Australian Ageing Agenda Autumn 2025

Triangulating risk

Health Generation gets you to where you need to be

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Tech in a new era

Welcome to the Autumn edition of Australian Ageing Agenda, which includes an extra focus on technology relevant to aged care operations and care delivery in 2025 and beyond.

We know the sector is working hard to be ready for the commencement of the new Aged Care Act on 1 July. To understand how that’s going, we asked 10 aged care provider executives about their preparations.

Providers are excited about the changes ahead but also concerned – particularly with the timeline to have IT systems ready – but positively many are also feeling supported through the changes (page 20).

On the tech side of aged care, this issue investigates cybersecurity (page 22), advances in robot technology and its potential to reduce loneliness (page 30), if aged care nurses are prepared for a digital future (page 32) and how it can make life easier for all staff (page 34).

We see technology is also supporting the improvement of clinical care including with medication management (page 40), the delivery of physiotherapy (page 36) and oral care – where dentists can now accomplish things they could only dream about 10 years ago (page 42).

These are just some of the stories in this edition, which our regular readers will notice also includes a new look for the new year.

Also keeping with times and the increasing demand for aged care news online, we’re changing the frequency of the magazine to quarterly.

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and

The next edition will have a special focus on allied health and be out in time for the two-day Positive Ageing Summit in Adelaide starting 28 May 2025. Head to positiveageingsummit.com.au to find out more.

Until next time,

Natasha Egan

Australian Ageing Agenda Editor Tel: 02 8586 6132 Email: negan@intermedia.com.au

Our team

Christopher Kelly Australian Ageing Agenda, Senior Journalist

Katarina Lloyd Jones

Australian Ageing Agenda, Journalist

Jodie Wolf

Australian Ageing Agenda, Journalist

Mark Ryu National Advertising & Marketing Manage

Reader

6 Comments

They said it

8 Nurse pay rise comes into effect

Abi makes mecwacare homes

18 Will and preference: a context for further debate Executive 20 Dialogue open between providers, department 22 Cybersecurity: ‘It only takes one’

A win-win

Prisoner services lacking

We need an information and navigation care finder

Counselling and psychotherapy more accessible now 32 Not tech ready

Triangulating risk: Health Generation is helping providers move to where they need to be

Operations

30 Are robots a cure for isolation?

34 How technology can make life easier 36 Bridging the gap with telephysiotherapy

40 The med-tech revolution 42 Dentistry goes digital

Dementia: Start the charge for action now

46 Evidence on vision

48 Ask the expert with Dr Miia Rahja: Holistic and person-centred

50 Resources

1 Social scientist DR CRAIG SINCLAIR discusses will and preference in supported decision-making – a guiding principle the new Aged Care Act emphasises (page 18)

2 Gerontological physiotherapist DR RIK DAWSON the findings of the TOP UP Study and its success in improving mobility and reducing fall risk (page 36).

3 Dementia innovation leader MARIE ALFORD shares her thoughts on aged care reform and the need to start the charge for action now (page 44).

4 Occupational therapist and researcher DR MIIA RAHJA explains the importance of reablement approaches for people living with dementia (page 48).

“Absolutely fabulous to see this article. I have known Anita since I first came to Australia … 20 years ago. And I know … like her other friends and colleagues … Anita was made for this role.” Victoria Traynor comments on LinkedIn on the announcement of Anita Westera (pictured) as new president of the Australian Association of Gerontology

“Sound just like the major supermarkets ‘discounts’ ... blow out the wait times, then drop them a little and claim ‘aren’t we going a great job’.” Dr Rodney Jilek comments on LinkedIn on the Productivity Commission report on accessing aged care

“All Australians should have access to high quality healthcare including Physiotherapy wherever they live. Our most vulnerable in aged care facilities are an example where funding is a barrier to the access to allied health services. Our parents, grandparents, loved ones and community members should have access to the services they need to live a safe and quality life.”

Past president Scott Willis on LinkedIn on Dr Rik Dawson (pictured) taking over as Australian Physiotherapy Association president

“The consolidation of aged care providers continues.” Glenn Edwards comments on LinkedIn on the acquisition of Point Cook Village by VMCH

iStockphoto.com/pixelfit

“Fantastic appointment. Looking forward to seeing how this group can contribute to thought leadership in our sector”

Dr Rebecca Bilton comments on LinkedIn on Sue Gordan (pictured) named National Aged Care Advisory Council chair

“Considering the absolute clinical complexity in a home care service, and the tendency to use staff without the appropriate clinical expertise, I would have thought that the situation would be worse.”

Ann Gaffney comments on LinkedIn on the sector performance report on home care provider standards compliance

“I acknowledge the role of allied health in supporting a person with dementia to ‘maintain physical and cognitive health, independence and wellbeing for as long as possible,’ but I also want to acknowledge the role of counsellors to support a person with dementia. Counselling can help the person to talk about their feelings and experiences of the diagnosis and the impacts on self and supports around them –including challenging conversations about future planning.”

Caroline Romeo comments on AAA online on the call for better access to allied health for dementia care

1

Govt to phase in digital changes until Feb

2

3

Nurse pay rise starting soon

Providers raise concern about ‘digital readiness’

iStockphoto.com/ Jose Miguel Sanchez

They said it

“Our evaluations highlight several areas where customer interactions need improving, particularly when it comes to how customer service assistants close calls.”

Tony Williams account director CSBA

“We really need to see that there is a collaboration between the universities and the healthcare avenues in order to reduce or minimise workplace violence. Violence should not affect nurses and other students and their mental health.”

Dr Hila Dafny, Caring Futures Institute researcher

“Despite the clear need, many older Australians struggle to access timely hearing care due to mobility issues, workforce shortages, and limited audiology services in residential aged care settings.”

Carolyn Mee, founder and CEO Sound Scouts

“Abi is bringing technology and empathy together – moving into more homes, providing real companionship for residents, and giving care teams the support they deserve.”

Grace Brown, founder and CEO Andromeda

Call for submissions

The next issue of Australian Ageing Agenda (Winter 2025) includes a special focus on allied health in residential and home aged care throughout.

• Topics on the agenda include:

• Positive Ageing Summit preview

• a holistic approach to better ageing

• exercise, reablement and restorative care

• nutrition, dental, mental health and wellbeing

• evidence-based strategies and bestpractice programs across disciplines

As always, we encourage input from our readers on these or other related topics. Get in touch if you have something to share: editorial@australianageingagenda.com.au

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1 April

National Aged Care Mandatory Quality Indicator Program expands to include enrolled nurses, allied health and lifestyle staffing measures in residential aged care

17 April

Feedback closes on Department of Health and Aged Care consultation on the National registration scheme to support personal care workers

Time to access care up

BY KATARINA LLOYD JONES

A report from the Productivity Commission shows year-on-year increases in the time taken across several stages to access aged care services. This includes the number of days from referral for an aged care assessment to when the Aged Care Assessment Team approves a service, the time between ACAT approval and the assignment of a home care package and service commencement, and the number of days until someone enters residential aged care.

In 2023-24, half of older people referred for aged care assessment waited at least 22 days for an ACAT approval after referral, up from 17 days in 2022-23, and 10 per cent of people waited at least 216 days to be assigned a home care package after approval.

According to Report on Government Services 2025, 10 per cent of older people waited at least 250 days between approval and service commencement, up from 236 days the year before.

Half of permanent residents who entered care during the financial year and within one year of ACAT approval waited at least 68 days and 10 per cent of this cohort waited at least 253 days to enter an aged care home.

Access Care Network Australia chief executive officer Dr Ricki Smith tells Australian Ageing Agenda the new single assessment process active since 9 December 2024 should bring down these wait times. ●

Nurse pay rise comes into effect

BY KATARINA LLOYD JONES

FOLLOWING THE landmark Fair Work Commission’s Stage 3 decision in the Aged Care Work Value Case, full-time registered nurses in aged care began receiving their pay rise on the first full pay period from 1 March.

Delayed from the original scheduled time of 1 January, the new weekly minimum wage increases to between $1,345.60 and $2,412.10 – dependent on qualifications and years of employment. Matching the FWC decision, the government announced on 3 March it would fund the increases over three phases in March, October 2025 and August 2026.

