that case, AT includes walking sticks, which have been around since time immemorial. But someone must have realised that putting extra little legs on a walking stick helped people to be steadier – improved safety – and we have seen the evolution of ‘walkers’, with frames, panniers and built-in seats – great for getting about when the legs don’t work as well as they used to. While I’m not sure a reclining chair with a foot rest could be defined as AT, tipping chairs certainly ease the getting-up process. But what people more often think of as assistive technology are more high-tech gadgets. These may be active – I do like the idea of a disk which cleans the floor (and provides something for adventurous cats to ride on) – or they may be passive, in that they

12 September–November 2016 | www.insitemagazine.co.nz

monitor activities and wellbeing, even though they are incredibly ‘smart’. An increasing number of assistive technologies aimed at the older adult are currently being developed. In Japan, beds that incorporate automated toileting and washing systems have been developed, plus others that can be separated and turned into wheelchairs. Electronic toilets can incorporate health monitors. The HRS-I system monitors health by capturing data, such as electrocardiograph signals and body surface temperature, and then transmitting that data to a mobile phone or PC where a health professional or family member can access it remotely. Exo-skeleton suits – normally associated with sci-fi films or military use – could potentially help nurses and carers to lift and move bed-bound residents safely.

Enter the robots And then there are the robots. A prototype ‘teddy bear’ has been developed with a sensor linked into a screen in the nurse’s station in a rest home or hospital. This helps the nurse to monitor the older person in case of falls and other episodes. It can alert staff to unexpected changes and record answers to questions. Yes, you could call it a robot. What about a therapeutic robot in the form of a baby harp seal, called Paro, which

responds to its name and being stroked, moves its tail and flippers and reacts by opening its eyes and moving its face toward the sound of a voice? Paro can show surprise, happiness and anger, and will cry if it is not receiving sufficient attention. Professor Wendy Moyle from the Griffith Health Institute’s Centre for Health Practice Innovation in Australia reports that her robot seal and prototype teddy bear have achieved incredible results with people in reducing symptoms of agitation. Both are used with older people to reduce stress, anxiety and social isolation. La Trobe University and the global electronics firm NEC Corporation have developed ‘social robots’ that can talk, sing, dance, play games, tell the weather and read the newspaper and even have names – Charles, Sophie, Matilda and Jack. They are the first of their kind to be used therapeutically for mild dementia sufferers. More elaborate robots – like Meccano’s Spykee – have wi-fi and Skype capability and are also designed to help fend off loneliness. They can see, hear and speak, take pictures and make videos, helping people keep in touch with family and friends all over the world. They can also provide environmental security and contact health services in case of emergency. Other robots and devices have the potential to improve the quality of life for older people

Technology with disabilities and could extend their independence. As well as health monitors and ‘Pill Pets’, which provide reminders when it’s time to take a pill or go for a checkup, there are now practical housekeeping robots that can clean the floors, load a dishwasher and do laundry – and even just pick something up off the floor for those whose mobility is limited. Voice-activated commands are becoming commonplace with digital devices. Many of these technologies can help to reduce the workload of family carers and reassure them of the safety and security of their loved family members, not to mention reducing the expense of elder care. There have been claims that robots could deliver a higher standard of care than poorly skilled care workers in residential homes and could standardise care. Managing incontinence in older people might be preferable to human care and make the job less onerous.

Practical considerations Using complicated technology requires special training and supervision if high standards of safety and care are going to be achieved and maintained. How acceptable will robotics be among care workers? Robots may be extremely helpful, but can they provide a substitute for personal contact, which is a vital component of psychological, and therefore physical, health? A poorly skilled carer needs training and monitoring, not removing altogether. Would we be restricting the social interaction experience of isolated older people even more if we substituted machines for the touch and voice of another human being? Robots can be a bit scary. Not everyone is as comfortable as some Japanese seniors when it comes to the idea of robots in their daily lives.

»» How can we ensure basic safety (which includes the prevention of injury as well as a rapid response in emergency situations) and assistance with daily living while also protecting privacy? »» How acceptable is the monitoring of daily social interactions and patterns of movement? In what situations and in relation to which older people can such monitoring be ethically applied? How will appropriate levels and types of monitoring be defined? »» What are the special requirements in relation to people with dementia? »» How will personal electronic devices be integrated with environmental control systems and how much control will the users have over these systems? »» What is the role of informal caregivers/ professional carers in relation to these systems? What information and training do they need and how will they receive it?

Left: Walking frame Below top: Teddy bear monitor Below middle: Japanese smart toilet panel Below bottom: Robotic disc floor cleaner

Whiz-bang technology certainly has value, but let’s not allow ourselves to become carried away without some profound consideration of human feelings and rights.

Ethical considerations Consider this. A 90-year-old woman with dementia is prone to wandering at night, putting her at risk of hypothermia and other dangers. As she opens her front door, a voice says, “Go back to bed, Mum, everything is all right.” It is not her daughter, but a recording of her daughter’s voice. Is this a good thing or a bad thing? Surely it is good that the woman is prevented from wandering out into the cold and darkness. But it is deceptive – her daughter is not there. Is that ethical? And what if there was a fire? Acceptance of sophisticated new technology and its capacity to deliver benefits may depend on the extent to which ethical and privacy issues are seriously considered. These must be given high priority, respecting the choices and autonomy of older people, allowing their voices to be heard in decisionmaking that affects them, and protecting people who are especially vulnerable or who have special needs. So we are left with many questions, such as: www.insitemagazine.co.nz | September–November 2016 13

Management

Adapting to changing media needs Media trainer PETE BURDON says retirement village operators and aged care providers must adapt to the changing needs of digital news media.

ome leaders in the retirement and aged care industries have attracted negative media publicity over recent years because they have been unaware of the changing needs of the news media. Most leaders avoid the media like the plague for fear of being misquoted, quoted out of context, or humiliated at the hands of an aggressive interviewer. This fear is nothing new, but many are unaware of the changes they need to make when dealing with reporters in the age of social media and the internet.

comment”. You’ll agree that’s not a great look, even if you are busy doing more important things. The story will then spread through social media like wildfire where you will be accused of either not knowing what is happening, or not caring. This will damage your reputation and bottom line. The answer is to know how to prepare a message quickly and have messages ready to go at a moment’s notice on issues that could blow up.

Shortness of message If there is an incident like a serious minivan crash causing death, you can’t hide behind a media statement. You need to front up to cameras. Some leaders have been trained to do this, while others are unprepared.

Speed of response An important change is the speed with which you must respond to media requests when it’s an issue that could damage your reputation. This could be an allegation about staff that’s likely to be false, or something more serious like a minivan crash causing death or serious injury to residents. I often hear clients in the aged care industry say the news media is not a priority and they can wait. I agree that in an emergency or crisis, other stakeholders are the priority. But the media must be a close second for good reason. Firstly, the media will produce stories about your issue whether you are in them or not. If you are not available, the story will probably be one-sided against you and be full of misinformation or speculation. Your contribution is likely to read something like, “The CEO refused to 14 September–November 2016 | www.insitemagazine.co.nz

Bill Ralston

Sorry seems to be the hardest word It was Warren Buffet who once said, “It can take 20 years to build a reputation and five minutes to ruin it. If you think about it, you’ll do things differently.” Media trainer Bill Ralston believes retirement village operators and aged care providers need to be mindful of this when

Pete Burdon

But things have changed over recent years; nowadays you need to select a few points you want to get across in the interview and be able to sum them up in about eight seconds each. This requires a new set of skills. If you can’t make your points in that time, you run the risk of being misquoted or quoted out of context. Remember that journalists will only use snippets of what you say. That’s why you must be as brief as possible and be skilled at coming back to your key points regularly. These are the new rules of the media interview.

Pete Burdon is the author of Media Training for Modern Leaders and developer of the online Media Training Academy.

things go wrong and the media swoop. Ralston shared his advice for delegates at the recent Retirement Villages Association conference in Auckland. Among his tips was that managers, when approached by the media by telephone, should feign that they’re just about to go into a meeting, but ask what the phone call is about and who else has been approached. This allows some information to aid the hour of ‘damage control’ that ensues before returning the phone call. If something major has gone wrong and an apology is warranted, Ralston recommends operators publicly say sorry and in doing so, convey empathy and sympathy if appropriate. However, ‘sorry’ on its own isn’t sufficient. Any apology needs to be followed by what they’re doing to address the problem. When crisis strikes, Ralston believes there is an advantage to establishing your position quickly, clearly and effectively. If you don’t spell out your position, the danger is that your competitors will do it for you.

