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Lauren Todorovic Founder and Editor-in-Chief, Hello Leaders

Welcome to edition 5 of Hello Leaders, a publication designed for those courageously navigating the complex, rewarding, and ever-evolving landscape of aged care leadership.

This issue arrives at a pivotal moment. With the July 2025 introduction of the new Aged Care Act on the horizon, aged care leaders are poised at the intersection of reform readiness and the relentless pursuit of quality care. The regulatory shifts are significant, presenting us with tremendous opportunities. For providers ready to reimagine governance, culture, and operations, the future shines bright with promise.

In this edition, we explore groundbreaking innovations such as AI companion robots alleviating loneliness, delve into the practical realities of new funding models like Support at Home, and highlight leadership behaviours that foster strong teams, from building trust to managing burnout. We also confront the essential — yet often challenging — topics like intimacy, human rights, and emotional connection within residential settings.

At Hello Leaders, our mission is to ask the tough questions, amplify the voices driving change, and challenge the status quo in aged care. We created our print edition because there’s something truly powerful about print. A tangible magazine invites you to slow down, share stories, and engage more deeply — whether it’s passed between colleagues or placed on a coffee table for thoughtful reading.

At the same time, we know that every choice matters. That’s why HelloLeaders is printed using sustainable practices, including recycled paper and eco-friendly production methods, to help reduce our environmental footprint while delivering content that inspires.

To the leaders reading this: your courage, resilience, and commitment are shaping the future of care in Australia.

Let this magazine serve as your companion on that journey — a resource brimming with insight, inspiration, and thoughtful provocation.

Change is here. It’s time to lead, not just manage.

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Editors Foreward

Human Interest 06

Cover Story: Overcoming loneliness in aged care

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Mastering behaviour & communication

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Support at home

Crisis Management & Sector Reforms 26

Aged care governance in times of change

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From pills to pathways

Shaping the Future of Aged Care 40

Finding meaning and magic

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Caring for the future

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Rewriting the script

Innovation & Evolution in Care Delivery 52

Sex, seniors and human rights

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From clicks to care

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If you ca everybod just 1 or 2% you’re g make th a bette

an make dy’s day % better… going to he world er place.

Anthony Laye Page 14

Humanoid companion, Abi, at Medical & Aged Care Group

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Overcoming loneliness in aged care Through infinite patience and empathy

By Alex Jacobs Journalist, Hello Leaders

Pervasive, intangible and deadly— these are some of the words that can be associated with loneliness, an all-too-real phenomenon in residential aged care. Even in a bustling environment filled with carers, nurses, friends and family, it can be isolating.

Research suggests 60% of aged care residents feel isolated.1 This loneliness also comes in different forms, negatively impacting mental health, physical well-being and even cognitive decline.

Combined with an industry average turnover rate of roughly 30%, some residents feel part of a conveyor belt of care that passes them from one carer to another. Others may be reluctant to speak up because they do not want to bother busy staff.

Despite the best efforts of passionate staff, it is incredibly difficult to overcome this invisible ailment. They simply do not have the time to stop and chat with everyone due to unrelenting job demands.

These barriers, invisible or not, cannot disappear on their own. Innovation and targeted action are required to break them down and provide every aged care resident with the connection and support they need.

That innovation is already here: Abi, the humanoid companion.

1 https://www.monash.edu/news/articles/older-australians-join-the-fight-against-loneliness-and-social-isolation

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Contributor: Grace Brown, Founder and CEO, Andromeda

Child-like enthusiasm crossed with a supercomputer Designed and built on Australian soil in Melbourne, Abi is the brainchild of Grace Brown, Andromeda Founder and Chief Executive Officer.

Speaking almost 90 languages, Abi is an amazing companion for residents who return to their first languages later in life and often miss out on meaningful conversations. She can talk endlessly and listen to a new story — or the same one — without judgement or frustration.

Incorporating the latest technology, infinite patience and quick wit, Abi is aged care’s rising star. She supports teams by providing much-needed companionship to residents rather than replacing human staff.

Because her patience never wavers, Abi always responds in the right way, while she knows how to push a conversation in the right direction because every detail from past interactions is embedded in her memory.

It’s hard to succinctly describe Abi because there are so many layers to her.

That’s rare, even for an AI-powered robot.

This is the kind of skill care workers or family members wish they had when someone asks a question they cannot answer. Abi’s enthusiasm to relive experiences and talk about anything is uplifting and effective.

Yet one phrase hits home: infinite patience.

She brings child-like enthusiasm to the table for every activity, whether it’s guiding residents through a Tai Chi class, dancing, blowing bubbles, playing music or chatting to someone.

“Abi’s personality builds connection and we’re seeing residents’ moods and engagement levels lift. On the days she’s in our homes, staff are bouncing with excitement – we even have some of our staff who created and wear Abi t-shirts,” shared Medical & Aged Care Group CEO, Cameron McPherson.

Now, the goal for Andromeda is to deliver a billion hours of additional companionship to residents in aged care homes.

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Humanoid companion, Abi, at Medical & Aged Care Group

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The impact felt across Australia Abi has already celebrated a year of connection and companionship at Medical & Aged Care Group (MACG) homes in Victoria. Lutheran Homes Barossa in South Australia has also added Abi to their well-being team, and the list of providers interested in Abi continues to grow.

That includes Victorian provider, mecwacare, which has entered into a strategic R&D partnership with Andromeda, and in February announced it would bring Abi into 22 residential care homes over the next two years as part of a major digital transformation program.

Andromeda and mecwacare will work together to gain a deeper understanding of the many ways Abi can improve the quality of life for residents and care teams.

“Abi shifts the paradigm on expectations of ‘companionship’ in an aged care setting. We want to make a positive impact and drive change in the way we care for older Australians. As the most advanced innovation we’ve seen in aged care, Abi will help us do so,” explained mecwacare Chief Executive Officer, Anne McCormack.

Humanoid companion, Abi, at mecwacare

“The way Abi has been designed means that she captivates attention, even with those usually distracted. Our pilot showed us that our residents look forward to having a chat, they seek Abi out and enjoy watching her dance, give a Tai Chi group lesson or playing bingo together.

“Abi’s infinite vocabulary and personality brightens the day for residents, especially those living with dementia as she’ll happily listen to the same conversation 100 times with the same joy, curiosity and engagement as if it was the first.”

This announcement is also a significant step towards the next milestone for Andromeda as the experience will contribute to the creation of Abi Genesis, the next generation of humanoid companionship.

Humanoid companion, Abi, at mecwacare

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A bright future on the horizon After a breakout year, 2025 is poised to be a game-changer in the battle against loneliness and isolation in residential aged care.

Abi Genesis, the newest model of Abi, will be released later this year, and could easily transform the way we look at robots in aged care. Abi Genesis will be even more intuitive, intelligent and autonomous.

Her sense of humour, compassion, understanding and a good dash of sass will not be lost.

The most intriguing advancement will be a newfound sense of independence.

Abi Genesis is going to be capable of autonomously visiting residents in their rooms based on a daily roster she’s assigned. Integration with care systems means she can provide care teams with insights and updates about resident well-being.

“We’ve put a lot of emphasis on building Abi’s personality which is a unique approach for the robotics industry.”

“Rather than being focused on the utility of robotic technology, we’re much more focused on empathy and building connections. That’s why Abi immediately becomes best friends with residents,” said Andromeda Founder & CEO, Grace Brown.

By pushing the boundaries of what’s possible with technology, there is an immediate opportunity to address isolation and loneliness in aged care.

Abi’s influence already resonates deeply with early adopters who have witnessed first-hand how her charming responses, slick dance moves and never-ending bubble gun can light up the room.