The Nurses Award 2020 defines an aged care employee as someone providing services for aged people in a hostel, nursing home, aged care independent living unit, aged care serviced apartment, garden settlement, retirement village or any other residential accommodation facility. It also includes someone who provides services for an aged person in a private residence.

NSW Nurses and Midwives’ Association acting general secretary Michael Whaites welcomed the news that members who are registered nurses and enrolled nurses will be receiving this additional pay rise on top of the 15 per cent received in 2023.

“It’s been a long time coming for this female-dominated workforce to be recognised

and valued for the incredible and crucial work they do caring for our communities,” he tells Australian Ageing Agenda

Originally issuing the wage increase on 6 December 2024, the Fair Work Commission reiterated the upcoming wage changes in early February. And at a webinar on 18 February, the Department of Health and Aged Care reminded providers of the need to reclassify employees before the wage change came into effect.

There has also been a subsidy increase of 0.10 per cent for Home Care Package providers with the department asserting that any pricing changes must be discussed with care recipients, consent must be given, and that pricing adjustments must be only made for care and services being delivered by RNs and ENs receiving the wage increase. ●

Gerontological nursing program goes national

BY KATARINA LLOYD JONES

THE NATION-LEADING

Clinical Placements with Older People program –known as CPOP#2 – has received $6.3 million through a Commonwealth tender process to expand to the University of the Sunshine Coast, Edith Cowan University, Curtin University, the University of Sydney, Southern Cross University, Central Queensland University, the University of Tasmania and numerous health service partners across the country.

It is part of a larger $18.4 million boost the government has provided for nursing students in aged care.

CPOP#2 Program lead Dr Kasia Bail tells Australian Ageing Agenda they see the funding as an opportunity for students and

staff to be recognised for what is an “excellent career choice.”

“We haven’t always had the same opportunities in terms of recognition and support, and we’re just so excited that both the staff that are in aged care [and] the clinical facilitators are getting additional support, as well as the students, to really be able to enjoy and thrive in that aged care work environment,” she says.

CPOP#2 is embedded in the Centre for Ageing Research and Translation at the University of Canberra and is comprised of a cross-disciplinary team of researchers with a focus on multicomponent care, digital and assistive technology, the connection between person and place, and a knowledge translation approach – all to maximise impact on policy and practice for community benefit. ●

Dr Kasia Bail

Abi makes mecwacare home

BY NATASHA EGAN

VICTORIAN not-for-profit aged care provider mecwacare has partnered with Australian robotics company Andromeda to roll out Australian-made humanoid companion named Abi across 22 aged care homes.

The implementation is expected to be completed before the end of the year.

Designed to help people overcome feelings of loneliness, Abi uses advanced artificial intelligence and machine learning models to recognise faces, understand and express emotions and remember conversations from days or months ago. She is also able to speak almost 90 languages.

The partnership follows a successful trial of Abi at two mecwacare facilities, and residents are “thrilled” that Abi is returning permanently, says mecwacare chief executive officer Anne McCormack.

“Since visiting mecwacare, Abi has brought joy and companionship to so many of our residents which has brightened their days and helped reduce their social isolation,” McCormack tells Australian Ageing Agenda

“Our residents and staff are looking

forward to having her cheeky and fun personality around more often.

Abi was created by Andromeda founder and CEO Grace Brown to combat the isolation she faced during the pandemic.

This partnership marks Abi’s transition from pilot phase to production.

“Abi is bringing technology and empathy together – moving into more homes, providing real companionship for residents, and giving care teams the support they deserve,” Brown tells AAA

“Together we are committed to replacing one billion hours of loneliness with joy and companionship, making a difference to residents, and supporting the people caring for them,” says Brown.

McCormack says mecwacare wants to make a positive impact and drive change – and Abi will help them do so, with her support enabling staff to focus on critical care minutes. ●

Aussie hearing app wins

BY KATARINA LLOYD JONES

AUSTRALIAN start-up Sound Scouts is one of six international winners at the ViVe 2025 digital health awards in Nashville, winning the HLTH Foundation Techquity for Health Case Study award for its hearing assessment app for ageing Australians.

The app, which can be downloaded to an iPad and easily used by aged care residents, was trialled with the University of Newcastle and Maroba Caring Communities and supported by a grant from Aged Care Research & Industry Innovation Australia.

By integrating hearing screening directly into aged care facilities residents can receive timely assessments without external referrals – reducing social isolation and falls risk, says Sound Scouts founder and chief executive officer Carolyn Mee.

It is an honour to be recognised for equity and inclusion with such an impressive group of innovators, she says. The win has validated “the years of research, development, and commitment we’ve put into ensuring that hearing screening is more accessible, particularly for underserved communities like older Australians.” ●

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A mecwacare resident interacts with Abi

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Industry movements

Galiazzo named first CEO at LPA

Former home care provider executive

Marisa Galiazzo has been appointed as the inaugural chief executive officer of aged care consultancy and training organisation Lorraine Poulos and Associates. Ms Galiazzo joined LPA in June 2023 as a senior consultant before being promoted to general manager in August 2024. Ms Galiazzo will work closely with LPA founder and managing director Lorraine Poulos, and said she looked forward to continuing the organisation’s focus on practical and meaningful support.

Inacio joins Pricing Authority board

Epidemiologist Professor Maria Inacio has been appointed to the board of the Independent Health and Aged Care Pricing Authority. Professor Inacio –who has expertise in population health surveillance, aged and health care services research – is director of the Registry of Senior Australians Research Centre at the South Australian Health and Medical Research Institute. She is also the Matthew Flinders Professor of Health Services and Epidemiology at Flinders University Caring Futures Institute and a National Health and Medical Research Council Fellow.

Sue Gordon announced advisory council chair

Aged care sector academic Professor Sue Gordon has been appointed chair of the National Aged Care Advisory Council

Professor Gordon was previously the research director at Aged Care Research & Industry Innovation Australia and brings more than 20 years of physiotherapy practitioner experience and 18 years in academia to the role. Other newly appointed members include Dementia Australia chief executive officer Professor Tanya Buchanan, Ballarat Health Services geriatrician Associate Professor Mark Yates, BaptistCare CEO Charles Moore and Federation of Ethnic Communities’ Councils of Australia chair Peter Doukas.

Rob Stokes new housing group executive

Former state politician Dr Robert Stokes has been appointed as the inaugural group executive for housing at Anglicare Sydney. Dr Stokes, chair of Faith Housing Australia, previously held ministerial roles in infrastructure, cities and active transport in the New South Wales government. In the new role he will be responsible for the growth and strategic direction of the Anglicare Sydney housing business unit.

Nicki Doyle moves to FTI consulting

Aged care specialist

Nicki Doyle has been appointed senior managing director at FTI Consulting Health, which is the newly established healthcare and human services industry practice at global transformation firm FTI Consulting. The former KPMP partner has 16 years of experience supporting aged care clients to navigate aged care policy, reform, regulation and changes to the market. Aged care is one of the target areas for FTI Consulting Health, which will be led by Nathan Schlesinger as newly appointed senior managing director and practice leader. Mr Schlesinger was the Australian health industry leader and global health services leader at until joining FTI Consulting in November.

Long-time advocate joins National Seniors

Former politician Kathryn Greiner joined the board of seniors advocacy body National Seniors Australia board in late 2024. Ms Greiner previously held roles in local government and with Pacific Power’s board, John Singleton Advertising, Carlovers and the Financial Planning Association. In 2012 she was appointed chair of the NSW Ministerial Advisory Committee on Ageing. Ms Greiner said she was delighted to be a part of an organisation that is so experienced, in touch with and committed to the people it represents.

Raad Richards retires

After close to 21 years as chief executive of Carrington Care, Raad Richards has retired from a career spanning 50 years. Over that time he’s held executive positions in the health and aged care sector and continues in board and non-executive director roles. In 2019 he was honoured for his outstanding commitment to the aged care sector at Leading Age Services Australia’s state awards. Mark Tutt, executive manager business operations will step into the role as chief executive.