Community health

Recognising the value of

informal caregivers Massey University’s PROFESSOR FIONA ALPASS reflects on the latest findings from the New Zealand Health, Work and Retirement Study, which reveal some of the challenges faced by informal caregivers.

pproximately 480,000 people in New Zealand are providing informal care for someone who is ill or disabled. This number has grown in line with the ageing population; however, the proportion of caregivers aged 55 years and over has increased at a faster rate than that of the general population. Unpaid family caregiving is the mainstay of long-term care in New Zealand and offers many benefits for the care recipient, including improved health outcomes, reduced re-hospitalisations and fewer residential care placements. There are also substantial fiscal benefits to society as a whole. A recent report estimates the annual economic value of informal caregiving in New Zealand at between $7.3 billion (3.4 per cent of GDP) to $17.6 billion (8.1 per cent of GDP). Clearly, it would be economically unsustainable to provide this care through the public sector. Over 90 per cent of older New Zealanders (65 years+) live in private homes. This means that many older people with disabilities and high dependency on others continue to live in the community. As such, with an ageing population, family-based in-home care for frail, ill, or disabled older people will become more common. The Health, Work and Retirement (HWR) Study has been tracking older New Zealanders for 10 years. One of the core features of the study is following the health and wellbeing of caregivers over time. As with similar international research, we have found that women are more likely to be caregivers than men. Women tend to report a greater caregiver burden than men. This may be because female caregivers have been found to receive less informal assistance and to have more restricted social roles due to caregiving responsibilities than male caregivers. We also found in the HWR Study that Māori were more likely to provide care than non-Māori. Māori have a higher burden of disease and disability than non-Māori, which may partially explain the higher proportion of family caregivers. However, caregiving is also a core value in Māori culture, with most older Māori remaining in family households as they age and very few residing in residential care. Given the higher rates of caregiving provided by women and Māori, it is important that formal supports be tailored not only for the particular needs of the care recipients, but

also for the caregivers, with ease of access and cultural appropriateness high priorities The HWR caregivers generally report lower mental health scores than non-caregivers, but there are few differences in physical health between these two groups. However, when looking at patterns of caregiving we found that those who cared continuously over a longer period of time had more stable levels of physical health than those who transitioned in and out of the caregiving role and those who stopped caring at some stage in that time period. It may be that those who are ‘permanent’ caregivers develop resilience and cope better over time by putting in place appropriate support networks and resources. It should also be noted that caregivers are often forced to cease caring due to their own health issues, which may explain the health trajectories for those who are no longer providing care. One of the key issues for older caregivers in our study is the difficulties associated with combining paid work with unpaid work. A large proportion (65 per cent) of New Zealanders providing informal care are also in paid employment and as older New Zealanders are staying in work longer, many will be combining work and care as they themselves age. In the HWR Study we have found that those who combine work and care have poorer mental health than non-caring workers over time, even when taking into account sociodemographic factors. In addition, this group was more likely to report higher levels of depression and lower economic living standards. One New Zealand study found that many carers reported being unable to continue to work at the same level, or remain in paid employment due to inflexible working arrangements and poor support services. In the HWR Study we found that around one third of carers were using sick leave, annual leave and unpaid leave to be available to their care recipients. Thus policy settings can facilitate or hinder the ability of individuals to combine work and care. The use of leave provisions by working caregivers to provide care to family members highlights the importance of flexible work arrangements and the need for a dedicated carers’ leave policy in New Zealand – a policy that is now available in countries such as Canada, Australia and the UK.

Providing care is also associated with considerable out-of-pocket expenses for informal carers, and attempts to combine paid work and care can result in opportunity costs such as lower wages, poorer career prospects, and reduced retirement savings. The HWR Study caregivers who were better off reported more positive value and fewer negative impacts of caregiving, and a higher quality of support. Public policy that supports informal carers to cope with the burden of care should include adequate income support and financial assistance with housing, transportation, healthcare and home support services. Although providing care is often found to be burdensome, it can also be a positive experience. Just over 40 per cent of our caregiving sample reported their lives were better for the caregiving experience. These caregivers were more likely to be male; they provided fewer care hours per week and reported being less lonely. There is some evidence to suggest that male caregivers receive more informal assistance (from friends and family) than female caregivers do and their social activites are less disrupted by the caregiving role than are those of females. This highlights the importance of helping all older caregivers to maintain their existing social networks. The provision of appropriate options for respite care and home support services can not only alleviate caregiver burden, but can also assist caregivers to continue to participate in social activities. These types of assistance have been shown to be related to lower levels of social and emotional isolation for caregivers. The availability of adequate training for often complex medical care and access to appropriate counselling services for carers would also assist in reducing caregiver burden. Families need access to useful information about services that are available to support them in their caring roles. These services need to be coordinated so that ‘one-stop shops’ can make the experience of seeking support less stressful and more accessible. Family caregivers provide a valuable and often unrecognised service for society. This is often at the expense of their own health and wellbeing. With an ageing population, the provision of informal care from families for the frail, disabled or ill will increase. Enhancing the health and wellbeing of caregivers will not only help individuals and families but will also benefit society. www.insitemagazine.co.nz | September–November 2016 15

Wound care

Wound care in older adults The New Zealand Wound Care Society (NZWCS) shares some tips for managing wounds in older people.

lder adults are at an increased risk of developing wounds related to ageing, chronic disease and disability; often these wounds are slow or fail to heal. Care for the older adult is complex and requires a high level of knowledge and skill. The importance of applying evidencebased wound practice is imperative in this high-risk population. This in turn can reduce the risk of wound infection, pain, sleep disruption, reduced mobility, loss of independence, anxiety, depression and other associated personal and healthcare costs. Wound infection is mostly diagnosed clinically; laboratory testing provides further information to guide management. Conduct a wound swab if there are clinical signs of infection such as an increase in wound size, delayed healing, cellulitis, malodour, or increased pain. Be aware that people who have diabetes or are immunosuppressed may show only subtle signs of infection.

Like other antiseptics, iodine can be used to prevent wound infection or a recurrence of infection in patients who are at increased risk of infection, to treat localised infection and to treat spreading infection when healing is delayed. Always check for patient allergies and contraindications when using any antiseptic.

Taking a wound swab

Biofilms are bacterial colonies that occur on chronically colonised or infected wounds and delay healing. At a basic level, bacteria are encased in a thick, slimy barrier of sugars and proteins and it is this barrier that protects the bacteria from threats such as antibiotics. They are highly inflammatory, and shed bacteria onto the surface of the wound, which excites an immunological response, leading to tissue damage and ongoing chronic inflammation. The risk factors for wounds developing biofilm include: being immunocompromised; decreased perfusion; the presence of foreign bodies; hyperglycaemia; necrotic tissue; oedema; malnutrition; increased moisture levels, and repeated trauma. Excessive moisture, for example, provides the rich nutrients needed to feed the continuation and proliferation of biofilms, and the underlying cause of the excess should be corrected or managed. Biofilms cannot be detected using a normal wound swab and are only seen by microscopy or specialised culture techniques. Swabbing using the Levine technique will only detect planktonic bacteria which are free floating bacteria that are not attached to the wound surface. It is these bacteria that are susceptible to systemic and topical antibiotics. An international consensus asserted that cleaning a chronic wound should occur at each dressing change, removing all dressing product and wound debris. Sharp debridement is considered the most significant method in the prevention and control of biofilm. Studies have shown that after debridement, biofilm is more susceptible to antimicrobial treatment for 24–48 hours and suggest regular debridement to remove the biofilm in conjunction with topical antimicrobials.

The Levine Wound Swab Technique should be used when performing a wound swab: »» This may cause discomfort so prepare the patient. »» Thoroughly rinse the wound with normal saline (non-bacteriostatic), remove pus, exudate; if within your scope of practice, remove hard eschar or necrotic tissue. »» Wait one to two minutes before taking the swab to allow wound exudates to rise to the surface. »» If the wound bed is dry, moisten the swab in sterile saline. If fresh pus or wound fluid is present, collect this. »» Rotate the swab tip in a 1cm square area of clean granulation tissue for five seconds, using gentle pressure to release tissue exudate. »» Label the swab and complete the laboratory form, including the wound site, current or recent antibiotics, and any history of multi-drug-resistant organisms.