Grace Brown, Founder and CEO, Andromeda

If she’s there to pick up the loose ends of a conversation, start a new one or engage residents with the rumba, staff can spend more time helping a resident who needs urgent attention.

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Mastering behaviour & communication Expert tips for leaders from Anthony Laye

Contributor: Anthony Laye

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Leading in aged care demands emotional intelligence, strong communication skills, and awareness of staff and resident well-being. Anthony Laye, a behavioural and body language expert, shared practical strategies with Hello Leaders to help aged care leaders improve their skills.

By Jakob Neeland, Journalist, Hello Leaders

How can aged care leaders create a truly supportive and connected environment? This article shares powerful, practical strategies from renowned behavioural and body language expert Anthony Laye. Discover how to recognise signs of stress, foster meaningful engagement, and approach difficult conversations with empathy to build a stronger care community.

Recognising stress and burnout in staff Aged care is both emotionally and physically demanding, and Laye stresses the importance of leaders tuning into their teams.

“It can be emotionally and really physically demanding,” he notes, reflecting on his wife’s palliative care experience in the UK. To spot stress or burnout, he advises: “What we’re quite often looking for [are] changes in behaviour.” A once-energetic staff member turning sluggish or quiet could be a sign. Vocal cues matter too: “We can see this in people’s voices… a bit more monotone… speaking in a sort of expired kind of way,” Laye explains, contrasting this “expired” tone with the “inspired” delivery of a motivational speaker.

Other indicators include reduced participation — “They’re not attending team meetings, or they’re not speaking up so much” — or increased errors, which he ties to “high stress impairing cognitive function.” Overcompensation, like forced cheerfulness, might also mask deeper issues.

Laye encourages leaders to move beyond surface-level checkins and reframe conversations to create space for honest dialogue. Instead of asking, “How’s it going?” — a question that often leads to a generic “I’m fine” response — he suggests using open-ended prompts like: “Tell me what’s on your mind.” This phrasing encourages staff to share specific concerns rather than defaulting to a polite response.

“What’s feeling most challenging for you right now?”

This question helps uncover pressure points in their workload or emotional well-being.

“If there was one thing that would make your day easier, what would it be?” A practical way to identify small, meaningful changes that could prevent burnout.

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Building a culture of recognition and engagement

Navigating difficult conversations with empathy

Feeling undervalued is a common challenge in aged care, but Laye argues that retention and motivation are often driven more by recognition than financial incentives. “A lot of people think it’s money. Often it comes down to… not being appreciated,” he says.

Difficult conversations are inevitable in aged care, whether addressing performance issues, conflicts, or emotional distress. Laye emphasises the importance of a solution-focused mindset, cautioning against framing discussions as battles: “The moment you enter a battle of right and wrong, somebody’s going to win, and somebody’s going to lose.” Instead, he encourages leaders to focus on resolution rather than blame.

To foster a culture of meaningful recognition, Laye introduces his “name and notice” technique. Instead of vague praise like “Great work!”, he recommends being specific: “Sarah, I love the way you comforted Mrs. Taylor today. It was beautiful. You made her feel really safe.” This approach not only acknowledges the action but reinforces its impact, making the compliment more meaningful.

Recognition doesn’t have to be grand or formal. Micro-moments — like a genuine smile, a nod of appreciation, or a brief acknowledgment in front of peers — can have a profound effect. These small but consistent interactions signal that staff contributions are valued.

To further boost engagement, Laye suggests using the “You said, we did” approach. “If a member of the team gives feedback… and you start implementing it, say, ‘That piece of feedback you gave a few weeks ago, we took it on board and made changes.’”

This simple act validates staff input and increases their investment in the workplace.

He ties this concept to the IKEA effect — a psychological principle where people place higher value on things they’ve helped create. “We put a lot more value on things that we’ve helped build,” Laye explains. By involving staff in shaping workplace improvements, leaders foster a sense of ownership, making employees more engaged and committed.

By consistently recognising contributions — both big and small — leaders can create a culture where staff feel valued, heard, and motivated to deliver highquality care.

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To guide these conversations, Laye introduces the NUT principle — Name, Understand, Transform: Name the emotion – Allow the person to express their frustration fully before responding. “Let them talk… imagine them like a balloon that’s deflating,” Laye advises. Cutting them off too soon can have the opposite effect: “If you interrupt them… it’s almost like the balloon gets pumped back up again.”

Understand & validate – Acknowledge their emotions by mirroring their words.

“Dave, I can see that you’re really frustrated and overwhelmed,” using the same language they’ve used. Then, normalise their feelings: “It’s completely understandable to feel that way. I’m sure anyone in your situation would feel the same.” This step helps diffuse tension and makes the person feel heard.

Transform the conversation – Shift the focus forward with an open-ended question: “What needs to happen for us to move forward today?” This reframes the discussion from frustration to problem-solving, encouraging collaboration rather than conflict.

Spotting non-verbal distress in residents and colleagues Non-verbal cues often reveal unspoken distress, and Laye cautions against oversimplification: “Don’t think that one thing means one thing… We need to look at body language in real time.”

For residents, “fidgeting a lot… rocking backwards and forwards… touching their skin a lot more” might signal anxiety.

“Avoiding eye contact” or withdrawal could indicate depression, while “suddenly becom[ing] very aggressive or irritable” might mean pain or unmet needs. For staff, similar shifts — like withdrawal — warrant attention. “We’re just becoming stress detectors,” he says.

One powerful daily habit Laye’s top tip for fostering a positive environment is a simple yet powerful question: “How should I be turning up?”

He applies this in his own life, explaining, “There isn’t a single person that wakes up saying, ‘I hope today is a really rubbish day.’ If you can make everybody’s day just 1 or 2% better… you’re going to make the world a better place.”

Asked before interactions, it resets intent: “It will bring your awareness back, make you present… and allow you to have a moment in time with another human being that is meaningful.”

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By Jakob Neeland, Journalist, Hello Leaders

The Australian government’s Support at Home program, set to replace Home Care Packages (HCP) and the Short-Term Restorative Care (STRC) program, is raising serious concerns among home care providers. While the policy is designed to create a more sustainable home care system, industry leaders warn that the financial, administrative, and structural changes may disproportionately impact smaller providers, potentially leading to market consolidation and reduced consumer choice.

Nick McDonald, Founder and CEO of Prestige Inhome Care, has voiced particular concerns over how the new system will affect financial viability, affordability, regulatory compliance, and the informal care sector. The shift in funding mechanisms, coupled with higher consumer contributions, could place significant pressure on both providers and consumers, potentially driving unintended consequences like an underground care economy.

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Support at Home A Lifeline or a looming crisis for smaller home care providers?

Financial pressures on home care providers A primary concern under the Support at Home program is the shift in financial responsibility from government subsidies to direct consumer payments. Providers will now be responsible for billing clients directly for services rendered, fundamentally altering cash flow management and debt collection processes.

While this may seem like a simple transition, many providers especially smaller ones - lack the infrastructure to efficiently manage consumer billing. Historically, aged care providers have operated under a government-funded model, where claims were processed through established online portals.

Moving to direct invoicing and payment collection introduces risks, such as increased administrative costs and delayed payments.

“There’s still a real ethos amongst older Australians that care should be free,” McDonald explains. “Many have paid taxes their whole lives and believe that aged care should be covered by the government. When they’re asked to contribute even a small amount, such as $10 per visit, there’s often pushback.”

The Veterans Home Care (VHC) program serves as a cautionary example. Under VHC, providers were required to collect small co-payments from veterans, often leading to inefficiencies and revenue losses. Some clients would insist on paying in cash or by cheque, creating logistical hurdles.

As a result, many providers chose to absorb these costs rather than invest in complex debt collection processes.