Skipper departs Silverchain

Anne Skipper retired from her 14-yeartenure as chair of Silverchain Group in January. Ms Skipper’s contributions to Silverchain are credited as assisting the transformation of the organisation into a leading provider of in-home health and aged care across Australia. Haydn Chrystal – who has been a member of the board since 2010 – has replaced Ms Skipper as chair. Two new board directors were also appointed in January – Di Mantell and Susan Neuhaus

Commissioner Hefren-Webb takes the helm

Liz Hefren-Webb, who was previously deputy secretary of social policy in the Department of the Prime Minister and Cabinet, took over the top job at the Aged Care Quality and Safety Commission in late January. The federal bureaucrat said she was honoured to be Aged Care Quality and Safety Commissioner and

Dr Rob Stokes

Nathan Schlesinger

Nicki Doyle

Anne Skipper

Raad Richards

Kathryn Greiner

Professor Maria Inacio

Professor Sue Gordon

Marisa Galiazzo

have the opportunity to contribute to making aged care services better for older people in Australia. Ms Hefren-Webb replaces Janet Anderson, who was the inaugural Aged Care Quality and Safety Commissioner and held the role for six years.

Rik Dawson commences as APA president

Post-doctoral researcher from the Institute for Musculoskeletal Health at the University of Sydney Rik Dawson started his new role as president of the Australia Physiotherapy Association in January. He will occupy the role for two years. His appointment follows his time as vice president of the peak body and as president elect in 2024. He succeeds Scott Willis, who was the first Indigenous man elected as national president of the APA and held the position for four years.

Anika

Wells promoted to cabinet

The Minister for Aged Care now has a seat at the table with other senior ministers following her elevation to Cabinet in January. At the announcement, Prime Minister Anthony Albanese said Anika Wells had delivered an “outstanding” job as Minister for Aged Care, delivering the most significant reforms for the sector this century. On her appointment, Ms Wells said it was a privilege and thanked the PM for the opportunity to join his senior team.

AAG refreshes board

Self-described political gerontologist Anita Westera has begun her two-year term as president of the Australian Association of Gerontology. Ms Westera is an experienced researcher, policy analyst, project manager and advocate. She replaces Dr Claudia Meyer after a two-year term. Lui Di Venuto – who is the team leader of active ageing and disability programs at South Australia’s City of Onkaparinga – has taken over as vice president. The board refresh also includes the appointment sport scientist Dr Elissa Burton, consultant writer, communication specialist and former AAA editor Keryn Curtis, researcher and teacher Dr Suanne Lawrence

Health Workforce Academy founder Dr Ashlyn Sahay

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Liz Hefren-Webb

Rik Dawson

Lui Di Venuto Dr Elissa Burton

Keryn Curtis Dr Suanne Lawrence Dr Ashlyn Sahay

Ambitious timelines border on the unachievable

2025 WILL BE remembered as a landmark year for reform in the aged care sector, and few changes are more critical than those affecting home care.

For many older Australians, staying in their own homes isn’t just a preference – it’s a fundamental part of maintaining their independence, dignity, and connection to their communities. Home care provides that opportunity, offering choice and stability in a familiar environment surrounded by family and friends.

The benefits of a strong home care system extend far beyond individual participants. By enabling older people to remain at home longer, we reduce pressure on residential aged care waiting lists and ease the impact on the healthcare system.

When older Australians can access the right support at home – including timely clinical care –unnecessary hospital admissions are

Tom

Symondson, chief executive officer of Ageing Australia

of the Support at Home program. This initiative, which replaces Home Care Packages starting on 1 July 2025, aims to streamline and improve access to services. Meanwhile, the Commonwealth Home Support Program will transition to SaH no earlier than 1 July 2027.

are left in an impossible position – forced to implement sweeping changes with limited information and resources.

currently waiting for Home Care Packages. And how many more are in need but unaware how to even start the process of getting an assessment?

Reforms under the new Aged Care Act aim to relieve this issue with the introduction

However, the challenge for providers is immense. With only months to prepare, they are faced with overhauling entire systems, replacing complex IT infrastructure, and navigating a host of yet-tobe-finalised implementation details. The timelines are so ambitious they border on unachievable, placing enormous pressure on both providers and the hundreds of thousands of older Australians relying on their services.

At the heart of aged care is a shared commitment to improving the lives of older Australians. Yet, without clear guidance and adequate time for transition, providers

The consequences of failure would be disastrous – not just for older Australians and the aged care sector, but for the entire health system too. One of the greatest risks is that an older Australian receives worse care on 1 July than they did on 30 June simply due to rushed implementation. That is a scenario none of us can accept.

I remain optimistic about our ability to influence sensible, sustainable change. Through Ageing Australia’s membership in the Government’s Aged Care Transition Taskforce, we have a seat at the table to advocate for practical, achievable solutions that put older Australians first. Our role now is to ensure these reforms are implemented in a way that delivers real, lasting benefits for those who need them most. ●

We need an information and navigation care finder

Have you ever tried to help an older friend or family member navigate the aged care system?  I have.

Even with my professional knowledge and links to aged care it has proven difficult and frustrating.

Navigating aged care has been an issue for such a long time. During the Living Longer Living Better reforms back in the early 2000s COTA Australia argued for a navigation service in local communities with real interactions with real people. The result was a digital response through the introduction of My Aged Care.

Like any reform, there has been both positives and negatives surrounding the creation of MAC. What is clear, is that older people and families and friends still struggle to find the services they need and access

“If they don’t trust My Aged Care or Services Australia, they have nowhere to go.”

the information they require to make informed decisions.

Navigation continued to be a hot topic with people telling government and us that more support is needed. The Royal Commission into Aged Care Quality and Safety highlighted this and the range of issues people were experiencing with MAC. Off the back of this feedback, funding was provided to trial a navigation service. COTA Australia was proud to lead the trial, which looked at different ways of

Patricia

Sparrow, chief executive of COTA Australia

effectively assisted to find the services they need.

Care Finders was borne from that process. It’s a great service but specifically targeting those who have higher level needs and vulnerability.

We know from the navigator trial that many people who

aren’t vulnerable or complex just need to ask a simple question to get the process right in their head. If they don’t trust My Aged Care or Services Australia, they have nowhere to go.

This is why we are advocating for an information and navigation care finder – a service that anyone can call on to get that little bit of extra advice and support, with links for those more vulnerable to the existing Care Finder services.

It’s what older people and their families have consistently said through many reform processes including the royal commission.

We all need to listen and act on the consistent feedback and find a way to give everyone some support as they navigate aged care – at least until we have a simple system that anyone can find what they need and want. ●

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Counselling and psychotherapy more accessible now

COUNSELLING AND psychotherapy for older people under Support at Home is a new service and has the potential to support older people who experience bereavement or even grief due to illness, changing homes, losing essential supports or conflict with family or friends.

Counselling is not simply a conversation. It can be an opportunity for reflection about ageing or lifestyle choices with a trained professional that contributes to personal satisfaction and contentment during a challenging period of life.

The aims of counselling and psychotherapy align well with the Aged Care Quality Standards with its focus on client autonomy, inclusion, and dignity and respect in standard 1, and delivery of a service that best meets a client’s needs,

Selection of a counsellor registered with Psychotherapy and Counselling Federation of Australia ensures that aged care services are utilising governance systems and a skilled workforce that meet PACFA’s standards for supervision and registration

Ageing in the age of AI

WE’RE ALL AWARE of the rapid pace of technological change across all aspects of society, particularly in relation to developments in artificial intelligence.

And there is no doubt 2025 will see technological innovation and advancement that has an impact on the lives of every Australian. While many older adults have embraced technology in some form, such as internet banking or keeping connected to family and friends via Zoom or similar apps, many remain unconnected.

Research shows the two biggest factors driving this digital divide are cost and user confidence.

of strategic workforce efforts to increase access to therapy where it is needed.

PACFA has more than 10,000 tertiary qualified members across Australia with a range of employment, contract or private practice models of work.

and provide quality clinical care within boundaries of the profession – which align with standards 2 and 5 respectively.

These quality assurance elements will be further boosted in 2025 with the introduction of the Federal Government’s National Standards for Counsellors and Psychotherapists as part

Some targeted initiatives attempt to support older Australians to gain the confidence and skills needed and relieve some of the financial costs. These include subsidised programs such as the Assistive Technology and Home

involvement of older people...”