The use of iodine in wound management The efficacy and safety of iodine is often questioned in clinical practice. Iodine is an effective broad-spectrum antimicrobial and with the introduction of iodophors this ensures the iodine has a controlled release of low iodine concentrations and is not cytotoxic in humans. Unlike antibiotics, iodine resistance is considered unlikely since iodine works on the cell wall. Examples of iodine used in wound care include dressings such as inadine and iodosorb and solutions such as Betadine. 16 September–November 2016 | www.insitemagazine.co.nz

When does a wound become chronic? A wound is considered chronic when healing fails to occur normally and the anatomic and functional integrity of the skin is not restored in approximately one month. This can be due to a number of underlying causes, such as medical conditions or infection. Once the skin is penetrated, the natural protective defence mechanisms can be impaired and the environment becomes conducive to bacteria from the environment, the surrounding skin or from mucous membranes.

Using biofilms

There is a plethora of antimicrobial dressings available to clinicians for use in practice. The main groups are silver, honey and povidine-iodine and all have broad spectrum antibacterial properties. More recently, PHMB is available in many forms with antiseptic properties. Choose a dressing that will provide antimicrobial action and matches the properties of the wound; for example, if exudate is an issue select an alginate or hydrofibre with antimicrobial properties. The management of the bacteria-hostwound continuum should aim to keep the balance in favour of the host by minimising opportunities for bacteria to overwhelm patient defences and cause infection.

Case study: treating unstageable pressure injuries Southern DHB Clinical Nurse Specialist – Wound Care MANDY PAGAN shares a case study in wound management. John*, an 87-year-old gentleman, was admitted to hospital with general deterioration and unstageable pressure injuries (100% covered in necrosis) to both heels (larger than the wound in this photo). John has dementia and does not talk or mobilise and has type 2 diabetes. In accordance with Guidelines for the management of pressure injury for an unstageable pressure injury, stable eschar (dry, adherent, intact without erythema or fluctuance) on the heels serves as the body’s natural biological cover and should not be removed. John was discharged to a rest home with wound care follow-up. The wound regime aim was to prevent infection, pain, offload any pressure and allow the necrosis to lift naturally. Iodine impregnated into a lowadherent dressing with a soft pad held in place with soffban and light crepe was used daily to every second day. As the necrosed edges lifted naturally, these were trimmed and revealed healed skin underneath. This process occurred from September 2015 until March 2016. John’s heels are now fully healed. This case study demonstrates the importance of reducing pain and distress and allowing the natural removal of dry necrosed tissue. Iodine was used to keep the area dry and infection-free. *name has been changed

Dementia

Rebecca Winsor (left) and Carole Kerr

Dealing with dementia: the need for education and support Dementia education sessions have been held for more than 450 health professionals across the South Island during the past 12 months as part of a Primary Care Dementia Education project.

wo out of three New Zealanders are touched by dementia and the number of New Zealanders living with dementia is expected to triple by 2050. It is stats like these that prompted the South Island Alliance to establish the dementia education sessions. A range of online training resources have also been developed, to ensure consistent future learning. The Primary Care Dementia Education project was established to educate primary care health professionals on aspects of the cognitive impairment pathway available on the information portal HealthPathways and the importance of a timely diagnosis, promote a personcentred approach to caring for people with dementia and their families, and introduce the training available. The South Island Alliance appointed Carole Kerr and Rebecca Winsor to coordinate the project. Kerr is based in Nelson and has worked extensively within older persons’ mental health services; she also works as a dementia educator for the Walking in Another’s Shoes programme. Winsor is based in Christchurch and has worked within the dementia assessment unit and more recently as a clinical nurse specialist for Older Person’s Health. Dementia is a long-term condition that can be managed effectively in the community, says Kerr. “For most people living with dementia, the majority of the care and support needed can be provided in their own homes. This is why it’s essential that people with dementia, along with their families, are assisted to maintain and maximise their abilities, optimise their sense of wellbeing, and have control over their circumstances.” Diagnosing dementia had previously been part of specialist services and not usually primary care, she says. “Now that there’s a shift from a specialist focus to a primary one, we wanted to provide the education and training to support this.” The pair began the Primary Care Dementia Education project in May last year and their involvement comes to a close on 30 June. Winsor says it has been a satisfying and rewarding journey.

“It’s been a really positive step towards raising the profile of dementia, as well as raising awareness of the HealthPathways portal and the role those pathways have in supporting diagnosis and providing a plan for the person going forward. “One of our key goals was to ensure that those who are diagnosed with dementia and their families or carers are referred to Alzheimer’s services as soon as possible and that they know exactly where to get the information and support they need.” The development of online training resources for health professionals was one of the significant outcomes of the project, which began with a survey of primary healthcare providers across the South Island. The national training resources were then developed based on extensive feedback from the survey, as well as input from specialist services, primary care, and NGOs. “We were also privileged to film interviews with people living with dementia, their carers and specialists. This footage was used for the resource. It’s the most comprehensive online dementia training available in the country.” One of the benefits of online training is that it’s enduring, Kerr says. “While people may prefer face-to-face sessions, it’s easy to forget a lot of what you learnt. With online training, the information is there to go back to if you need it.” Support for the project has been very positive, Winsor says. “Everyone was really engaged and the PHO managers were instrumental – we could not have done this without their help. Many organisations have been proactive and made changes to their practices already. We are really happy with what has been achieved so far and look forward to a more person-centred approach to diagnosing and supporting people with dementia in the future.” See case study ‘Jan’s story’ on next page >> www.insitemagazine.co.nz | September–November 2016 17

Dementia

Case study: Jan’s story

Christchurch woman Jan Dunne attended local sessions and found them valuable both professionally as well as personally.

Palliative care

hen a family member is diagnosed with dementia, it’s a difficult time for everyone – and practice nurse Jan Dunne understands those challenges from a personal perspective. Dunne’s husband John was diagnosed with early onset dementia in September 2015. She says her experience demonstrated both the importance of a timely diagnosis and the need for education and support for families. To gain more of an understanding of the illness and how she could help people in a similar position through her role as a practice nurse, Dunne came across Primary Care Dementia Education sessions. She says the sessions were a source of valuable information and a great way to learn how to make a difference in a professional context.

“The sessions were fabulous and I learnt so much, such as what to expect when it comes to the changes and emotions you will face, the role loved ones play, and other tips and scenarios to look out for. “One of the helpful resources I received through the sessions was the dementia poster, which informs and guides others about what the person with dementia is going through and the best way to interact with them. Even John thought it was great, so I gave a copy to every member of our family. From a nursing perspective, I would like to see this resource handed out to relatives. “My personal experience also showed me there is a real need for support for the spouse of the person diagnosed – particularly for the younger age group. With more and more people being diagnosed with dementia at a younger age, I would like to see more communication and help offered to the families one-on-one, at a practice level.” A significant amount of work is currently being completed by the South Island Alliance’s Health of Older People Service Level Alliance (HOPSLA) to achieve this, and the sessions are an important step.

Dunne’s personal experience and knowledge she gained through the sessions has helped to bring about positive changes at her workplace, including ensuring referrals to Alzheimer’s support services. “After John’s diagnosis, I had to ask my GP for a referral to the organisation. This has now become standard practice at our clinic. It’s also about an awareness to listen to family if they have any concerns so that tests can be done as soon as possible – a conclusive and timely diagnosis is really important.” The diagnosis of a loved one is a real grieving process, she says. “There are huge adjustments to make in your life and it’s an emotionally draining time. The role of the spouse is huge and you don’t get any break from that. It’s also hard to know whether you are doing the right thing or not with every little decision you have to make, so the more support and information you have, the better.” Dunne believes there is a real need for a greater awareness of the illness. “It’s about education and getting the word out there to lift the stigma. It’s important not to be frightened of these things so we can help make a difference to the lives of those affected by dementia.”