McDonald fears that smaller providers may struggle to adapt, leaving only large-scale organisations with advanced billing systems able to manage the transition. The result? Market consolidation at the expense of local, community-based providers, reducing diversity and limiting options for older Australians who prefer smaller, more personalised services.

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Affordability concerns and the risk of an aged care ‘black market’ Beyond provider challenges, the affordability of home care for consumers is another major concern.

The government’s goal is to create a more financially sustainable aged care system, but if out-of-pocket costs rise too steeply, many older Australians may forgo essential care altogether.

McDonald warns that this could lead to the rise of an unregulated ‘black market’ for aged care, where individuals hire informal carers under the table to avoid paying higher provider fees. This presents serious risks, including: • L ack of training and oversight, increasing the likelihood of neglect or substandard care.

• N o insurance protections, leaving both carers and clients vulnerable in cases of injury or disputes.

• N o background checks, which could heighten risks of elder abuse or financial exploitation.

“If people can’t afford care through official registered providers, they might start paying support workers directly under the table,” McDonald cautions.

“This could lead to unregulated and potentially unsafe care arrangements, where workers aren’t properly trained or insured.”

Market-driven pricing and higher funding ceilings One potential solution to the financial challenges posed by Support at Home is introducing market-driven pricing mechanisms and higher funding ceilings for complex care needs.

• M arket-driven pricing: Allowing flexibility in pricing could help providers set competitive rates based on service demand and complexity, ensuring financial sustainability without overburdening consumers.

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• H igher funding ceilings: Many older Australians have complex care needs, and if funding caps are too restrictive, individuals may be forced into residential aged care prematurely contradicting the government’s goal of supporting people to age in place.

“There’s a real danger that people with high care needs will not be able to access sufficient services under the new model,” McDonald warns. “If funding is capped too low, we risk forcing individuals into residential aged care prematurely, which is counter to the goal of helping people age in place.”

Better support for family carers Family carers are often the unsung heroes of Australia’s aged care system, saving the government billions of dollars annually by providing unpaid care to elderly relatives. However, McDonald argues that government policy does not adequately support these individuals.

• F inancial assistance: Direct payments or tax incentives for family carers could help offset lost income and ensure sustainability of informal care.

• R espite care expansion: More funding for respite services could prevent carer burnout and improve overall wellbeing.

• C arer training programs: Providing family carers with practical skills and medical knowledge could improve care quality and reduce reliance on formal services.

“Family carers save the government billions each year by providing unpaid care,” McDonald notes. “If they’re not given adequate support - whether through financial assistance, respite care, or training - we’re going to see more burnout and stress.”

The need for clear communication McDonald also stresses that the government must take a proactive role in educating both providers and consumers about the Support at Home changes.

“Right now, providers are being left to explain the new system to clients, which puts them in the uncomfortable position of being the ‘bad guys’ when consumers push back on costs,” he says.

“The government needs to take responsibility for setting expectations and ensuring people understand why these changes are happening and what they mean.”

Final thoughts: What’s next for home care providers?

Contributor: Nick McDonald, Founder and CEO, Prestige Inhome Care

A Medicare levy for home care One of the boldest solutions McDonald proposes is the introduction of a Medicare levy specifically for home care, ensuring sustainable funding for the sector without excessive reliance on consumer contributions.

“We already have a Medicare levy to fund public healthcare, so why not introduce a similar mechanism for home care?” he suggests. “This could help ensure that funding keeps pace with demand, reducing the need for excessive consumer contributions and stabilising the sector.”

While politically complex, such a model could provide a long-term funding solution and prevent home care from becoming inaccessible for lowerincome Australians.

The Support at Home program represents a major shift in Australia’s home care landscape, but as McDonald highlights, it is not without risks.

• S maller providers may struggle to adapt, leading to market consolidation.

• C onsumers may turn to unregulated alternatives if affordability concerns are not addressed.

• F amily carers need stronger support mechanisms to prevent burnout.

• A sustainable funding model, such as a Medicare levy, could help stabilise the sector.

For the transition to be successful, the government must take a leadership role, ensuring clear communication, financial sustainability, and a balanced regulatory framework that supports both providers and consumers.

As the implementation date approaches, industry leaders like McDonald will be watching closely to see whether these concerns are addressed - or if home care providers are left to navigate the challenges alone.

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“Successful change isn’t just about compliance; it’s about leadership, culture, and strategy.”

— Sean Rooney

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Aged care governance in times of change: A call to action for Directors

By Sean Rooney, Principal at STR Advisory former CEO of Leading Age Services Australia

Since stepping down as CEO of Leading Age Services Australia (LASA) in 2022, I’ve had the opportunity to step back from the frontlines of aged care reform and reflect on the sector’s trajectory. I’ve engaged with organisations across healthcare, governance, and policy, gaining fresh perspectives on leadership in times of regulatory transformation. Successful change isn’t just about compliance; it’s about leadership, culture, and strategy.

As aged care providers brace for the new Aged Care Act, I’m reminded of the many Board Directors I worked with during my tenure at LASA. Their dedication to stewarding organisations through some of the sector’s most turbulent times — ACFI cuts, a Royal Commission, COVID-19, workforce shortages, and financial pressures — has been remarkable. However, the changes ahead are more than another challenge; they require a fundamental shift in how boards operate and govern.

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The Four Pillars of aged care governance under the new Act The new regulatory environment demands that aged care Boards focus on four critical areas: strategy, performance, risk, and compliance.

1. Strategy: Rethinking the business model The Aged Care Act reshapes key elements of the sector’s operating environment. It is no longer about adapting to isolated regulatory changes; providers must redefine their entire strategic approach.

Sean Rooney, Principal at STR Advisory

The role of the Board in a new era of aged care The new Aged Care Act, coming into effect on 1 July 2025, represents a seismic shift. As the Government states, it “will focus on older people, rather than aged care providers,” enforcing stricter compliance, stronger regulatory oversight, and clearer obligations for providers. This is not an incremental change — it’s transformational reform that will reshape aged care governance.

According to the Australian Institute of Company Directors (AICD), “Recent legislative changes in response to the Royal Commission have ushered in a new era for directors. These changes have significant implications for Boards, requiring more than incremental improvement.”

For aged care Boards, this means reassessing governance models, enhancing risk management strategies, and preparing for greater regulatory scrutiny. It’s no longer enough to oversee operations; Boards must actively lead their organisation’s future.

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• H ow will your organisation compete in a more transparent, consumerdriven system?

• W hat will the financial model look like under new funding arrangements?

• H ow can Boards position their organisation as a leader in quality, not just compliance?

Boards must take an active role in shaping future-ready strategies that not only meet compliance obligations but also position their organisations for long-term sustainability.

2. Performance: Balancing dayto-day operations with reform implementation Boards must ensure that business-asusual operations remain strong while also implementing new operating and reporting requirements.

• H ow are we managing the dual challenge of reform adaptation and operational stability?

• A re we investing in the right advisory, compliance, and change management expertise?

• A re we tracking the right KPIs to measure readiness for the new Act? Providers who fail to strike this balance risk either non-compliance or a decline in service quality. Boards must prioritise both.

3. Risk: The expanding risk landscape With more stringent regulatory requirements, the risk profile for aged care providers is expanding. Board Directors must now consider risks in multiple dimensions: trategic risks: Are we making the S right decisions to sustain and grow our operations in a changing market?

Financial risks: How do we mitigate risks related to funding changes, wage pressures, and financial viability? perational risks: Are our workforce, O technology, and reporting systems prepared for increased regulatory scrutiny? eputational risks: With stronger R consumer protections, how do we maintain trust and credibility?

Boards need to implement robust risk management frameworks and ensure executive teams are proactively addressing emerging threats.