Modifications Scheme. And the e-Safety Commissioner’s Young Mentors program that connects older people with students.

However, more is needed to support older people to access affordable technology and gain the knowledge and skills to confidently go online. Involving older people on consumer panels about new technologies and user experience would ensure older voices are heard and considered.

Funding through government, community and philanthropic grants to support research and initiatives that consider the experiences of older people will also positively impact the lives of older Australians, address the digital divide, and create a more inclusive and equitable society for all ages.

Among existing streams, the Australian Association of Gerontology Research Trust is proud to financially support innovations that seek the input of older Australians, such as the work of Dr Wei Qi Koh to codesign a pet robot to support people living with dementia.

The inclusion of counselling and psychotherapy in Support at Home can normalise the value of talking therapies to support older people’s mental health so that they experience improved mood. This, in turn, can help older people to connect with other services and their community so they live a good life.

This is an admirable goal and doing it well is important work. Counsellors and psychotherapists are pleased to have an opportunity to play a greater role in supporting older people and aged care services in all locations. ●

Projects that use a collaborative approach encourage the involvement of older people in the development of new technologies, and legitimise the opinions of older people and their lived experiences as tech users.

We call on researchers, policymakers and aged care sector leaders to work together to ensure technology is accessible to all Australians and that older Australians are not left behind as we enter this new age of AI.

And of course, we wouldn’t be the AAG if we didn’t also highlight the need for these emerging technologies to be appropriately monitored and evaluated to ensure the needs and interests of all people are met, particularly those at the receiving end of care-related innovations. ●

Caroline Romeo, PACFA Older People’s Interest Group convenor

Johanna de Wever, chief executive officer, Psychotherapy and Counselling Federation of Australia

Anita Westera, president of the AAG

Will and preference: a context for further debate

The incoming Aged Care Act emphasises will and preference as a guiding principle and sets out a framework for supported decision-making – but it does not clearly define what will and preference is, writes DR CRAIG SINCLAIR.

As a social scientist, I’ve had a long interest in finding better ways to support older adults in making decisions about their lives. I believe the will and preference concept has advantages over existing approaches, however further discussion and debate is needed, so it can be understood and confidently applied in different settings.

First, a short history of the emergence of the will and preference concept.

Across the past century, our society’s response to people with cognitive disabilities has evolved. For most of this time, the dominant approach has been “substitute decision-making”, in which a person –sometimes known as a guardian, attorney or administrator – is authorised by a court, tribunal or enduring appointment, to make personal, lifestyle, healthcare and/or financial decisions about someone else’s life.

While there are protections – for example a formal determination that the person lacks “decision-making capacity” before activating the power – this remains a delicate area of medico-legal practice with significant human rights implications. Many older adults fear cognitive changes due to conditions like dementia or acquired brain injury may result in them losing the right to make their own decisions.

Different jurisdictions have adopted different standards for how substitute decision-making should be done. For example, across America the “substituted judgment” standard requires substitute decision-makers to “stand in the person’s shoes”, and make the decision the person would have made, based on the available information.

The United Kingdom has tended towards the “best interests” standard, requiring substitute decision-makers to promote the individual’s interests, usually framed in terms of safety, financial security and broader wellbeing. In Australia, some states and territories use substituted judgment, and others use best interests standards.

In practice both approaches have problems. While substituted judgment is more consistent with human rights, it can be hard for substitute decision-makers to demonstrate how they are applying the person’s values, especially in the absence of documented preferences.

The best interests approach is more readily held to an objective standard, for example in a decision about maximising a person’s

financial estate during sale of assets, however it is hard to apply when the decision is more personal or values-based.

The emergence of the will and preference concept has come largely from the disability sector, where advocates have noted challenges in applying these principles for people with disabilities. For example, some people with lifelong disabilities and significant support needs may never reach a level of independent function that enables autonomous decisions; this is problematic for the substituted judgment standard.

Advocates have also shown how the vagueness of the best interests standard has enabled human rights breaches, particularly in institutional settings.

The will and preference language has been adopted in human rights treaties, which were developed mainly with reference to people with lifelong, developmental disabilities. With this language now also adopted in the incoming Aged Care Act it is timely to consider implications for people with a life history of independent decision-making, along with emerging decision-support needs.

It is simple enough to think of will and preference as reflecting “what a person wants”; particularly when their preferences are consistent over time. But in the real world things can be more complex.

In her recent article in Australian Ageing Agenda magazine (November-December 2024), Theresa Flavin’s depiction of will and preference as two separable components is useful.

A person’s will draws on rational, deliberative mental processes and ties to their longer-term goals and values. Preference on the other hand would be the impulses, desires or behaviours in response to emotional, sensory or physiological aspects of a person’s experience.

This separation aligns with decision-making science, and it’s not just relevant for people living with dementia. A long history of research in cognitive psychology shows that while humans are capable of rational, deliberative thought, real-world decision-making is prone to biases and can be swayed by emotions, sensations or physiological processes, as well as unconscious processes.

We can probably all relate to having a longer-term goal of achieving better health through a diet and exercise program thwarted by momentary temptations to over-indulge at the restaurant, a few drinks at the bar and finally missing the morning

Dr Craig Sinclair Credit: NeuRA

gym session by sleeping in. For those with the ability to reflect on their actions, and refocus on a longerterm goal, this can be just a temporary lapse. For those with cognitive disabilities who face challenges in recalling past behaviour or integrating these with longer-term goals, these mismatches can lead to challenges in providing appropriate, responsive care.

As Flavin’s article points out, both will and preference are “part of us”. Our full personhood includes both our goals and values, arrived at through rational and deliberative processes, and also our more momentary responses to emotional, sensory or physical experiences. Conditions like dementia can impact on these mental processes. In the advanced stages of dementia, a person may not be able to recall or reflect on their past behaviour, or may have difficulties in thinking ahead.

The will and preference approach considers both aspects of a person’s decision-making in formulating an approach to care. Hence it could be thought of as more disability-neutral than the substituted judgment approach, which can over-emphasise a person’s previous behaviours or documented preferences prior to the cognitive disability. As conditions like dementia often result in a gradual, fluctuating process of cognitive decline, it is important that supported decision-making is used through this phase.

support – and it is lawful, feasible and reflects their will, it should be respected, even if it entails risk

• If the person is expressing a preference that is not consistent with their will, this should still be considered, unless one or more of the following applies:

• it conflicts with a prior explicit directive expressing their will

So where does this leave family members, carers, health professionals or service providers in responding to the needs of people with dementia? Does a human rights approach mean simply enacting their momentary expressed preferences, with no consideration of current decision-making capacity, consistency with their life history or risks to their financial, physical or emotional wellbeing?

No, I don’t think so. Many people express preferences, for example through signing a legal document, or pushing a plate away or behavioural expressions of unmet needs. The will and preference approach demonstrates that not all preferences are created equally. Some express our will, some are a response to emotional, sensory or physiological factors, and some are a combination. A disabilityneutral approach considers both will and preference.

However, as Flavin eloquently points out, for some people it is of utmost importance to ensure, while their will holds sway, to make directives that can ensure certain aspects of their care are always consistent with their lifelong values.

In other cases, high quality care may be about responding to a person’s emerging patterns of behaviour or expressed preferences, even when these are not formulated through rational, deliberative processes. This could be because in these cases satisfying the person’s preference can contribute to their wellbeing, without risking their deepest values, financial legacy or safety.

A working model for implementing a will and preference approach in aged care settings might look something like this:

• If a person can understand the nature and consequences of a decision – independently or with

“The will and preference approach must recognise that not all preferences are created equally.”

• it constitutes a significant risk to their personal, cultural or social wellbeing

• it is inconsistent with the rights of others

• it is unlawful or otherwise not feasible to implement. In this sense I propose that when a person’s will and preference conflict, we should still give regard to their preferences, but enable a person to choose to prioritise their will, for example through the “advance social directive” that Flavin advocates.

All of this needs to be tempered with recognition that at present supported decision-making and will and preference is only legislated within the Aged Care Act. Other decisions under the scope of state and territory laws would be subject to the relevant frameworks. Future law reform may lead to developments in these laws as well.