Removing cultural barriers to palliative care Mercy Hospice’s Cultural Care Project is helping to address the common barriers preventing families from accessing timely, culturally appropriate palliative care.

ast year, when Yin Ling Tsang finally admitted she needed palliative care for her 97-year-old father, she regretted not saying ‘yes’ sooner. Like many Chinese, Yin Ling felt ashamed to ask for help; traditionally it is expected that family members provide the support and care. “I kept saying ‘no’ to the help and support I was offered and finally one day I was so exhausted, I knew I had no choice but to accept some help,” says Yin Ling, whose father is under the care of Mercy Hospice. According to University of Auckland Research Fellow Dr Rosemary Frey, stories like this are not uncommon in New Zealand, and with its increasing diverse population there is a real need to deliver culturally appropriate palliative care for Māori, Pacific and Asian patients. Dr Frey has conducted a study that found that there were a number of barriers affecting families to access timely culturally appropriate palliative care. The qualitative study published in 2013: ‘Where do I go from here’? A cultural perspective on challenges to the use of hospice services’, included 37 Māori, Pacific and Asian cancer patients, family and bereaved family 18 September–November 2016 | www.insitemagazine.co.nz

and 15 health professionals who either utilised hospice services or required palliative care in some other setting. The contributing barriers included a lack of awareness in different ethnic communities of available palliative care services, continuing misconceptions about the nature of hospice services, language barriers particularly for Asian patients and their families, and having no carers of one’s own ethnicity among hospice carers. Dr Frey says the study has opened opportunities to identify gaps and a number of training programmes have been developed, but more can be done. She says one step would be to gather more accurate information about what people need and want. Mercy Hospice Auckland is aware of the growing need to provide a culturally responsive service to its increasing ethnic population – 238 patients (30 per cent of all patients) in 2015 compared with 211 in 2014 (26 per cent of all patients). Community social worker Maree Goh at Mercy Hospice Auckland says in 2011 the hospice began a Cultural Care Project in response to the challenges being faced as a result of the increasing culturally and linguistically diverse community served by the hospice.

The project has focused on “developing systems and resources so patients and their families can receive the care they require at the end of life and providing education and mentoring to support staff so they are equipped to deliver culturally appropriate care”. “Our cultural liaison officers have promoted hospice services [for a number of years] within their respective communities and provided cultural support and advice to patients and their families, as well as guided staff within the organisation,” says Maree. “A significant challenge is to find more suitably qualified staff and volunteers from ethnic minorities to be engaged in hospice services nationally.” Additionally, Mercy Hospice works alongside other Auckland hospices to help bridge the gap, such as providing an information stall at the annual Pasifika Festival; developing Pasifika resources and increasing awareness of hospice services through radio interviews and public events. Yin Ling Tsang was able to speak Cantonese with Angel Chen, Mercy Hospice’s Chinese cultural liaison officer, and says, “Knowing that she understood our Chinese cultural background and what we really needed made all the difference.”

Education and training

Easing culture shock:

helping new migrant staff get settled INsite recently published an article on the importance of migrant workers to New Zealand’s aged care sector. Here, Skilled Migrant Business Advisor LISA BURDES discusses how employers can help new migrant staff settle into work and life in New Zealand, and Canterbury in particular.

he face and accent of Canterbury is changing. New migrants from all over the world have come to help with the rebuild and, for many, to settle into a new life in New Zealand. While this injection of global talent is new to many employers in the trades and construction sectors, it is not a novel experience for those recruiting and employing in the aged care sector. Despite the length of time that aged care providers have been employing in this market, it can still be a challenge to settle and retain migrant staff. Good employers have recognised that sound settlement practices lead to happy new migrants, a stable workforce, and ultimately high retention rates. Successful settlement is a two-way process. While there is an expectation that new migrants will arrive armed with the necessary skills, experience, and attitude to fit into the New Zealand life and work culture, the role of the employer is one of the most important. Employers should be thinking about how to provide settlement support well before the new migrant touches down. Communication with the healthcare worker while offshore can include such things as providing a cost of living comparison and a warning about how cold houses in New Zealand can be in winter.

Nuts and bolts Getting it right at the start is crucial for employers. Upon arrival, it’s important to put time and resources into enabling your new migrant employees to find their bearings and be able to concentrate on the ‘nuts and bolts’ of setting up their new lives.

These nuts and bolts may include registering with a doctor, opening up bank accounts, enrolling children in schools, and orientating themselves with their new local community. All this takes time and energy, and for those who have no existing support systems in the region, employer support is vital. New migrants, regardless of the country of origin, do need some extra time and energy invested in them. Set up a buddy system, provide a welcome kit with important contact details and local information, help with transport, and ensure that they are aware of the unique New Zealand road rules and driving conditions. Even those migrants who have been in New Zealand for some time will appreciate any advice and information.

Remember existing staff Keep your existing Kiwi workers in mind throughout the process. Be prepared to answer questions and concerns from your current staff, especially if they have never worked with new migrants before. Encouraging social contact between the new and existing employees, particularly in those first few weeks, can go a long way to making everyone more comfortable. Some of your residents may struggle with being looked after by migrant workers. Prepare your new employees for the possibility of older residents (particularly those with dementia) exhibiting challenging behaviour and language due to their culture. Give them strategies to cope in these situations. Communication is one of the biggest hurdles for new migrants to this country. Speak a little slower, and don’t assume that just because they speak English well that they

fully understand us – the Kiwi accent and unique language can be confusing! Encourage your new employees to speak slowly too if you are having trouble understanding them.

Helpful resources Immigration New Zealand (INZ) recognises the aged care sector as a leading employer of new migrants. In response, two guides have been developed; one for employers and another for new migrant employees. The guide Are you employing migrant workers in aged care? provides information for employers about understanding the benefits and challenges of employing migrants, how to prepare for the arrival of the new workers, and advice on how to ensure successful settlement and retention of your new employees. There are useful, practical tips for employers around such issues as cultural differences and communication challenges. The aged care workers’ guide Working in aged care in New Zealand provides essential information about what it’s like to work in an aged care facility in this country, and tips and advice around differing terminology, employment practices, and support services. There is also useful information about the cost of living and New Zealand work habits, as well as the cultural differences that new migrants will encounter.

Skilled Migrant Business Services is an Immigration New Zealand funded programme delivered through the Canterbury Employers’ Chamber of Commerce, which supports employers of new migrants to the Canterbury region with settlement advice and information. www.insitemagazine.co.nz | September–November 2016 19

Education and training

Indian nurses as caregivers in New Zealand: “I would not have come” NYEMUDZAI ESTHER NGOCHA-CHADEROPA shares the stories of four Indian nurses working as caregivers in New Zealand residential aged care facilities. Their experiences – at times distressing – differ significantly from their expectations of life and work in New Zealand.

t is really a privilege to teach the newbies as they start their journey in New Zealand as postgraduate students, but it is the first statement in their introductions that catches my attention: ‘Hi, I am so-and-so from the Philippines/India and I am a registered nurse.’ They always start with who they are in terms of occupation before they talk about their families or why they are here. This shows how much they respect their nursing qualifications. Usually almost three-quarters of the class is made up of registered nurses from overseas. Fast forward a few months in and most of these students get jobs in the ARC sector as caregivers – the beginning of their dream coming true. The many stories in the media in recent months about immigrant labour made me consider conducting an inquiry into the expectations before coming here and the experiences, now that they are here, of these nurses. This study was conducted in Rotorua through interviews with eight caregivers, comprising four Indian (three females and one male) and four Filipina (all female) caregivers with nursing backgrounds. In this article I focus on the responses from the Indian employees.