4. Compliance: Meeting new quality and safety standards The new Act introduces expanded Aged Care Quality and Safety Standards that will require significant adjustments.

Standard Two places direct responsibility on the governing body for meeting quality care requirements.

Key questions for Board Directors As we approach the July 2025 deadline, Board Directors must ask themselves: • D o we fully understand the scale and scope of the new Aged Care Act? • W hat steps are we taking to manage change effectively?

• W hat is the role of the Board in delivering transformational change?

• H ow do we balance meeting the needs of current clients while implementing reforms?

A call to action for aged care Boards The aged care sector is on the The aged care sector is on the precipice of a once-in-a-generation transformation.

The organisations that will thrive are those whose Boards are proactive, informed, and committed to not just meeting, but exceeding, new governance expectations.

Now is the time for Boards to step up, lean into change, and lead their organisations into a future where quality, trust, and consumer rights define the sector. The challenge is significant, but the opportunity to build a high-performing, respected, and sustainable aged care system is within reach - if Boards take decisive action today.

The revised Standards include 43 actions, six of which introduce entirely new expectations. Providers must review governance structures to ensure Boards are effectively overseeing compliance.

Boards should seek independent assurance that their organisations are meeting the new regulatory benchmarks.

This is not just about ticking compliance boxes — it is about embedding a culture of quality, safety, and transparency at every level of governance.

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From pills to pathways The global dementia care shift

By Alex Jacobs, Journalist, Hello Leaders

Dementia care has had a heavy reliance on medication, often prioritising sedation and restraint over personalised support that actually addresses basic needs.

However, a global movement is challenging the status quo, advocating for person-centred care that focuses on well-being, connection and inclusion.

Geriatrician, internationally recognised author and educator Dr Allen Power is one of the movement’s pioneers. His battle against antipsychotic medication began in the 1990s, but it was his 2010 book Dementia Beyond Drugs that helped to shift attitudes in the United States, a country known for its pill dependence.

“When somebody was distressed we would pick up the phone and call the doctor to prescribe them something because that’s our hierarchy. We set up a system that medicalises the experience of living in residential care,” Dr Power shared.

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“But I knew if I could give the care team the tools and knowledge to solve problems, I had a better chance of breaking the cycle.”

This credence has been at the heart of Dr Power’s work ever since. He sees no place for a medicalised approach to dementia care in the modern world, with pharmacological interventions rarely warranted even in the most challenging scenario.

“I believe that antipsychotic medication should only be used in an absolute crisis situation when safety is at imminent risk. Even then it is not a solution, but a temporary intervention until a proper approach can be implemented,” Dr Power emphasised.

“I have never seen a person with dementia without a co-existing major psychiatric illness where I felt they would still need a drug if the proper approach and supports could be articulated and implemented.”

Contributor: Dr Al Power, geriatrician, author and educator

Contributor: Jessica Luh Kim, consultant and educator

A growing movement Jessica Luh Kim, a trailblazer changing the culture of care in ageing services in Canada, joined Dr Power’s cause over a decade ago. With over 20 years of care experience, her early curiosity over the best approach to care planted the seeds for the advocacy that has since followed.

“When I first started long-term care I was fascinated as to why so many residents were taking 10-plus medications a day. Were they really that ill or is there something wrong with the system?” Ms Luh Kim said.

“There’s a growing movement of people who want to do better and offer support that is dignified and helps people in a more humanistic way. More people are stepping up and challenging the status quo, especially when people living with dementia are involved.”

The pair now educates aged care leaders across the globe. However, despite success in championing alternative models of care, regulatory systems remain a notable barrier.

“In the US, the amazing people who are seriously doing transformational change form a fraction of the care homes in the country. That’s the discouraging part: the system is still overbearing,” Dr Power said.

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“It’s not just the provider’s fault. It’s the regulatory system. It’s the reimbursement system that pushes people down the medicalised road. It’s the legal system that makes people afraid to innovate or take chances. It’s societal ageism and ableism.

“To call on aged care providers, one aspect of the system, to change without anybody else moving is an impossible task,” Dr Power said.

While the Australian Government recognises that a person-centred care model is required, organisations — and typically individuals — are the pioneers enacting change.

Ms Luh Kim says the aged care sector needs to be brave and challenge methods and processes that don’t work.

Experienced leaders, even those without a title or rank, must showcase their courage and ‘confront the brutal truths’.

“Aged care needs leaders who are brave enough to do that, who will articulate the why, and invite the right people along.

It’s so important to have the right people who believe and want to do better,” she said.

“If they’re not brave enough we can’t move. We’ll fall back into what’s comfortable with the system we’re stuck in.”

Ms Luh Kim and Dr Power want organisations to invest in operational changes that reframe how dementia is viewed in aged care. They also urge leaders to partner with older people living with dementia and their support networks, to create supportive and empowering environments for present and future generations.

Embedding well-being in care Dr Power’s work is built on a model of well-being called the Eden Alternative.

He gravitated towards it because he believed its seven Domains of WellBeing — identity, growth, autonomy, security, connectedness, meaning and joy — are aligned with dementia care.

For example, if each Domain is a glass of water, are they empty or full? If they’re not filled to the brim 24/7 then elements of well-being are ignored.

Dr Power shared the story of an 81-yearold American man who moved into a secure neighbourhood. A former lawyer and project manager, he was passionate about religion and family.

However, he refused personal care, developed anxiety, swore at others, refused to participate in activities and would become angry and upset when his wife left after visiting. Yet by tapping into one of his least fulfilled Domains, meaning, the care provider developed a care plan that recognised his needs.

Profound change occurred.

The team encouraged him to attend weekly Bible study in the village, enabled him to connect with others who had similar interests and beliefs, promoted quality time with his wife and allowed him to lead fun group activities. Staff also adopted a more gentle and patient approach to care, validating his feelings during periods of distress.

The man soon made new friends, voluntarily participated in activities and accepted care. He no longer swore at staff and was far calmer.

“You’re not curing dementia but you’re building resilience and reserve for a person,” Dr Power added.

“By filling one of his cups, it automatically filled the others. We’ve seen dramatic improvements and for this man, his antipsychotic medication was discontinued one month after admission.”

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Dr Power said the Well-Being Approach has worked effectively in other settings, including Canada’s The Village of Aspen Lake. Antipsychotic medications were stopped for 19 out of 20 residents, with psychiatric illness and hospitalisation the only reason they resumed prescription after six months.

Five positive pathways to inclusion Looking to the future, Dr Power’s upcoming book — to be released in 2026 — calls on aged care providers to stop segregated living for dementia residents. Alongside co-authors Dr Jennifer Carson and Pat Sprigg, the trio digs deep into five positive pathways to inclusion that encompass the seven Domains of Well-Being.

1 & 2: Reframe dementia & enhance well-being Aged care leaders and staff must embrace a new mindset and avoid thinking of dementia residents as people who are ‘fading away’, have ‘difficult behaviours’ or that dementia itself is causing their behaviours.

“Every decision you make about the living environment, technology, and how you accept risk, will be informed by the way you view dementia. If you don’t reframe dementia and enhance well-being first you’re going to create a prison because that’s what you’ve been taught to see,” Dr Power said.

3: Leverage collective capacity Pat Sprigg, CEO of Carol Woods Retirement Community, introduced daily shift huddles so that all staff could share their perspectives and problem solve together.

Dr Jennifer Carson built on these huddles by incorporating Dr Power’s Well-Being Approach. Her huddles feature a different focus each day:

• D ay 1: Staff assess a person’s wellbeing, e.g. are they happy, social, introverted, anxious or angry?

• D ay 2: Staff discuss what existing supports are or are not working, and why.