I don’t argue that the will and preference approach is a silver bullet to resolve the intricacies of caring for people with cognitive disabilities. Instead, it is a development that more accurately acknowledges these nuances.

Only close and careful attention to a person’s decision-making process, current situation – for example, hunger, fatigue, delirium – longer-term behavioural patterns and life history can provide a path to deeper understanding of their expressed preferences, and how to respond.

I propose that the will and preference approach provides a context for further debate, which might ultimately enable the aged care sector to provide higher quality supported decision-making. Debating diverse views and perspectives on this topic can only stimulate deeper understanding. ●

Dr Craig Sinclair is a senior research fellow in the School of Psychology at the University of New South Wales

Dialogue open between providers, department

KATARINA LLOYD JONES talks to 10 aged care provider executives about their preparation strategies ahead of 1 July as well as their concerns about implementing reforms in the indicated timeline and how well they’re feeling supported in the lead up.

Rather than feelings of dread, a common sentiment among aged care providers about the upcoming sector-wide reforms is excitement, according to conversations around the country with Australian Ageing Agenda in February.

the timeline for the reforms, including how the lack of concrete information has made preparing difficult.

“One of the very important things we have to do before the Act starts is a lot of training for our employees,” Morgan tells AAA.

The chief executive officers for Victoria-based Benetas, nationalscale Bolton Clarke and South Australian-based Resthaven –Sandra Hills, Stephen Muggleton and Darren Birbeck respectively – all say it is indicative of a new era for the sector.

“The new Act provides us with a once-in-a-generation opportunity to enable a better experience for Australians, against a backdrop of an ageing population,” Hills tells AAA

“It’ll have to cover whistleblower requirements, a new code of conduct, the quality standards [and] the client rights. And we want to be able to do that well, but we don’t want to do it until we’ve got enough detail to give the employees because that’s what they’ll want to know.”

“We’re having to rebuild and shape the boat; they’re trying to build an arc, and there’s no time to do it in.”

This feeling is echoed by Muggleton, who says: “The new Aged Care Act is an important response to the royal commission. It represents a rare opportunity to lay the foundations for an integrated system of long-term care and support focused on independence and self-determination.”

This confidence is shared by Birbeck, who tells AAA:

“This is an exciting time for the aged care sector. While there is a lot of work to be done to be ready for 1 July, we are confident that the changes will result in better outcomes for older people.”

Most providers say they have formed dedicated working groups to prepare – with a focus on digital readiness. While some, like Warrigal, have also included a focus on incorporating good operational governance.

However, despite implementing similar strategies others have expressed more concern about their preparations than their counterparts – particularly with the indicated timeline to have the IT administrative system changes operationally ready.

Among them, Flexi Care general manager Adrian Morgan, Anglicare Southern Queensland chief operating officer Kane Singh and Juniper CEO Russell Bricknell all voiced worries about

For Singh, the biggest concern is digital readiness, and whether there will be enough time to implement the new system and technology requirements. For larger providers like Anglicare SQ –whose workforce numbers more than 2,600 aged care employees –the pace information has been released has made the transitionary period challenging.

Singh says the $10,000 Support at Home and new Aged Care Act Transition Support Grant is a welcome first step in supporting providers to be digitally ready for the reforms, but the cost of compliance remains daunting, and he hopes more will be done in terms of operational and administrative funding.

Some providers are not too concerned about the digital changes including national for-profit operator Opal HealthCare whose CEO Rachel Argaman tells AAA they had been investing in their digital systems in the years prior. And Peter Williams – her counterpart at Tasmanian-based not-for-profit OneCare – adds the industry must be receptive to the fact that things will come when they’re ready.

Argaman says their early implementation of digital changes –partnered with their “proactive strategy of person-centred care” that saw the implementation of system changes before the new Act was announced – has left the provider feeling confident.

Warrigal CEO Jenni Hutchins shares in this sentiment, saying

Sandra Hills Stephen Muggleton Darren Birbeck Adrian Morgan Kane Singh

it comes down to providers and the Department of Health and Aged Care recognising that both parties are doing all they can

“A challenge is that we don’t have everything we think we need or want to be able to be 100 per cent ready by July 1,” Hutchins

“It worries me a bit, I must say, but I think best endeavours come in here, and we can say to the government, we’ve used our best endeavours with the information we’ve got to be as ready as we can be for the new legislation and standards.”

Meanwhile, David Moran – CEO at Southern Cross Care SA, NT & VIC – describes the timing of the digital changes as “woeful.” He tells AAA they had only just started implementing a system when the changes were announced – requiring them to start over.

Providers feel supported

“We’re having to rebuild and shape the boat; they’re trying to build an arc, and there’s no time to do it in,” Moran tells AAA Williams says he too believes the department is doing the best it can dealing with “the biggest reform change we’ve had in a very, very long time.”

“We don’t have everything we think we need or want to be able to be 100 per cent ready by July 1.”

As part of his role chairing the Tasmanian members council at provider peak body Ageing Australia, Williams coordinates conversations with the state’s providers and meets with representatives from the department, the Aged Care Quality & Safety Commission and Tasmania Health. He says it leaves him cognisant of just how much information both the department and providers are trying to stay abreast of.

It appears the recognition of workload is mutual, with Minister for Aged Care Anika Wells writing for AAA in late-February that providers’ concerns about IT administrative changes have been heard and digital changes will be phased in.

Bricknell says a lot of information has come too late and too quick for the proposed timeline in his view, but he relieves the department of fault, telling AAA that much of the delay is due to the time it took to get the Act through Parliament.

Also recognising the department’s attempts to support providers during this time, Moran, Hutchins and Argaman all say they can see the department’s goodwill and have applauded their provision of resources in such a short timeline.

“It’s time to stop and pause and recognise the work that’s gone into aged care from the royal commission, from various inquiries, as well as the work that’s going into aged care now,” Hutchins tells AAA

Moran adds: “The sector’s got a lot of work to do, and there’s actually a sentiment of sympathy for those working in the government because they’ve got a Herculean task.”

“I understand that adapting business to new requirements, upgrading ICT systems, and implementing new workplace processes is a significant change for providers who are still in the thick of delivering services every day,” Wells writes.

“This is something that the [Aged Care Transition] Taskforce has discussed – specifically that ICT delivery is a big undertaking, and more time is needed for providers to meet the requirements. I have taken this onboard, and this is reflected in the way we will stage digital changes.

“We will continue to work with the taskforce to deliver the critical elements for 1 July, with full implementation by February 2026.” ● Find out the latest on the government’s aged care digital reform plans at health.gov.au/our-work/aged-care-reforms/aged-caredigital-reform

Peter Williams Russell Bricknell Rachel Argaman David Moran Jenni Hutchins

‘It

only takes one’

IAt BaptistCare, cybersecurity is everyone’s responsibility, DANIEL PETTMAN tells NATASHA EGAN.

n addition to common email tools to test the phishing literacy of staff, aged care provider BaptistCare has – with permission – used the form of artificial intelligence know as deepfake technology to create hoax videos.

“We deepfake our executives and then play it back to our staff and see if they can tell the difference,” says Daniel Pettman – chief information and digital officer at BaptistCare.

“And most people can’t because it’s a video. Sounds like, looks like, behaves like one of our executives, and then we educate them that no this is not a real video,” he tells Australian Ageing Agenda second half of 2024.

“And you can see in people’s minds the gears churning and this is unfortunately a reality you have to deal with. Is the person on that Teams meeting even real anymore? You can clone audio in a couple of seconds from a person, so is that person on the phone real?”

In addition to his role at BaptistCare, Pettman chaired the sector’s technology roundtable for almost three years until recently. He was also the founding and inaugural chair of the Australian Aged Care CIO Network for over two years from mid-2021.

He says aged care organisations need to have good controls and awareness of these types of scams, particularly as they are going to become more sophisticated and complex as AI technology matures.

Cybersecurity has been a big piece of BaptistCare’s digital transformation puzzle, says Pettman, who’s been with the organisation since 2011.

Starting over six years ago, he breaks the journey into three phases:

1. architecture and systems integration

2. cyber and data

3. innovation.

Cybersecurity was already taking prominence after some in the sector were compromised, says Pettman, and then the Optus and Medibank breaches in 2022 made it a mainstream concern.