Manpreet’s story “I thought New Zealand was like what we see in movies, all green and peaceful,” Manpreet told me. Manpreet was looking forward to coming to New Zealand to study and work. He had applied to come and study as a way of getting into New Zealand and after completing his studies, he had hoped to work as a nurse in New Zealand hospitals. His first experiences were not so good and he recalled at one time wanting to go back home. Manpreet had lived in a suburb that he described as rough and told me that he and his friends had been taken advantage of a lot of time. One incident he described was a local person who leaped into their car and demanded they drive him to some party or else he was going to make them suffer. He said he has had to move after a series of similar incidents. 20 September–November 2016 | www.insitemagazine.co.nz

“We felt helpless and bullied by these local people. Sometimes they demanded we cook curry for them; we ended up locking ourselves in the house so that they would not bother us before we moved to another place.” At work he was happy with his manager mostly, because she had promised to support his visa for permanent residence. However, he mentioned two things he was not happy with. One was residents refusing to receive care from him, as exemplified by an incident when an elderly man told him, “I am not comfortable being showered by a guy”. He was subsequently surprised when a male Kiwi caregiver confessed that he always showered the resident without any problems. “This was the first time l looked at myself differently, not on the basis of how I did my job and treated residents, but at my colour,” he said. Manpreet is a dark-coloured Indian man who is very softly spoken. He had worked as a nurse for two years back in India and considered his knowledge valid for the job he was doing. He said he would love to be treated with respect. The second thing he wasn’t happy with was how he felt that Filipinos had an upper hand when it came to work favours. “If a facility is looking for four caregivers and three Filipinos and five Indians apply, the jobs will be offered to the three Filipinos and the remaining one will be offered to an Indian,” he said, by way of example. He felt there was a lot of bias when it came to Indians and Filipino caregivers. “Filipinos are good at talking about the job and Indians are good at doing the job,” he smiled. He said because of his upbringing he did not say anything to the manager because he did not want to cause any problems that would stop his manager from supporting his permanent residency. The last question I asked him was, if he knew then what he knows now, would he have come to New Zealand? He paused and said, “No, I have suffered a lot and my parents have paid a lot of money for this adventure. I am single and life is hard without someone to share your troubles with.”

He then revealed with a grin that his parents had found a girl for him to marry and he intended to return home in a month to his wedding ceremony. He is now working and raising money to enroll for his capping programme, which will see him become a New Zealand registered nurse – something that has always been his dream.

Surpreet’s story “New Zealand is the land of milk and honey and greener than other green pastures,” said Surpreet. She had anger in her voice because she said this is what they were made to believe by their agencies back in India. But then she quickly changed her tone and said, “Don’t get me wrong, the people are lovely and the culture is very welcoming.” Surpreet is an outgoing young Indian girl who had worked as a nurse for six years back home. She was studying and also working as a caregiver. She mentioned how she enjoyed shopping as a way of dealing with stress and how much she missed going out at night to shop and enjoy city life. She said that Rotorua was dead at night. “I remember the first days when I got here noticing that around 5pm people are already indoors. It is not safe to walk at night because we have been attacked twice.” She moved forward and whispered, “How can this happen in a country like this, aye? We had our groceries taken away from us by local guys ‘cos they said they didn’t have food to eat. I am a student and working only 20 hours a week – where do you think I get the money from?” Her experience as a caregiver had been filled with joy and tribulations. The joy came from the lovely ladies and gentlemen for whom she cared. “Some of them remind me of my grandparents – oh my gosh, one of the ladies I care for always hugs me and gives me kisses. This makes me feel appreciated by those I care for.” She was not entirely happy with the other caregivers (Indians mostly), however, who were always talking about her outgoing lifestyle behind her back. She felt judged by people she hardly knew and said they made

Education and training

“I get minimum wage and only work 20 hours a week. They said I didn’t have New Zealand experience, but people are people. The way we treat people is the same the world over.” her life miserable at work. She said there was a lot of jealousy among people of the same nationality at work, especially about the number of shifts, how well one related with the residents and whether one was doing well in their studies. “If I had known that it was going to be this hard to get a job as a nurse here, I would not have come. I miss my parents and my former co-workers back home. I had a better life back home. I didn’t have to work so hard to get |basic stuff. The problem with people here is that they label all of us with the same brush – ‘Ohh they are here because they were struggling in their home countries’ – and that is not always the truth.” Surpreet is still working as a caregiver and hoping that her manager will support her permanent visa after her job search visa expires.

Amandeep’s story Amandeep worked in Delhi as a nurse for two years before looking for a better life overseas. “New Zealand was not my first preference. I wanted to go to Canada, but it was a bit expensive. The life here is laid back and I come from Delhi where people dress well and look really good. I thought this was going to be better than that, but living here for a year now I have noticed people can go to town in their pyjamas.” She had been told by her agent that in New Zealand she had to study and work, which was different from where she came from. “I was prepared for the worst and I am happy being here.” The first problem she experienced was renting and then finding a job to sustain herself. “Renting was a problem since we had to work for accommodation. I was staying at this motel where the owner offered accommodation and we had to work 30 hours a week for that.” This was hard for her and her friends since they needed money to buy food and to send back home to their families. They ended up leaving this motel and looking for accommodation elsewhere. “I always cried myself to sleep since this was a new country and the experience was not good at all.” She was happy there was a great Indian network ready to give her support, but due to studies and work she did not have time to go to Indian celebrations.

“My employer is really good and I love what I am doing – helping other people. I hope she is going to support my work visa after my studies.” She seemed to be happy to have a job, since she said some of her friends were still looking for care work. “I went to the rest home that I am working for now to drop off my CV and they interviewed me that same day because they had a shortage of caregivers.” Rotorua has received a lot of international students in the past five years and most of them have a nursing background. This has caused a shortage of jobs since these students are looking for any job that can provide them with enough money to survive. “At work, my residents love me. The only thing that I miss is being in a position where I can make decisions as a nurse. I am always reminded that I am not a registered nurse here when the residents ask to see a real nurse”. She ended by saying although New Zealand was not her first preference she did not regret coming here. She now loves going to the beach, taking long drives and gazing at the scenery – all of which is really good and is peaceful and different from being in the city.

Gupinder’s story Gupinder chose to come to New Zealand because a friend of hers had told her that it was a great country. She had very high expectations for New Zealand and was disappointed when she got here. She had come as a student and was now on a job search visa and working as a care worker. She was not happy with her job. “The main issue is the job itself. I have the qualifications and experience to do my job [as a nurse] here in New Zealand but I can’t get it. It is degrading to do the sort of job that I feel I am over-qualified to do. Not that I am looking down on the job, but I feel I should not be doing a job that does not require any qualifications.” She mentioned how hard it was for her to watch other nurses do what she called “my job”. She also revealed how she felt about people using generalisations about Indians, for example being called ‘liars’. She felt like she had to work extra hard to convince people that she was different, and she was also unhappy with her pay. “I get minimum wage and only work 20 hours a week. They said I didn’t have

New Zealand experience, but people are people. The way we treat people is the same the world over.” She went on to explain how she felt like she was being used by the care facility as they gave her a minimum pay rate but at the same time went to her for her nursing knowledge. “If I could turn back time, I would still be working back home and enjoying life without thinking about what other people think about me so the answer is, no, if I knew about these experiences I would not have come.”

What I have learned from this study From the stories above, the main issue that was brought to my attention is managers’ support for permanent visas. As long as their managers supported their visas, the caregivers were happy. The focus was not on their experiences at work but their futures in New Zealand. There were also some cases of bullying, racism and discrimination from residents, other caregivers and the community. From a management perspective, employees’ experiences must not be ignored. Adverse work experiences should be resolved because if they remain unresolved they will eventually affect the delivery of care. A study by Ravenswood in 2011 investigated the relationship between employee participation, productivity and employee wellbeing in the aged care sector and found that it is very important that employees feel valued by the company they work for. These registered nurses are generally happy to be in New Zealand and even though they are going through challenges they still continue to deliver quality care because they feel called upon to help others and want to be accepted as part of the community.

Please note the names used in these stories are not the real names of the participants and any similar references are coincidental. About the author: Nyemudzai Esther NgochaChaderopa is a lecturer at Waiariki Bay of Plenty Polytechnic and a PhD candidate at the University of Otago. She is investigating the work experiences of native-born and migrant care workers in the New Zealand aged residential care sector.

www.insitemagazine.co.nz | September–November 2016 21

Opinion

If a resident wishes to pay for additional accommodation packages and other services then they should be able to, but this simply isn’t an option under the current model.

On the soapbox… Brien Cree Why aren’t the elderly afforded the same rights and privileges as the young? BRIEN CREE, managing director of Radius Care, can’t understand why the Birthcare model can’t be adapted for aged care to allow add-on services.