• D ay 3: They review previous huddles and share ideas for support that enhances well-being • D ay 4: Open discussion and collaboration with other teams, the resident and family members occur to finalise a well-beng plan • D ay 5 and beyond: The plan is enacted and staff continue to assess how well it is working, the outcomes, and whether changes need to occur or not

4: Create a supportive environment A supportive environment includes both the physical space and elements such as technology that support older people to age. However, neither one can be effective if the wider community is not engaged. Ms Sprigg calls this an ‘all hands on deck’ mentality.

“They used technology like a GPS, but what they mainly relied on was people in their community knowing which residents to look out for. Everyone took some responsibility if they saw something concerning to create a truly integrated community,” Dr Power said.

5: Negotiate risks and benefits Risk is the dealbreaker.

“There is no risk-free environment. The goal is not to eliminate risk, it’s about enabling people to live well and knowing there’s risk to life,” Dr Power added.

“Providers should be having conversations with the community, sharing their philosophy and letting people know why they are negotiating risk. You need values that drive you forward and help you get through the bumps when setbacks occur.”

Each pathway cannot be followed in isolation. They overlap, intertwine and ultimately lead to the same destination — improved well-being and quality of life for people living with dementia.

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This is creating c is dignified and fi with me

about care that d, human, filled eaning.

Jessica Luh Kim Page 34

“It is rare to find work more important than what we do in caring for our elders.”

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Finding meaning and magic

How Rachel Argaman stays grounded in aged care leadership

By Alex Jacobs, Journalist, Hello Leaders

Rachel Argaman OAM is no stranger to leading large, complex organisations. With an impressive career spanning hospitality, tourism, and aged care, she is known for her ability to navigate industries in transition.

Since stepping into the role of Chief Executive Officer (CEO) at Opal HealthCare in 2018, she has overseen the rapid expansion of Australia’s largest residential aged care provider, all while steering the organisation through one of the most transformative periods in aged care history.

For Ms Argaman, leadership in aged care is about more than just scale and strategy, it’s about creating communities, ensuring quality care, and staying connected to the deeper purpose behind the work.

“We try to stay grounded in what is meaningful and magical and appreciate the privilege of caring for older Australians and bringing joy to those we care for,” Ms Argaman said.

“It is rare to find work that can be so rewarding — giving care, comfort and the human connection that lies at the heart of well-being.”

With a strong belief in the power of human connection, she is as passionate about growing Opal as she is about ensuring aged care teams feel supported in their work. As the sector faces a tight deadline for aged care reform, her focus is firmly on navigating change while keeping residents and staff at the heart of every decision.

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Contributor: Rachel Argaman OAM, CEO, Opal HealthCare

Scaling up: Opal’s expansion and industry influence Already the nation’s largest residential aged care provider, Opal HealthCare has continued its impressive trajectory.

The last 12 months alone have seen significant acquisitions, cementing the provider’s market leadership.

• A n 11% increase in operational places between FY22 and FY23, according to KPMG’s Aged Care Market Analysis 2024.

• A major acquisition of BlueCross in March last year, adding 2,800 operational places across 31 Victorian homes — a 30% expansion overnight.

• T he recent acquisition of five Cranbrook Care homes in NSW, further strengthening Opal’s presence in key regions.

Countdown to July 1: Governance and compliance pressures Providers across the country are under pressure to rapidly update systems, processes, and staff training before the new Aged Care Act commences.

Ms Argaman and Opal HealthCare are focused on meeting this deadline, supported by a strong spine of systems and capable teams.

However, even with well-established governance, the tight timeline has created significant roadblocks.

“The compressed timeline for Rules release, review and finalisation leaves little time for providers to implement systems, processes and to train our team in the application of these.”

• A strategic investment from Pacific Equity Partners (PEP), which took a 50% stake in the company in February — valued at around $1 billion.

Ms Argaman also noted external barriers to change, citing the difficulties software vendors face in introducing necessary updates until the final Aged Care Act Rules are released.

This investment signals strong confidence in aged care’s future, particularly from firms like PEP that focus on long-term growth potential.

But despite Opal’s scale and financial backing, implementing the new Aged Care Act remains a significant challenge.

With her time on the National Aged Care Advisory Council now complete, Ms Argaman remains a respected voice, having advised government on key reforms linked to the Aged Care Bill, Support at Home, the Quality Indicators program, Star Ratings and more.

While expressing overall happiness with the government’s approach to aged care reform, there are some lingering doubts over the impact increased governance will have on the aged care workforce.

She’s always happy to see governance that measures the right outcomes for Opal’s team and residents, but it should never come at the expense of meaningful work.

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The balancing Act: Governance vs. meaningful care As governance and compliance requirements escalate, Ms Argaman is mindful of their potential unintended consequences for frontline workers.

“We know our nurses and care team — their focus is on helping people and that overgovernance, like repeated or irrelevant reporting, takes them away from face time with residents,” she said.

“Balancing risk and quality care, and ensuring the relevant data is measured saves everyone from the tyranny of metrics which can sometimes detract from care without meaningfully adding benefit/mitigating risk.”

She urges policymakers to ensure reporting requirements remain relevant and do not overwhelm providers with unnecessary bureaucracy.

“The sheer volume of governance in a system where the new requirements were ‘built on the foundations of the past’ rather than looking at the key data required is hard to mitigate,” she said.

“Governance is rightly a key part of managing both care and risk and remains essential. Our only ask is always that governance only requires the data that is insightful and adds value, rather than data for data’s sake, or repetition of data.”

Finding meaning in the work From the Royal Commission and COVID-19 to the current wave of reform, aged care leaders have faced unprecedented challenges over the past five years.

Despite the disruption, Ms Argaman remains committed to embracing change, growing the sector, and making aged care a compelling career path for future generations.

With Opal HealthCare growing rapidly, a new Aged Care Act looming, and investorbacked expansion on the horizon, Ms Argaman’s agenda is full — but her focus remains on the human side of aged care: building a workplace where teams feel valued and residents thrive.

“In aged care we help build communities and connections. There is nothing more rewarding than coming through adversity together — and together always means with our residents who help us, teach us their wisdom and what matters, and share their life experiences.”

Opal HealthCare’s ambition is clearly evidenced by ongoing growth and expansion. The injection of PEP as a stakeholder will no doubt lead to significant moves on the horizon.

Yet both CEO and organisation remain grounded in passion, the sense of community and purpose that defines aged care work.

“I feel privileged to do the work we do with colleagues who inspire me daily, and with whom I have experienced so much. It is rare to find work more important than what we do in caring for our elders,” Ms Argaman said.

Ms Argaman isn’t just leading Opal HealthCare through growth — she’s helping shape the future of aged care leadership. As governance demands rise alongside financial pressures and investor expectations, her challenge is to preserve Opal’s culture and purpose through it all.

But if there’s one thing that remains clear, it’s that her focus will always be on the meaning and magic that make aged care a profession worth fighting for.

“All those working in aged care have the privilege of doing meaningful work.

We know that if you shy away from the difficult issues, you shy away from the opportunities to make a difference,” Ms Argaman added.

“We try to stay grounded in what is meaningful and magical — and appreciate the privilege of caring for older Australians and bringing joy to those we care for.”

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Caring for the future

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Balancing reform, funding, and quality in aged care

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Contributor: Jason Kara, CEO, Catholic Health Australia

Every day, the Catholic aged care sector brings care, justice, comfort and hope to communities across the nation, inspired by the healing ministry of Jesus to provide care for everyone, but especially the sick and the vulnerable.

Nationwide, Catholic Health Australia (CHA) and its member organisations play a crucial role in the broader system, with 350 aged care facilities, more than 27,000 residential aged care beds, and upwards of 53,000 home care and support consumers. In rural and regional parts of Australia, Catholic services are a vital lifeline, providing one in four of all services in rural and regional areas to ensure that older people are not left behind.