During that period, “we were aligning to cyber frameworks, we were putting in all the technical controls, having lots of conversations with our board and executive around it’s everyone’s responsibility.”

Over four years the results from staff testing on phishing literacy improved from a 19 per cent fail rate to under 4 per cent at the time of speaking. “Which is pretty much best in class,” says Pettman.

His takeaway message: “Security is not optional. It’s got to be

This includes orientation, which led to a new starter questioning Pettman over its history of attacks.

“They said, ‘Wow, has BaptistCare had a major cyberattack or something? I can’t believe it’s in orientation.’ I said, ‘No, we don’t want to have one.’

“We’ve tried to build that into the culture of the organisation that the realities are that everyone’s trying to steal our data that’s in our systems and we have to all be aware. It only takes one person to get tripped.”

Tech decisions are strategic

At BaptistCare, Pettman heads up Business Technology Solutions –the BTS department, which he highlights deliberately includes the words “business technology” rather than “IT”.

“Everything we do ties to a business strategy, the business outcome. That’s implicit in the name. That’s how we think.”

The number one business priority at an organisational level is growth, he adds. Which is evident in the ongoing amalgamations for the once New South Wales and Canberra-based provider.

Daniel Pettman

credit: BaptistCare

Most notably among them is the merger with Baptistcare WA in 2023 followed by the very recent uniting with counterparts Baptcare VIC, TAS, SA, Baptist Care SA and Baptcare – which collectively serve Victoria, South Australia and Tasmania.

This merger was announced in November 2024 and completed on 7 March. The organisation now has over 12,000 staff and provides aged care and retirement living services, community housing and family and community support to over 38,000 customers across five states plus the ACT.

“There’s no shortage of IT related things to address when you’re a growing organisation,” Pettman tells AAA

The list includes everything from cyber and data reporting to integrating systems, decommissioning old systems and making sure data is private and secure.

Integration activity involves getting everyone on common platforms, systems and reporting processes and skilling them so they can use the common platforms they may not have used before, he adds.

“And often there’s quite tight timelines, particularly to do some acquisitions of handover and things have to be done by this date, and you’ve got to work with counterparties as well. There can be differences in maturity of technological systems and the quality of data and to make it all work on day one, there’s a lot of work to get done.”

The BTS department has five teams each responsible for different areas including:

• data analytics

• cyber

• project delivery, such as strategic projects, mergers and acquisitions

• operations, which runs IT support 24/7

• innovation.

2. Good vendor management and partnerships

“The great challenge in this sector is lack of maturity, sometimes in the vendor space, which has been a cottage industry” where “a lot of solutions are designed for small players,” says Pettman.

Bigger organisations “need industrial strength technology solutions,” which is “about leveraging platforms, rather than lots of smaller solutions.”

Working strategically with partners can help you get what you need in the product for your organisation and help vendors have a better product for the sector, he says.

3. Security is not optional

“Security is such a fast-moving thing. The lesson we learned early on, is you have to bake security into absolutely everything you do. If you don’t bake it in you have to fix it later. And that’s really hard when you’re really busy and you move on to the next thing,” he says.

The last team, he says, has the most exciting time because they get to look at the tech that’s three years away. “They get to be in the AI and robotics spaces, virtual reality and those type of things,” says Pettman.

“Security is not optional.” iStockphoto.com/D-Keine

“It’s the fun stuff and they get to work directly with residents, our clients and customers and understand where technology can take us in the future,” he says. “AI is moving at such speed. That team is amazing to keep tabs on all of our AI initiatives.”

Digi transformation lessons

BaptistCare can spend more time on the fun stuff – innovation –because it has its digital foundations laid and made its systems secure.

Reflecting on the organisation’s digital transformation to date, Pettman has tips for others in the sector that come from both “things we did well” and others he “definitely would have done differently with the benefit of hindsight.”

1. Top-level buy in

“You absolutely need your board and executive onboard for digital transformation because it is a partnership between the technology department and the business,” says Pettman. “The IT department can’t do it alone. The business can’t do without the technology department.”

5. Culture is key

“Do it early. Align with the best standards out there in the industry. Make sure you have enough resource and capability in the security space because if you suffer an incident, then it’s going to slow everything down on every level of the

reputation and the client impacted if their data is

4. Be prepared to fail

“For every little innovative thing you explore, you will find some things that feel like they don’t work. But there are some things that work incredibly well and have huge benefits to the

You have to try things, “learn it along the way” and see mistakes or missteps as informative that you can apply to the next phase, he says.

The culture of the technology team is incredibly important, says Pettman.

Looking into “the deployment of AI and other emerging technologies, a lot of the research says that the barriers are often in the IT department because this technology is moving so fast.

“The IT department doesn’t necessarily need any more pressure or stress, so we’ve taken a very deliberate cultural approach in our IT department to get everyone to be involved in AI,” says Pettman.

This includes a hackathon where every team has to come back with a solution, weekly meetings where the whole team talks about AI, what’s coming and use cases, guest speakers and individuals responsible for driving the culture, says Pettman.

“That’s so important because IT departments sit in the middle of everything going on in an organisation, and if they’re not on that journey or they can’t be the ones being the forerunner and proving this stuff, it’s difficult to get traction in the broader business,” Pettman tells AAA

“For us that was a critical point that we’re leading by example, and we’re up to date with the latest stuff and then we’re practicing what we preach.” ●

A win-win

With both Australia and Indonesia experiencing staffing issues, a new initiative may solve two birds with one stone. CHRISTOPHER KELLY reports.

Both Australia and Indonesia are facing a crisis in their aged care sectors. However, they are diametrically opposed.

“It’s no secret that Indonesia has quite a significant oversupply of nurses and care workers and Australia is grappling with very much the opposite,” Benjamin Gilmore, chief executive officer of University of New England Partnerships, tells Australian Ageing Agenda

Indeed, Indonesia’s aged care sector has a surplus of over 500,000 care workers, resuting in Indonesians having to migrate to countries desperately in need of care workers due to ageing populations – such as Hong Kong, Taiwan and Singapore.

“It’s about bridging the gap between the Indonesian care sector and the Australian care sector.”

Australia’s aged care workforce shortage is equally acute. Currently facing an estimated deficit of around 110,000 direct aged care workers by 2030, that number is projected to blow out to more than 400,000 workers by 2050 unless steps are taken.

Through Katalis – a bilateral Australia-Indonesia business development scheme funded by the Department of Foreign Affairs and Trade – UNE Partnerships is taking such steps through a pilot training program designed to solve each country’s dilemma.

As Gilmore explains, on one hand: “The program aims to ease the critical workforce shortage that has adversely impacted our health and community care sectors for many years and provide elderly Australians with improved quality of life and quality of care.”

And on the other: “It’s trying to find really compassionate Indonesian carers who have already dedicated their lives and their careers to working in the care sector with employment opportunities in Australia.”

Also on board are Living Well Senior Communities – an internationally operated aged care provider in Indonesia – and Binawan University in Jakarta, from which 20 final-year nursing students have been selected to participate in the pilot.

The six-month program – which began in February – is run remotely by UNE Partnerships. Comprising a series of academic and practical modules – “many of which these Indonesian nurses

will be quite proficient in,” says Gilmore –the program aims to introduce students to Australian aged care sector standards.

“It’s about helping them understand how things are done here,” says Gilmore. “It’s about bridging the gap between the Indonesian care sector and the Australian care sector.”

Take something like lifting an aged care resident from a bed, for an example. “When an Indonesian nurse needs to lift a patient, they might just find four or five care workers and they’ll all lift together. Whereas in Australia you’d use lifting machines and lifting belts because that’s the way we do things,” says Gilmore.

The program also features 120 hours of work placement at a Living Well Senior Communities home. “In many cases they will spend a day a week working as a carer,” Gilmore tells AAA. And, while in Jakarta, “it is an aged care facility that runs more aligned with Australian policies and procedures.”

Once the students have completed the program, UNE will present them with a Certificate III in Individual Support (Ageing), qualifying them to work in the Australian aged care industry.

And since the federal government introduced the Aged Care Industry Labour Agreement in 2023, providers can sponsor participants for the Temporary Skill Shortage (subclass 482) visa. Applications will then be fast-tracked by the Department of Home Affairs.