22 September–November 2016 | www.insitemagazine.co.nz

ecently I got talking to a friend about the suite of services offered by Birthcare, the popular birthing centre in Parnell, Auckland, where she has given birth to two of her children. While the same level of healthcare is offered by the centre to all mothers who stay at Birthcare, there are a number of other services available for an additional fee, depending on the individual requirements and circumstances of the mother. For example, there are different levels of accommodation offered by the centre, from the standard, government-funded accommodation through to premium rooms that offer hotel-style comforts and are available at an additional cost. My friend said that while the level of care remained consistent regardless of what level of accommodation and other services a mother chose, it was nice to have other service options available to purchase as required. I found this discussion fascinating when looking at it in comparison with aged care services. The Birthcare service model is exactly the sort of model that would work in aged care, yet currently the sector is not allowed to offer paid-for, add-on services. Regardless of individual requirements or wishes, when a person comes into rest home care, they are offered a standardised level of nursing care, and an inflexible government-subsidised accommodation package. The government-funded accommodation package generally provides a room and single bed with a bathroom. While it’s crucial that there is a set standard of nursing care available to all elderly persons who come into care – this should never change regardless of individual situations – if a resident wishes to pay for additional accommodation packages and other services then they should be able to, but this simply isn’t an option under the current model. This rigid approach to aged care seems completely unfair and disrespectful to aged persons and their families. If a family or the resident wishes to pay for add-on services that meet the individual requirements, such as larger rooms, bigger beds, various appliances or any other services that might make their stay more comfortable, why should they not be allowed this option in the same way that new mothers can also decide on what services and accommodation they would like at Birthcare? The elderly and the young are arguably the most vulnerable in society, yet for some reason we seem to value those coming into the world more than we do those in their last years, who have worked hard all their lives and made a valuable contribution. The same rights and privileges should be afforded to the old that are afforded to the young. I want to see the same commonsense approach that a birthing centre is able to offer applied to the aged care sector. There is no escaping the fact that it is the ageing population that is increasing, and the model has to change to accommodate this ever-more significant group in society, and meet their needs too.

Aged care

Let’s snoop around… Malyon House JUDE BARBACK visits Malyon House in Mount Maunganui shortly after the family-owned rest home celebrated its 20th anniversary.

alyon House manager Amy Munro is excited to get my call. Having recently cited various INsite articles as part of her studies for her postgraduate diploma in health management, she was pleased to have her rest home featured among its pages. I say ‘her rest home’ intentionally, as it belongs to Amy’s family. Her parents David and Cecily Munro own Malyon House and Amy, a registered nurse, has this year taken the reins as its facility manager. Amy says she enjoys sharing the home’s history with prospective residents. It’s a story worth sharing. Cecily Munro, also an RN, worked at Mary Shapley Rest Home in Whakatane as clinical manager. Her ambition to own and operate her own rest home led her and her husband to purchase Malyon House, a 12-bed facility on Hinau Street, Mount Maunganui, in 1996. In 1999 the business expanded to Te Puke, establishing a branch of Malyon House there; this was sold in recent years to CHT. Meanwhile, the Mount Maunganui rest home grew to 18 beds before the need for further expansion required them to look for a new site. Malyon House was relocated to a larger facility on nearby Heath Street in 2007. A major expansion and renovation project over 2011 and 2012 saw the home grow from 29 beds to the 57 beds it is today. Of these 57 beds, eight are officially resthome-level beds, while the others swing to deliver hospital-level care. The majority of rooms have ensuites; 15 have shared bathrooms. “People love the fact that Malyon House is family-owned,” says Amy. She thinks the

fact that they are one of the few non-corporate facilities offering hospital-level care counts for a lot. They rarely have vacancies and don’t need to advertise, such is the strength of Malyon’s good name. The turnout they had at the home’s recent 20-year anniversary celebration is testimony to its popularity within the community. Residents, their families, local press and over 100 people from the community all came to honour the occasion at two celebratory afternoon teas held at Malyon House. The celebrations also recognised two long-standing staff members – senior carer Fran Humbke, who has been with Malyon House since before the Munros acquired it, and Monette Burns, who had been Malyon’s facility manager for the past 20 years. Monette worked with Cecily Munro at Mary Shapley in Whakatane. “We’re not letting Monette go!” says Amy. She is grateful for Monette’s support as she transitions into the manager role. Meanwhile, Monette has pared back her hours to become a part-time education manager. She hints at retirement, but I sense this new arrangement is working well for now. Staff seem to be very important at Malyon House. They have 75 employees and a low staff turnover. Again, Amy attributes this to being privately owned. Things like giving staff members their birthdays off, a staff Facebook page and a general positive working environment all go a long way with employees. “We have an amazing team,” says Amy. “They don’t think twice about volunteering to work extra shifts if needed.” Malyon House is also part of the WorkWell initiative, which requires businesses to select a number of health-related focus areas for their staff. Malyon’s efforts at becoming smokefree and physically active (staff members participated in group walks to the top of the Mount and in Baywave’s ‘Swim a k a day in May’ challenge) and meeting their other goals saw them achieve gold accreditation for their efforts. Like virtually every other rest home in the country, Amy wishes they could pay their staff more.

“We tell our staff that what we get, we pass on to them. It’s just not enough,” she says. Malyon’s reach also extends to the community through its meals on wheels service. Monette says that while it isn’t the most lucrative of activities, it is a good way of engaging with people in their own homes who might require residential care one day. On my tour of Malyon House I meet various staff members and residents, including a woman who has lived in Mount Maunganui for over 50 years. From her room she has a view directly facing the Mount. I meet Donna, the diversional therapist. Although she is technically on sick leave, she has come in today especially to help with a knitting project that has seen residents knit tiny baby clothes and blankets for the Special Care Baby Units at Tauranga and Whakatane hospitals. Donna describes how this project – and others like it – has been led by a volunteer. Volunteers play an important role at Malyon, but I sense there is a strong ethos among the residents and staff for ‘giving back’ too. The SCBU knitwear is one example, and Amy describes how the residents make things like lemon honey to sell as charity fundraisers. Thursday Bingo rates highly on the activity calendar, which is delivered to each resident every month. So too does the exercise class ‘Too fit to sit’, which is run three times a week by the home’s physio and activities team. They also enjoy their van drives out to the new subdivisions of Tauranga or simply to the beach for an ice cream. I feel that Malyon House exemplifies the role that rest homes play in our society – how they interface with our communities, appreciate their surroundings and add to the colour and vibrancy of Kiwi culture. I’m pleased to think they enjoyed a lovely celebration for their 20-year anniversary. The year 2036 sounds an absurdly long time from now, but I have little doubt that Malyon House will be celebrating another 20 good years in due course.

www.insitemagazine.co.nz | September–November 2016 23

Aged care

Up close and personal with Gabby Clezy TerraNova Homes & Care chief executive Gabby Clezy tells INsite editor JUDE BARBACK that it is time for more collaboration and open communication about the challenges and opportunities faced by the sector.

ne of the hardest things about interviewing interesting people is that there is a temptation to become engrossed in their story. I embarked on our chat intending to get a sense of the main issues affecting the aged care sector, but I could have easily wiled away my half hour with TerraNova’s chief executive Gabby Clezy just talking about her rather impressive career. The nutshell version goes like this: Clezy trained as a pharmacist in Wellington but soon found herself in the UK juggling the demands of a young family with her job. She worked within the NHS and in an academic capacity, before eventually heading back to New Zealand, where she held a variety of positions, including an auditing role in medicines control for the Ministry of Health, within the mental health and addictions sector for Odyssey, and a position as business improvement manager with Bupa. Clezy is clearly well versed in healthcare, however her chief executive role with TerraNova Homes & Care, which she began in November 2014, was her first executive position. TerraNova underwent restructuring about this time, using the departure of its clinical and operations managers as an opportunity to introduce a chief executive role to lead TerraNova’s five facilities with a total of 300 beds. Eighteen months in and Clezy is passionate about her job and TerraNova. “I’m privileged to be leading this fabulous organisation,” she says. The elephant in the room – for me, at least – is TerraNova’s involvement in the ongoing equal pay case. In 2012 TerraNova caregiver Kristine Bartlett, supported by the union, lodged a claim with the Employment Relations Authority, alleging Terranova was in breach of the Equal Pay Act. A long legal process has ensued, running parallel to the Government’s attempts to negotiate an out-ofcourt settlement. I’m not good at tackling elephants so I sidle into the question. Clezy, on the other hand, is very clear on the issue. 24 September–November 2016 | www.insitemagazine.co.nz