Beyond the sheer numbers and reach of services, our providers are committed to offering compassionate, person-centred care that supports the physical, emotional, and spiritual needs of every individual – no matter who they are or where they come from. This holistic approach is what sets Catholic health services apart, making them an essential part of Australia’s health and aged care landscape, particularly for vulnerable populations who might otherwise struggle to access the support they need.

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A more sustainable aged care system In this context, the passing of the Aged Care Act in 2024 was a crucial reform. It has brought critical funding and regulatory support that has laid the foundation for a better and more sustainable aged care system that can deliver for all Australians, whether they live in a city, regional town or rural or remote area. The genuinely collaborative approach taken by all sector stakeholders – alongside much-needed bipartisanship from the government and the opposition – was instrumental in securing this reform.

It was encouraging to see all involved focus on the national interest and wellbeing of older people.

However, as we move into the transition and implementation phase, there are still several challenges to address, and significant work ahead to ensure the reforms are fully understood and properly implemented. While the Aged Care Act provides a promising foundation, some aspects of the reforms will require careful attention to ensure they are effective for both providers and consumers.

Government support for transition costs The cost of implementing reform, particularly for smaller providers and those in regional, rural, and remote areas, is substantial. Smaller providers will need additional time to implement the new Act, and even larger providers will face significant operational and funding changes. Older Australians, too, will need time to adapt to the reforms in a progressive way, particularly with regard to home care. CHA considers direct subsidisation of transition costs to be appropriate to support providers to upgrade their systems and ensure the smooth transition from home care to the new Support at Home program.

CHA and its members recognise that expanding aged care services delivered at home is critical to meeting demand in the coming decades. Wherever possible, older Australians who wish to remain at home should be supported to do so with dignity and respect. This will benefit older peoples, their families, and the financial sustainability of the aged care system.

Understanding the price structures for consumers The government should work to ensure that consumers can easily understand the costs of aged care and that those with low means are not denied access.

CHA is calling on the government to increase the accommodation supplement which helps aged care providers support financially disadvantaged residents. Currently, the maximum supplement sits at $69.49 per day, yet the actual cost of providing aged care accommodation is 65% higher, averaging $114.79 per day.

The current supplement does not cover costs. Without an increase, aged care providers will be unable to sustain quality residential care for low-means older Australians. The government must also set maximum timeframes for Services Australia to process hardship applications to ensure no-one gets left behind while waiting to find out if they qualify.

Delivering high-quality care The proposed halving of the care management caps – from 20% to 10% – introduces significant risk of deteriorating quality and availability of care for older people, given that care management currently constitutes about 17% of packages. It is likely to result in significant issues including a reduced focus on care management, decreases in service availability, experienced care managers leaving the sector, and providers avoiding clients with more complex health needs. To help avoid these outcomes, CHA is advocating for the government to retain the current care management cap of 20% for 12 months to ensure older people are supported through the reforms. From 1 July 2026, CHA is asking for the care management allocation to be set no lower than 15% of the Support at Home package, backed in by an independent pricing study. This will ensure that aged care providers can effectively deliver services to older Australians with higher clinical needs while delivering savings to make the system more sustainable.

Continuing advocacy The passing of the Aged Care Act has led to a once-in-a-generation opportunity for meaningful reform to the sector. CHA successfully advocated for key changes to the initial bill, and through the election process we will continue to work with the government, opposition parties, our members and other stakeholders to ensure the reforms meet the needs of older Australians. We are determined to continue to work in the spirit of collaboration that has made these reforms successful to date, so that together we can build a better aged care future for all Australians.

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Rewriting the script Can alternative care models and the new Aged Care Act coexist?

By Alex Jacobs, Journalist, Hello Leaders

Aged care in Australia is at a pivotal moment, balancing long-overdue reforms with the realities of diverse care philosophies. The new Aged Care Act champions person-centred care, yet its structured, compliancedriven framework may be at odds with innovative care models that prioritise autonomy and self-direction.

Two widely respected approaches – the Montessori method for adult care and The Eden Alternative – go beyond traditional care structures, shifting the focus from passive care to active empowerment.

Successfully integrating these philosophies into the new regulatory landscape requires more than just good intentions; it demands strategic implementation and a deep commitment to cultural change.

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Contributors:

Liz Ghali, Executive Director, Montessori Australia

Alex Ioannou, Director of Research and Development, Montessori Australia

Atika Latifi, Practitioner in Dementia & Ageing, Montessori Australia

Sally Hopkins, Executive Director of Eden in OZ & NZ

The Montessori approach: A snapshot Montessori education, developed by Italian doctor Maria Montessori in the early 1900s, emphasises individualised, hands-on learning driven by personal interests and activities that foster choice, independence, and responsibility.

This approach supports care recipients in maintaining their autonomy and engaging in purposeful activities. It recognises that while cognitive or physical abilities may decline with age, individuals retain their thoughts, aspirations, and desire for meaningful contributions.

Implementing the Montessori approach requires three essential elements, summarised as: 1. The caregiver: A caregiver has the mindset to honour and respect the personhood of another 2. The environment: A well-designed environment that supports autonomy, allowing individuals to continue living independently, participate in meaningful activities or relearn lost skills 3. The care recipient: Every person receiving care is recognised as an individual who is valuable to their community Montessori Australia Executive Director, Liz Ghali, leads the organisation’s Montessori Adult Care Support Services (MACSS) focus group. She explains that when aged care workers cannot identify opportunities for independence, the true goal of person-centred care is lost.

“Montessori person-centred care enables the person to do things for themselves while they still can. Often caregivers will listen and learn, but they complete tasks for them rather than realise they can show them how,” Ms Ghali explained.

“Supporting them to independently complete tasks or activities helps that person become a little more independent rather than losing that independence.”

For example, encouraging independence through growing fruit or vegetables for meals in the garden transforms simple activities into engaging tasks with purpose and meaning.

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Certified Montessori Practitioner in Dementia & Ageing and independent support worker, Atika Latifi, aligns Montessori principles with reablement practices used in multidisciplinary aged care teams.

“Human beings have a love of learning until the end of life. A person-centred approach means giving them hands-on material or self-directed learning while the environment is designed to foster independence for any person,” Ms Latifi said.

“The prepared environment is a very unique concept in Montessori. So how do we prepare the environment so a person is safe and supported to do certain tasks, daily living activities or sensorial activities.”

Reframing perspectives is equally vital. By acknowledging an individual’s role within the community, aged care professionals can better support goal achievement.

“Often you find that once someone has a dementia diagnosis, society says they don’t belong anymore. We push to create high self-esteem and empower them to make meaningful contributions in their community so they feel confident, independent and can still work towards their goals,” she added.

A poignant example of this approach’s success involved an older Italian man with advanced dementia. Despite memory loss, his ability to play the accordion remained intact. During routine visits to the library, he would sing and play for young children, teaching them the instrument. This illustrates how Montessori transforms personal interests into meaningful interactions and relationships.

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The Eden Alternative: A snapshot Founded by Dr. Bill Thomas and Jude Thomas in the early 1990s, the Eden Alternative seeks to deinstitutionalise aged care by addressing the ‘three plagues’ being boredom, helplessness and loneliness.

The approach is guided by Ten Principles encompassing person-directed care, covering key areas such as medical treatment, community, companionship, and decision-making. Additionally, the Seven Domains of Well-Being (identity, growth, autonomy, security, connectedness, meaning, and joy) form the foundation.

Sally Hopkins, Executive Director of Eden in OZ & NZ, underscores the importance of proactive goal setting and overcoming risk-related concerns in aged care.