“We hope they will be well-positioned to apply for the visa,” Gilmore says. “We’d love to see this pilot group provided with the opportunity to live and work in Australia.” Ideally, he adds, in a small regional community crying out for care workers.

Once the pilot has demonstrated the model is viable, the plan, says Gilmore, is for either Indonesian students to self-fund their place on the program or for Australian providers to subsidise them.

He tells AAA: “Our expectation is, as the program progresses, we’ll identify three or four host employers in Australia – providers who might start to consider this as a potential part of their recruitment mix.”

And why wouldn’t they? After all, it’s a win-win. ●

Representatives from UNE Partnerships, Katalis, Living Well Senior Communities and Binawan University with prospective students at inaugural information session.

Images credit:

Binawan University and Living Well Senior Communities.

Benjamin Gilmore (right) with Said Saleh Alwaini, CEO of Binawan Group

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Prisoner services lacking

The demand for aged care support for older people during and after their prison terms is rising. JODIE WOLF reports.

It’s no secret the population is continuing to grow, and in turn, we are living longer. But not everyone will age gracefully among family and friends.

Australia’s prison population is made up of adults with different types and lengths of custodial sentences, including older people.

According to the Australian Institute of Health and Welfare, between 2009 and 2019, the number of Australian prisoners aged 45 and over rose by 79 per cent.

Research published by the Australian Institute of Criminology highlights four main types of sentences served by older prisoners. These include:

• people incarcerated for the first time at an older age

• people who enter and exit prison multiple times during their lifetime and return to prison at an older age

• those serving a long sentence who age while incarcerated

• people sentenced to shorter periods of incarceration later in life.

AIHW data highlights that older inmates are 1.7 times more likely to have chronic illness and “more likely to experience poorer health” and require medical treatment than younger prisoners.

service, including allied health and case management.”

Lougheed tells AAA that Corrective Services NSW is responsible for the movement of people in custody, but generally speaking, patients do not remain in the aged care unit after their sentence has finished unless under exceptional circumstances.

However, there are aged care patients in custody who do complete their sentence but have nowhere to go as they are not accepted into conventional residential care. This is an issue Lougheed says Justice Health NSW has been working “exceptionally hard” to advocate for.

“Our patients who require access to residential care have served their sentence and are simply seeking the same care that anyone would expect as they age,” she says.

“Very few residential homes will accept people from custody.”

Aged care is a specialist field of Corrective Services New South Wales and Justice Health and Forensic Mental Health Network. It includes dementia care, and provides aged care for limited numbers of aged and frail inmates in the maximum-security Long Bay Hospital Aged Care Rehabilitation Unit at the Long Bay Correctional Facility in Malabar, in Sydney’s south-east.

In light of increasing and changing demand for aged care, Rose Lougheed – Justice Health NSW general manager of primary care – explains they are shifting their strategy to ensure ample planning for the rise and to provide the increasingly older and frailer patients with the care they need.

“This includes an adaptive ageing framework and model of care, which focuses on the needs of older people and how best to care for them in a correctional centre,” Lougheed tells Australian Ageing Agenda

“We are also supporting additional training for all clinical staff on the latest care models for healthy ageing, as well as improving multidisciplinary care through an enhanced integrated care

“The Aged Care Assessment Team does assess our aged population while in prison, but even if funding for residential care is granted, very few residential homes will accept people from custody. This significantly impacts those who have either completed their sentence or reached their earliest release date.”

Positively, Lougheed says the team has been working with one aged care provider, who has been “fantastic” in supporting patients to transition to care homes that meet the level of their needs.

“This has ensured that our departing patients have benefited, as has the provider. It is a relationship we would love to see extended to other aged care providers across New South Wales,” she says.

“Despite ACATs being completed in prison, assessments for Home Care Packages cannot be completed. This makes release to home difficult for those with additional care needs. Justice Health NSW works closely with CSNSW and residential homes, but unfortunately, the options remain very limited,” says Lougheed.

By 2066, it is estimated that Australia’s population of over-65s will make up between 21 per cent and 23 per cent of the total population – up from 16 per cent in 2020.

Worldwide, elderly inmates are also increasing both in number and as a percentage of correctional populations.

According to a review of National and International Research on Ageing Offenders by Shelley Turner and Christopher Trotter, the increasing number of elder prisoners across Australia is bound

Indoors and outdoors at Long Bay Hospital Aged Care Rehabilitation Unit at Long Bay Correctional Facility

to have an impact across a variety of correctional domains.

“Prison health services are likely to experience increased requirements for specialist services and chronic disease management services, as well as screening and treatment for age-related illnesses including dementia and terminal illnesses,” they write.

They say a greater need for accommodation arrangements suitable for prisoners with frailty and mobility issues is also likely and implications for correctional budgets, including costs associated with catering for older prisoners with higher healthcare needs.

“There are implications for correctional research. Information about the needs of older prisoners and the extent to which the current trends will continue is vital for the planning of prison services,” they found.

Despite the plans in place at Long Bay Correctional Facility, they are still facing challenges daily in regard to older aged care people in custody with specific needs. Coping with demand for services will be one of the biggest ones for the foreseeable future, says Lougheed.

When AAA visited the aged care ward at Long Bay in late 2024,

all 15 inhabitants were male and aged over 60. This included two aged 60-69, seven aged 70-79, and six aged care 80 or older.

“The aged care unit at Long Bay Hospital is currently the most suitable accommodation for elderly men in custody who have complex healthcare needs or require assistance with activities of daily living,” Lougheed tells AAA.

“We are exploring ways to expand these services to ensure we meet the needs of all our patients with complex age-related health needs, including access to an aged care residential facility or care home.”

Lougheed says they would like to see an increase in nursing, medical, and allied health resources statewide to improve aged care screening and rehabilitation services, allowing older patients to remain in rural locations once suitable accommodation is in place.

“We will continue advocating for our patients and working with the aged care sector to ensure they have access to aged care facilities that support them when they are released back into the community.”

www.expo.atsa.org.au

Triangulating risk

Health Generation has developed a three-pillared approach to help aged care providers shift to where they

need

to be – proactive assessment and continuous improvement.

We know that aged care providers in Australia are facing a range of challenges such as unprecedented critical staff shortages, meeting care minute requirements, and preparing systems and teams for 1 July 2025. All while striving for high standards of care and financial sustainability.

But the top challenge right now, says Joanne Speck – Director of Clinical and Consulting Services at Health Generation – is language.

“This is a 30-year change to aged care,” Speck tells Australian Ageing Agenda referring to the transition from Aged Care Act 1997 to a new rights-based Act.

The last 30 years in aged care have been about compliance – box ticking exercises, she says. “We know how to meet legal requirements, avoid penalties, pass our audits, comply with regulations and show due diligence to necessary training. It has been a means to an accreditation end.

Actionable insights

Tangible benefits of the AssureTrend Companion include:

• a continuous improvement action plan outlining risk areas and recommended interventions

• a funding integrity report to ensure financial sustainability

• a comprehensive assurance report detailing clinical risks, systemic trends, and compliance status

• a workforce development plan aligned with training needs and care delivery requirements.

“That is no more. The language has to shift from compliance to continuous assessment of conformance,” explains Speck.

Because basic human rights – a concept central to the new Act – are based on the principles of dignity, equality and mutual respect.

“We want to be treated fairly, to know others are being treated fairly and the ability to make those choices ourselves,” says Speck. “We need to be talking about enhancing trust and leading the industry to transform care so that it sets new benchmarks for quality.”

Because so many risks can impact care quality, older persons, their loved ones and the Aged Care Quality and Safety Commission now want ongoing assurance of improved outcomes. Triangulating this data to identify trends is the name of the game, says Speck.

“Under the strengthened Aged Care Quality Standards, applicable from 1 July, providers need to continually provide the confidence they are recognising their risk, restoring the trust of the older person and their families and representatives in their care, and doing the best they can to prevent a re-occurrence. Providers need to position themselves as partners in achieving excellence, not vendors in ensuring compliance. This encompasses clinical and non-clinical business areas of the service,” says Speck.