However, the biggest challenge for aged care providers continues to be how to operate effectively in the face of funding constraints, says Clezy. In addition to delivering quality care, there is pressure to meet the demands of auditing, compliance and things like interRAI. Providing an increasing amount of respite care and end-of-life care is also placing a squeeze on resources, due to the insufficient levels of, and unclear parameters around, funding for these types of care. Clezy says the inadequate funding doesn’t stop them from delivering the best possible care, but it is frustrating. “The funding model really needs to be reworked. Ideally we need to throw it up in We need everyone to put the air and start again,” she says. Clezy thinks there is a desperate and real egos and agendas aside and need for sector collaboration on funding be open and ready to work and other issues. She would love to see together to identify the a forum developed to help foster better communication across the residential aged issues and come up with a care sector and with others, like the home range of solutions. and community support services sector, for example. “Residential aged care is actually not in anniversary event in Auckland, she asked competition with community care,” says Bartlett to accompany her to the celebration. Clezy is a big believer in developing people’s Clezy. She gives the example of TerraNova’s potential and places emphasis on educating and close work with Geneva and MedCall and training staff. She strives to drive a values-based says there is scope to build on relationships culture that is open, honest and fair for all staff, like these. I suggest she is well placed to take a residents and their families. “We’ve recently received a stamp of approval leadership role in developing such a forum; Clezy agrees that she is up for the challenge. from Careerforce, which recognises our “The sector requires people to be brave,” organisation-wide induction and orientation she says. “We need everyone to put egos and programme for Level 2 certification in Health agendas aside and be open and ready to work and Wellbeing,” she says. “The cost for our together to identify the issues and come up caregivers to receive their national certificate with a range of solutions.” is $200 per employee” – money well spent, There also needs to be more recognition of according to Clezy. all the positive things happening in the sector, In addition to workforce development, at she says. the top of Clezy’s ‘to do’ list are the ongoing “I think we need to celebrate all the challenges of increasing occupancy and meeting fabulous things that are happening. It’s a clients’ expectations. Clezy personally takes all after hours calls to the business, viewing this as really exciting time to be in this industry.” a good opportunity to keep her finger on the pulse with regard to clients’ needs and queries. “It is a sector-wide issue and the provider position is now handled by the NZACA,” she says matter-of-factly. Since joining TerraNova she has been very much “on the edge of it”. It doesn’t follow that Clezy doesn’t have an opinion on caregiver wage levels. Like others in the sector, she wants to see caregivers receive better pay and hopes the legal or negotiations process will ultimately result in more funding to allow better wages. “I really admire and respect Kristine,” she says. “I’m a feminist – we’re all feminists,” she says, indicating us both. In fact, Clezy is a member of global women’s advocacy group Zonta International. At their 60-year

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Clinical

Case study: Falls Prevention Programme One aged care provider’s initiative to reduce the number of falls by residents is proving very successful.

n 2015 Oceania Healthcare developed and implemented a programme to lower the number of sentinel events (falls with fractures) in its South Island aged care facilities. The plan was designed to reduce the total number of falls which would in turn reduce the number of sentinel events occurring. In the period from 1 June 2015 to 31 May 2016, Oceania achieved a 20 per cent reduction in total falls in the South Island and a 13 per cent reduction in sentinel events. One facility reduced its number of falls by half after implementing the programme. Susan Mountier, Oceania’s clinical and quality manager for the South Island and project manager for the company’s Falls Prevention Programme, began by training the clinical managers and RNs on how to assess individual residents’ needs and create specialised care plans that help prevent the incidence of falls. A structured process called intentional/routine rounding (IR) was introduced. IR involves the staff adopting specific behaviours and carrying out regular checks on individual residents at set intervals (typically hourly). During these checks, staff perform scheduled tasks or observations with the resident that help to mitigate the factors that are likely to lead to falls. The checks include

monitoring pain, checking positioning, attending to toileting needs, assessing and attending to the resident’s comfort, and checking the environment for any risks to the resident’s comfort and safety. The round ends with the closing words: “Is there anything else I can do for you – I have time.” It also includes a statement about when the resident can expect a staff member to return. Another factor that is also very beneficial in reducing falls is ensuring that the appropriate equipment (i.e. perimeter mattresses, low beds or bed levers) is available at all sites and is being utilised. Regular exercise is important in the prevention of falls, but keeping residents

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Increasing staff awareness for all staff, including healthcare assistants, cleaners and kitchen assistants, has had a huge impact on reducing falls.

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motivated to engage in activities can be a challenge. As part of the Falls Prevention Programme, facilities are encouraged to offer at least five group exercise sessions per week. To help keep the exercises varied and fun, an activities blog has been created where activities coordinators can share their ideas. The blog is supplemented with regular email communications promoting some of the most creative or popular ideas.

Increasing staff awareness for all staff has had a huge impact on reducing falls. Awareness of who is at risk, times of day that residents are more at risk of falling, and planning the carers’ duties around this is very important. To increase awareness, falls prevention notice boards have been set up at nurses’ stations and in staff rooms. These notice boards clearly display statistical information around vitamin D prescribing, sentinel events and number of falls, along with information on interventions to prevent falls. Each month, a highly visible, colour-coded poster is put up on the notice board at each facility and updated every day showing the number of falls (a figure coloured in red for each fall that occurred) and the number of days without falls. This helps staff to focus on the day or shift they are working on and motivates them to better the current record of days without falls. Ongoing monitoring and support is vital, and Susan Mountier continues to compile falls statistics each month and send out monthly email bulletins to all clinical managers with information on falls prevention. The response rate to a recent survey sent out to all Oceania clinical managers about the Falls Prevention Programme clearly demonstrates their enthusiasm and commitment to continuing to reduce the number of falls. Based on this feedback and the outstanding results achieved in the South Island, Oceania has set a goal of reducing falls by a further 10 per cent across all its facilities nationwide over the next year. www.insitemagazine.co.nz | September–November 2016 25

Policy

Upcoming new programme to reduce risk of falls ACC’s GILL HALL discusses a new programme to support initiatives aimed at reducing falls for older New Zealanders.

Education and training

aby boomers are widely credited with being the generation that changed the world, and for agencies like ours they’re continuing to shape and influence the way we deliver services. By 2035 the number of people aged 65 years and older is expected to make up around a quarter of the population. With falls being the most common injury for over-65s, every day

Karla Gounder (at back) helps a resident

A day in the life of… Karla Gounder Caring in a compassionate and authentic way for our elderly who find themselves in the hospital wing of a residential aged care facility takes a special sort of person. INsite talks to KARLA GOUNDER, a healthcare assistant at Enliven’s Woburn Home in Lower Hutt. 26 September–November 2016 | www.insitemagazine.co.nz

we see the devastating impact a fall can have on a person’s independence and the way they live their life. In July this year ACC, in partnership with the Ministry of Health and the Health and Quality Safety Commission, announced a new programme of work to support initiatives aimed at reducing falls and injuries for older New Zealanders. In addition to looking at how we manage fracture liaison services and better integrate services for older people who have had falls, we’re focused on supporting better access to exercise programmes that build strength and increase balance, as we know these types of programmes can help to reduce falls and injuries. Although confirmation of the finer details of how this programme will roll out is some way off, after holding community meetings throughout the country in August and September, an agreed approach is starting to take shape. Communities want the opportunity to work together to design and deliver strength and balance programmes that truly reflect the needs of their own communities.

This is a radical shift from how we currently do things. Rather than fund individual classes, the thinking now is to develop a way to support community groups to run their own classes through new lead coordinator/agency roles. These lead people or groups will have oversight of a district – or potentially a region – to support community strength and balance providers with training, quality standards and maintenance, and referrals from doctors and other health providers and organisations. A lot of planning and thinking still needs to go into this, but what we do know is that a lot of good work is already being carried out by people who are committed and passionate about the health of older people. We see this new programme as a way to better coordinate our collective efforts, with the ultimate goal of increasing access to community strength and balance programmes in a way that can be sustained well into the future. Our consultation phase will remain open until the end of September and we invite you to contribute questions or comments to us at preventfalls@acc.co.nz.

training I have been able to better myself. It’s made me better at my job and it puts everything nicely into its place. I am a lot more aware of what a resident is capable of doing and what they can’t do, and how I can best support them. I have a lot of confidence in everything I do now, and when the families of the people I care for come and praise me, I know that I am doing great. I feel that I’m exactly where I’m meant to be. I’ve also been invited to train to become a REAL Observer and have done some training around this. I’m looking forward to helping others complete their training.