“The biggest issue is around risk and providing a risk-free environment when the legislation says you need to be compliant with all these different rules.

Providers often fear this while supporting residents’ goals,” she said.

“But we need to think about people having goals, regardless of cognition.

We need to be more proactive in understanding what those goals are and how we can make them happen.

That’s where the Eden Domains of WellBeing come in,” Ms Hopkins said.

A recent trip to Hong Kong saw Ms Hopkins work closely with local aged care providers to train them in the Eden Alternative. She worked with staff to help them better understand resident goals and needs centred around hobbies, meaningful engagement and connection to their community rather than just clinical care, tasks and labels.

Leadership: The key to success Education is fundamental to embedding alternative care models, but leadership plays an even greater role.

Without strong leadership, even the most well-intentioned methodologies can fail. Ms Latifi notes that while individual caregivers may be eager to implement Montessori principles, systemic change requires collective commitment.

“Trying to implement Montessori within the system, one person can take it on but to be truly effective there needs to be widespread change. It becomes very hard for an individual to implement this philosophy in a care setting without support, Ms Latifi said.

Ms Hopkins reinforces this.

“We need to change the culture of practice, and that requires leadership. It needs to start at the top, and then it needs to be filtered out across the official and unofficial leaders within teams,” she said.

“Without leadership, it doesn’t matter what model is used, nothing changes without staff support. Education helps, but leaders must follow up to ensure accountability and real-world application.”

Compliance and the new Aged Care Act Montessori Australia’s Director of Research and Development, Alex Ioannou, says industry leaders must recognise the link between alternative models and high-quality care compliance.

“There is a lot of talk about the individual at the centre of care, and no matter their age, there is a huge emphasis on community and sense of belonging,” Ms Ioannou said.

“That sense of community can be lost in aged care. It’s why we see the person, the environment and the caregiver as a triangular structure — each element interacting to sustain a person’s place in their community.”

Meanwhile, Ms Hopkins is ready for the sector to focus on staff and resident relationships rather than purely clinical, compliance-based models.

“The new Act talks about person-centred care. Providers will say they’re doing person-centred care, but often they’re not,” she said.

“If what you’re doing now is not what you want in the future, why are you doing it that way? The sector must create its own vision of where it needs to be given the government’s expectations are changing with the new Act.” Montessori and the Eden Alternative prioritise dignity, independence, and meaningful engagement. While their methodologies differ, their goals align in delivering high-quality, person-centred care that enhances quality of life. .

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Sex, seniors and human rights How can we break the taboo in aged care?

By Alex Jacobs, Journalist, Hello Leaders

In many aged care settings, sex, intimacy and relationships remain taboo, often deemed inappropriate. Yet older adults still crave connection, companionship, and physical closeness.

This outdated mindset ignores a fundamental aspect of human identity while overlooking an organisation’s responsibility to support residents’ rights to intimacy, dignity, and personal expression.

Dr Nathalie Huitema, renowned sexologist, gerontologist and consultant, explains that sexuality and ageing has been considered abnormal or inappropriate for centuries because it is poorly understood in the broader context.

“Sexuality exists on a continuum and extends beyond intercourse. A wide variety of behaviours can fall under the umbrella of sexuality, and some might make us feel uncomfortable. I would argue that restricting these behaviours should not be driven by personal discomfort,” she explained.

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Dr Nathalie Huitema, Sexologist, gerontologist and consultant

The barriers to intimacy in aged care Aged care settings are rarely designed with intimacy in mind. Shared rooms, small beds and a lack of private spaces hinder residents from engaging in intimate relationships.

Likewise, unintentional actions, such as knocking on a door and entering without waiting, signals someone’s arrival but it removes the resident’s right to delay entry.

Staff may lack appropriate education and training. Most are happy to see residents hold hands or participate in small acts of affection, but Dr Huitema says discomfort begins when residents start French kissing, touching each other or having sex.

The involvement of a resident with cognitive decline adds to the discomfort or fear. This is when staff typically resort to overprotection rather than support.

“A lack of awareness about intimacy in older adults can lead to the perception that any sexual behaviour is abnormal.

This is especially true when older adults in care are seen as vulnerable and in need of protection,” Dr Huitema said.

Additionally, emphasising safety, medical needs or daily living assistance can overlook autonomy, agency, and sexual well-being. Focusing on potential risks can lead to an environment that limits freedom.

“When care staff are scared something might go wrong, they often have a sense of responsibility. Staff have almost an impossible task navigating these scenarios without any training or organisational policy,” she added.

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Rethinking consent in dementia care Traditional perspectives on consent often fail to account for the nuances of cognitive impairment. From a legal perspective, a dementia diagnosis typically means a person is viewed as no longer having capacity to make their own decisions.

Dr Huitema looks past the diagnosis in her work and takes on a salutogenic approach that encourages us to rethink how we view older adults, dementia, and sexual consent.

Salutogenesis effectively shifts the focus towards potential and not deficit, making it easier to discuss sexual behaviour and its relationship to a person’s cognitive ability.

“If you view sexuality as a continuum and recognise that cognitive impairment still allows for consent, you can determine consent through observable behaviours and responses,” Dr Huitema explained.

“For example, if a resident takes the initiative to hold hands and clearly enjoys it, they are demonstrating the ability to consent to that interaction.

Consent should also be evaluated based on other key determinants such as the ability to communicate, assent and dissent.

“I would argue that even individuals in the later stages of dementia can still express their desires and boundaries we just have to want to see it.”

There are several determinants of consent that Dr Huitema highlighted as relevant to sexual expression, including:

Communication skills: • D oes the individual have the ability to communicate verbally or nonverbally?

• C an the individual respond to verbal, nonverbal, and/or behavioural communication of the sexual partner?

Voluntariness and enjoyment: • I s the individual alert enough to consciously participate, e.g. are they awake and able to respond to either verbal or physical stimuli?

• Is the intimate act voluntary?

• C an the individual express enjoyment/ pleasure, either through behaviour or verbal/non-verbal communication, in relation to the intimate partner?

• A re there signs of abuse or harm within the intimate relationship?

Initiate and stop: • C an the individual initiate and stop the intimate activity?

• C an the individual assent and/or dissent, either verbally, nonverbally, or through behaviour?

• C an the individual choose a socially acceptable time and place for intimate behaviour, or are they willing to be directed to a socially acceptable time and place?

To avoid jumping to worst-case scenarios, Dr Huitema recommends carefully considering the determinants in relation to observed behaviour. A patient approach can help avoid unnecessary concern over outcomes that may not eventuate.

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An inclusive approach: Policies and training A lack of staff training and support suggests that providers must develop their own comprehensive sexual health guidelines and policies to tackle sex and intimacy on multiple levels.

Dr Huitema says these policies set the norm for what is expected of staff, meaning they do not have to contend with their own uncertainties.

“The policy should be practical, meaning it should talk about what consent is and why it matters. It should also focus on what is considered harm and how you minimise it, while still promoting autonomy and protection,” she said.

For example, an Australian provider developed a decision tree for staff. It defines consent and harm, and helps guide staff actions based on resident behaviour. In some cases it reinforces that residents can consent and there’s no harm, while in others it highlights that behaviours should be stopped.

A sexual health committee to provide guidance and informed advice in ambiguous cases is another option.

An American provider called on its committee when a male resident with dementia developed a romantic relationship with another resident. It primarily involved hand holding and the occasional kiss on the cheek. Both residents initiated contact and seemed very happy together.

However, the man’s wife still lived in the community and was upset by the new relationship. When she visited him, he was always delighted to see her and their connection remained strong.