For you personally, what is the most important aspect of your work? Karla: Making people happy. It’s all about making the residents smile. I love to have a laugh with them and I will pretty much do what they want to do based on how they are feeling that day. If they are in a good mood and want to have a dance, I dance with them. I love talking to them about what they used to do in their lives and hearing their stories. I treat all the residents like they are my grandparents. It’s also really important to remember that I’m not coming into a workplace – I am coming into their home to work.

How did you come to be in this job? Karla: I used to do teacher aide work in a kindy but decided it wasn’t the route I wanted to take. So I went to the opposite end of the scale and started working with the elderly. I did a training course through the Salvation Army, who then connected me with Enliven. I have worked here for two years now and have just completed more training and am also working towards becoming a workplace observer.

Tell us more about the training and the difference it makes in your work? Karla: I’ve just completed the New Zealand Certificate in Health and Wellbeing in Health Assistance (L3). This was done with the support of Careerforce and it’s really reinforced everything that I had previously learnt or done. I love to stay fresh and up-todate with what’s going on and through this

Editor’s note: A Careerforce REAL Observer plays a significant role in the workplace training process. Working alongside trainees, they are able to support the Careerforce supported assessment process by collecting evidence of a trainee’s competence. Observers know the correct standard of performance expected of a trainee and are able to capture “naturally occurring evidence”.

What do you love about your job? Karla: I just love to care for people and make them happy. Having a good time is the key and I work with a great crew. But what I really love is that two of my children now volunteer here at the home. They are eight and 14 and spend a few hours a week here with the residents, taking them for walks in their wheelchairs or just doing things with them. The kids learn so much empathy and respect from this.

Conferences

Upcoming conferences HCHA 2016 conference Home and Community Health Association (HCHA) conference Theme: Looking in, looking out Where: Te Papa, Wellington When: 28–29 September 2016 The year’s HCHA conference will explore the challenges and opportunities of changes occurring in home and community services. The conference will give delegates the chance to look inwards at: »» clients – their physical, mental, social or cultural needs, gifts and challenges »» workforce development, including regularisation and training »» the best ways to work with people and other organisations »» organisational quality, health and safety, information technology, financial management, privacy and governance. It will also offer opportunities to look outwards at: »» health strategy planning and funding, medium- and longterm planning »» robotics and other technologies »» emerging and future care and support options »» what’s new in rehabilitation, restoration, injury and illness prevention and health and wellness promotion »» intersections between home support and other social systems. Programme, registration and other information can be found at www.hcha.org.nz/conference-2016.

NZACA 2016 conference New Zealand Aged Care Association (NZACA) 2016 conference Theme: The pursuit of excellence – building on our strengths Where: SkyCity Convention Centre, Auckland When: 4–6 October 2016 This year’s NZACA conference aims to celebrate the quality of care provided by New Zealand’s aged residential care sector and confront the challenges faced by the sector.

The programme, while still in the fine-tuning phase and subject to change, looks set to address issues relating to palliative care, interRAI, dementia care, the sector’s workforce and much more through a selection of local and international experts on a variety of topics. Technological change is having an impact on many facets of aged care, from the business operation of facilities to the care they deliver. The conference will look at some of the trends emerging with digital technology and how providers are managing the change. It will also look at how to manage the growing expectations of its customers in a highly regulated, tightly funded and competitive environment. As usual, the feather in the conference cap is the gala dinner, at which the winners of the annual Excellence in Care Awards will be announced. Entries closed for this year’s awards on 11 August. Delegates should start dusting off their sequins for the disco-themed evening.

the Selwyn Institute for ageing and spirituality 2016 Gerontology Nursing Conference Theme: Spirituality and the foundations of human caring Where: Tasman Room, Alexandra Park, Greenlane Rd West, Epsom When: Wednesday, 7 December 2016, 8.30am – 5.00pm. It provides 6.5 hours of certified professional development. Keynote speakers will be Dr Jean Watson, Dr Michal Boyd, Dr Richard Egan, Dr Maree Bernoth, Dr Chris Perkins and Professor Thomas Petschner

2017 diary date New Zealand Wound Care Society’s 8th national conference Theme: Clearing the air – dispelling the myths and misconceptions in wound care Where: Energy Events Centre, Rotorua When: 18–20 May 2017 Keynote speakers will be Professor Keryln Carville, Associate Professor Geoff Sussman, and Professor Rod MacLeod. www.insitemagazine.co.nz | September–November 2016 27

Opinion

Last Word… Paul Rea New Zealand Seniors Party chair PAUL REA says it’s time for New Zealand to rethink its current pension scheme to deliver a fair deal for older Kiwis.

fter more than 50 years of work, the time finally arrives for you to retire and you anticipate enjoying the rest of your life doing the things you always wanted to do but never had the time. Then it suddenly hits you, gone is the big weekly pay cheque, only to be replaced by the New Zealand super paid out once a fortnight. You now find you have to survive on a meagre $17,458.48 per annum before tax – what an absolute shock to the system. This pension is far from that promised by the late PM Sir Rob Muldoon, who offered ALL New Zealanders a FREE pension to get the National party re-elected in 1975. Muldoon abolished the Labour compulsory scheme instigated by Norman Kirk and promised us we would receive 80 per cent of the average national wage. To date that promise has not been kept and the current rate is around 33 per cent of the average national wage – a long way from that promised 80 per cent. Had the compulsory scheme still been in existence, with both employer and employee contributing, New Zealand would have many billions of dollars in this fund and would be able to pay pensioners a ‘living wage’ as promised. Since its inception, the retirement age has risen from 60 to 65, with many expecting it to rise even further to 67, similar to Australia, as the number of pensioners increases and the pressure grows on our economy.

A proactive solution There’s no doubt that something has to be done to prevent a catastrophic blowout and that time is drawing nearer. The New Zealand Seniors Party was formed because successive governments have stopped listening to older people and perceive us all as ‘old fogies’, forgetting that we bring a lifetime 28 September–November 2016 | www.insitemagazine.co.nz

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There’s no doubt that something has to be done to prevent a catastrophic blowout and that time is drawing nearer.

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of experience and knowledge to the table. They also seem to forget that seniors alive today fought to give all New Zealanders the freedoms they currently enjoy and it was our generation who helped to build this country. The New Zealand Seniors Party has a proactive solution: amend the current pension system to a pro rata system that will create a level playing field, with the eligibility for receiving a pension extended to working for 30–35 years, with a minimum period of 10 years as a resident before receiving a percentage of the full pension. There has also been a lot said about Section 70 of the Social Security Act concerning those immigrants who are entitled to overseas

pensions and have them deducted from their Kiwi pensions. The Government has labelled them ‘double dippers’ but, if adopted, this pro rata system would do away with this once and for all and bring New Zealand in line with most other OECD countries. Should a person then qualify for a full New Zealand pension (having worked for 30–35 years depending on the period adopted) and also be entitled to an overseas pension, they should receive both, having worked, qualified and contributed in both countries. Pensions should be means tested. We would also like to see compulsory superannuation reintroduced to provide for future generations similar to the super scheme currently operating in Australia. KiwiSaver, although good, will not provide future generations with sufficient funds to live on as it is a voluntary, not compulsory, scheme. We find ourselves at a crossroads, with a choice of either continuing down the slippery slope we are currently on or taking a proactive approach and introducing a universal system, whereby future generations can retire in the knowledge that they have sufficient funds to enjoy, not endure, their retirement. New Zealand Seniors Party policies address many of the issues currently affecting New Zealanders. These include nonnegotiable policies for a living wage for seniors and the removal of GST from medical services and supplies. We do not make rash promises as other parties do, using scare tactics to gain votes then not delivering on promises when elected. We can only promise that, if elected, we will bring common sense back into government and work tirelessly to make New Zealand a country to be proud of once again.

Subscribe to INsite is a magazine at the heart and soul of New Zealandâ&#x20AC;&#x2122;s aged care, retirement, and community care sectors. Through its close ties with industry associations and attendance at conferences, INsite provides extensive coverage of the issues that are important to the sector. INsiteâ&#x20AC;&#x2122;s four themed editions include retirement villages as a business, long term care needs, nutrition, diet and clinical focus. Each issue is packed with in-depth feature articles and opinion from your colleagues. INsite reaches the decision makers. It is targeted at owners and managers of New Zealand aged care facilities, chief executives, financial officers, directors of nursing, government departments and decision makers directly involved in the aged care and retirement sectors. Subscribe to INsite today so you can be in the know about what really drives the sector.

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