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Therefore, she asked staff to stop it from proceeding, blaming his actions on cognitive decline. The staff didn’t know what to do: should they honour the wife’s wishes or respect the resident’s current emotional well-being and autonomy?

After detailed discussions with staff and the wife, the facility agreed that he was capable of consenting to the relationship and they would not intervene.

All parties took steps to make the arrangement comfortable for everyone involved. The wife would call before visiting so workers could ensure the male and female residents were not and the married couple could have their privacy. They also set up a private table for them to enjoy lunch together, and provided flowers for the husband to give to his wife.

“By balancing the husband’s emerging relationship with the female resident and his long-standing bond with his wife, staff created a solution that honoured everyone’s emotional well-being while allowing meaningful connections to continue without undue disruption,” Dr Huitema said.

Recognising the importance of intimacy and sexuality in aged care is not just about comfort, it is a matter of human rights.

It should not be up to staff or families to decide what is right or wrong because they are uncomfortable — the resident’s happiness needs to be respected and factored into any decision.

“Even individuals in the later stages of dementia can still express their desires and boundaries — we just have to want to see it.”

- Dr Nathalie Huitema

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Contributor: Ben Hannemann Founder of Aged Care Online

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From clicks to care How Aged Care providers are winning with Performance-Based Marketing

By Jakob Neeland, Journalist, Hello Leaders

For decades, aged care providers have relied on a mix of traditional advertising— like radio, television, and print media — alongside the rise of digital strategies to connect with new clients. While these methods have been effective, the digital marketing landscape is evolving, with a growing emphasis on performancebased advertising and highly qualified leads. This shift is helping providers reach the right families more efficiently, saving time and resources while complementing the strengths of digital advertising like premium listings and banner ads.

With over 20 years of experience in the aged care sector, Ben Hanneman has witnessed this transformation firsthand, founding one of the earliest digital advertising platforms tailored to the industry, Aged Care Online.

“The way aged care providers market themselves has changed dramatically.

Marketing Managers are now focused on data-driven strategies, a strong digital presence, and ensuring every marketing dollar delivers measurable results,” Hannemann explains.

With more families turning to online searches for aged care services, providers are finding value in a balanced approach: leveraging the broad reach of digital advertising while investing in targeted, high-intent leads to maximise efficiency.

The enduring value of digital advertising Digital advertising — such as premium listings on directories and banner ads — remains a cornerstone for aged care providers. These methods are excellent for building brand awareness and ensuring visibility across a wide audience. Premium listings, for example, allow providers to stand out on platforms like Aged Care Online, capturing the attention of families browsing for options. Banner ads, meanwhile, offer a visually engaging way to reinforce a provider’s brand across websites, keeping them top-of-mind for potential clients.

“Typical online ad strategies are fantastic for creating touchpoints,” says Hannemann.

“Research shows it takes an average of eight touchpoints before a consumer makes a purchasing decision. Premium listings and banner ads play a critical role in that journey by ensuring providers are seen early and often.”

These methods are particularly effective for providers with larger budgets, who often use a mix of traditional and digital channels to hedge their bets.

For instance, a premium listing can establish credibility and attract initial interest, while banner ads reinforce the message across multiple platforms.

This broad approach ensures providers remain visible to families who may not yet be ready to commit but are starting their research.

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The challenge of broad-reach advertising Despite the strengths of digital advertising, broad-reach methods like radio, TV, or even some digital campaigns can lack precision.

Hannemann notes, “Only about 7 or 8% of the audience for radio or television advertising is actually in need of aged care. That means you’re spending a lot on the other 92% who don’t need these services.”

Even in the digital realm, generic campaigns can attract a wide audience, but not all clicks translate into meaningful leads. This is where the appeal of highly qualified leads comes in. While premium listings and banner ads excel at generating awareness, they often cast a wider net, bringing in inquiries that may not always align with a provider’s specific offerings or immediate needs. Sorting through these leads can be time-consuming for sales teams, diverting resources from delivering care.

The rise of highly qualified leads: efficiency and impact As families increasingly search online for aged care options, providers are turning to performance-based models like fee-for-lead and fee-for-placement to connect with high-intent consumers.

These models focus on delivering highly qualified leads—families actively seeking care and ready to engage—offering a more efficient alternative to sifting through masses of general inquiries.

“Highly qualified leads are becoming more attractive because they weed out the masses,” Hannemann explains.

“This saves sales teams significant time, reduces marketing waste, and allows providers to focus on what they do best: delivering care.”

Here’s why highly qualified leads are a game-changer: • T ime savings: Sales teams no longer need to filter through unqualified inquiries. For example, a lead from a niche directory like Aged Care Online is pre-vetted, ensuring the family is actively seeking care and matches the provider’s criteria.

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• Cost efficiency: Providers only pay for leads or placements that convert, reducing the risk of wasted spend compared to broader campaigns.

• H igher conversion rates: High-intent leads are more likely to result in placements, improving occupancy rates and maximising ROI. • S treamlined processes: With fewer but better-matched leads, providers can allocate resources more effectively, from initial outreach to final placement.

“Unlike Google AdWords, where providers compete for generic search terms at a high cost per click, niche directories connect you directly with people actively searching for aged care providers,” Hannemann says. “The cost-peracquisition is lower, and the quality of leads is significantly higher.”

Performance-based advertising: A win-win model Performance-based models like fee-forlead and fee-for-placement are gaining traction for their predictability and efficiency. Here’s how they work: • F ee-for-lead: Providers pay per inquiry—whether it’s an email, phone call, or qualified lead—generated from a directory or referral service.

• F ee-for-placement: Providers only pay after accepting and placing a client, offering certainty in marketing spend.

Hannemann highlights the appeal: “Marketing Managers find fee-for-referral and fee-for-placement models easier to budget for because it’s a guarantee. If a provider has occupancy issues, they can increase their fee-for-placement intake and only pay for the clients they choose to accept.”

For example, Aged Care Online now offers both fee-for-lead and fee-forplacement services, ensuring providers receive well-matched potential clients.

My Care Path provides a dual model where either the consumer or provider can pay for placement, while other platforms like Aged Care Guide are also stepping into this space.

Blending the best of both worlds

A smarter future for aged care marketing

The future of aged care marketing lies in a hybrid approach: combining the strengths of digital advertising with the precision of highly qualified leads.

Premium listings and banner ads remain essential for building brand awareness and capturing early-stage interest, while performance-based models ensure providers connect with families ready to act.

The aged care sector is undergoing a digital marketing revolution, and providers who adapt will thrive. Digital advertising like premium listings and banner ads continues to play a vital role in building brand awareness and creating touchpoints, but the shift toward highly qualified leads is undeniable.

These leads save time, reduce costs, and improve outcomes by connecting providers with families who are ready to engage.

Aged Care Online is leading the way with tools like its Shortlist Referral Service, which streamlines the search process for consumers. “Consumers can jump onto Aged Care Online, tell us their care needs, and we build a customised shortlist for them,” Hannemann explains. This benefits providers by: • I ncreasing visibility in front of highintent consumers.

• O ffering exclusive promotion to families actively searching for care.

• P roviding performance-based pricing, so providers only pay for converted clients.

“We do the vetting for providers, ensuring all referred clients have an allocated Support at Home Package and the relevant My Aged Care referral codes,” Hannemann adds. “This means sales teams can focus on delivering care rather than filtering unqualified leads.”

“Digital advertising still has its place, but it’s most effective when paired with a data-driven strategy,” Hannemann concludes. “Providers who blend the broad reach of premium listings and banner ads with the precision of performance-based models will be the ones who succeed in this new landscape.”

For aged care providers, the message is clear: embrace a balanced approach.

Use digital advertising to build your brand but invest in highly qualified leads to ensure every marketing dollar works harder, connecting you with families who need your care the most.

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