This is where the Health Generation AssureTrend Companion comes in. The consultant-led and tailored service aims to provide residential and home care providers with confidence in their trend predictions, take a proactive data-driven approach to achieving high quality care, and move beyond compliance to proactive assessment and continuous improvement.

Joanne Speck

AssureTrend Companion does this via three interconnected pillars, offering providers expertise and tools to manage clinical risk, optimise funding and enhance workforce capability.

Together the pillars aim to empower aged care providers with robust data analytics, targeted education and compliance support to meet requirements, sure up financial sustainability and improve care outcomes.

Three pillars in action

Assessing how effective care practices and service delivery enhancements are in supporting the safety and wellbeing of aged care recipients is at the heart of aged care conformance to high quality care, says Speck.

“Continually transforming care is about ongoing assurance that providers know where they are, they action trends identified in clinical care and are implementing continuous improvement.”

The first pillar – the Clinical Risk Companion – aims to identify systemic trends in care standards by conducting a deep dive into key indicators such as the National Aged Care Mandatory Quality Indicator Program, feedback and complaints, the Serious Incident Response Scheme, and internal incidents.

The audit methodology:

• identifies systemic risks by triangulating data sources, including complaints, surveys and incident reports

• reviews care profiles of older persons, ensuring individual care plans align with assessed needs

• supports continuous improvement by providing a structured action plan to address identified gaps in care delivery.

Also critical to maintaining quality care is sustainable financial health – requiring optimisation of funding for direct care through AN-ACC and ensuring the financial acuity of operations.

The second pillar – the Funding Companion – supports providers in this area by:

• analysing current funding data to uncover potential reclassification opportunities

“We also provide clinical manager mentoring and leadership programs to bring out the very best in clinical teams. Providers can best utilise their workforce by training and retaining. From early out-of-degree qualified RNs just starting out in aged care, to experienced clinical managers and carers who have been in the industry for years, the July 1 changes mean staff education will be critical for clinical teams and leadership to evolve with the Act.”

Future-proofed approach to excellence

More than an audit tool, Speck stresses the AssureTrend Companion is a partnership with providers in supporting excellence in care, financial viability, and conformance in an increasingly complex regulatory landscape.

“The language has to shift from compliance to continuous assessment of conformance.”

• aligning clinical documentation with funding requirements to enhance financial integrity

• supporting reclassification requests and funding submissions, ensuring providers receive appropriate financial support.

Staff are naturally crucial to care quality. Strengthening workforce capability through targeted training and professional development can also assist in mitigating the effects of an industry wide workforce shortage.

The third pillar – the Education Companion – works by:

• reviewing staff training and competency records to identify areas for improvement

• delivering tailored short courses, clinical workshops, and mentoring programs to upskill staff

• enhancing compliance with care minute requirements by ensuring staff are equipped to deliver efficient and effective care.

“We can assist providers to ensure their workforce is best placed to cover required care minutes across the day,” says Speck.

“We’re giving providers confidence in trending,” she tells AAA. “If they want to push their registration to as close to three years as possible, they’ll need proactive confidence in trending that can give CEOs and governing bodies assurance that all the right things are happening.”

In addition to being a complete solution, each aspect of the AssureTrend Companion can be implemented independently as per providers’ needs.

“It’s about listening to where the provider is on their journey,” says Speck. “The triangle is the big picture. But they may not need every corner of that triangle. Health Generation understands where the risks exist, where providers cannot show confidence, and where they do not have the assurance that operations are running well. We can offer providers a service that focusses on benefits not requirements.” ●

Are robots a cure for isolation?

With loneliness on the rise in older Australians, could robots be the answer? JODIE WOLF investigates.

Loneliness is described in the Oxford Dictionary as: “sadness because one has no friends or company; feelings of depression and loneliness”.

To understand the extent and impact of loneliness and social isolation locally, consumer peak body COTA NSW surveyed 2,200 adults over 50 living in New South Wales for the report Voices of Solitude: Loneliness and Social Isolation Among Older Adults in NSW

It finds over half experience high rates of loneliness and isolation, with women particularly affected – especially those aged 60-64. It also finds three in five respondents are lonely, half are socially isolated and a quarter experience extreme levels of loneliness.

And it’s not just older Australians who are feeling desolate.

In 2022, Statista surveyed 30,636 adults online across 16 countries. More than half of respondents aged 55 and older reported negative effects on wellbeing from feelings of loneliness (54 per cent).

In an examination of survey data from 27 countries, published on NIUSSP in 2023, researchers predicted the number of lonely adults aged 50 and above in the sample countries will triple from 105 million in 1990 to 333 million in 2050.

Countries surveyed included Greece, Italy, Croatia, Portugal, Republic of Korea, Poland, France, Czechia, Estonia, the Netherlands, Sapin, Belgium, Sweden, Slovenia, Germany, Israel, Luxembourg, China, Switzerland, Austria, Thailand, United States, Indonesia, Mexico, Ireland, England and Denmark.

Many countries are trying to find ways to combat isolation in the elderly, with the World Health Organisation stating a variety of face-to-face or digital interventions have been developed to reduce social isolation and loneliness among older people including more accessible communication technologies.

With technology aiding all aspects of our lives and continuing to develop rapidly, naturally some are thinking about loneliness and how to tackle it from a technological perspective.

Among those who are is Dr Wenxin Li – a former social cognitive neuroscience researcher in Japan – who is developing a companion robot for the elderly with the outward appearance of a soft stuffed toy.

There’s also Andromeda’s AI robot Abi, who has been befriending Australian aged care residents through trials at several homes since a prototype pilot with Allity in 2023. These include late last year at Kew Gardens Aged Care, where she led quizzes and Tai Chi, and earlier in 2024 at Benetas’ St George’s facility in Altona.

Now transitioning from trial to production, Andromeda and Victorian provider mecwacare announced a partnership in February 2025 that will see Abi move permanently into 22 aged care homes (read more on page 9).

Countries including Singapore, and Korea are also developing service-oriented robots for elder care.

Dr Liang Zhao, former robotics lead at UTS Sydney and now Reader in Robot Systems at the School of Informatics at The University of Edinburgh, says robots can genuinely help relieve isolation in older adults.

“Human-robot interaction has been a prominent topic in robotics research and has been studied for decades,” Zhao tells Australian Ageing Agenda

“One major application of HRI is in healthcare. Robots not only communicate with older adults but also assist in various healthcare aspects, such as offering nutritional advice, providing reminders, monitoring and reporting emergencies,” he says.

Zhao agrees there are downsides to consider when it comes to robot companions.

“Robots don’t look like humans, so they lack the sense of familiarity found in human-to-human interactions,” he tells AAA.

“With the rapid advancements in AI technology in recent years, robots are becoming increasingly capable of learning individual habits and improving their communication with older adults for more personalised and effective interactions.”

It seems the functions that AI robots bring to the table aim to enable the elderly to maintain their independence for longer and potentially lower the need for higher levels of care.

But is there a downside to the arrival of robotic companions? Can techno-solutionism – the idea that all problems can be solved by technology – end up creating more work in the long run for carers?

According to Swedish research the answer is yes.

“The analysis shows that the use of robots can affect both the physical and the psychosocial work environment, in positive as well as in negative ways,” say the authors of the paper Caregivers’ use of robots and their effect on work environment – a scoping review

“Robots are used in care settings to reduce physical and mental demands of the caregivers, but they can, in fact, increase caregivers’ workload. Thus, the review indicates that robots can improve the quality of work, but that they seldom work as a shortcut to increased efficiency or time effectiveness.”

The review, published in Journal of Technology in Human Services in 2021, also points out that reducing nurses’ and care workers’ workload may play an essential role in providing a positive work environment and an effective quality of care. In this regard, “robots appear as a potentially promising tool in care work.”

However, the authors say that robots may also pose “new risks if, for example, they replace the empathic relationships with patients that help to make the work meaningful.”

“The 24/7 companionship of robots may lead to dependency in the elderly, and once the companionship ends, it could make them feel even more lonely.”

Looking more deeply at the cons – or more precisely the gaps in understanding the disadvantages – Australian and international researchers consider the complexities of robot integration in care services in a review published in the International Journal of Social Robotics in January 2025.

While social robots can provide benefits including better care and efficiency, the technology can also bring emotional, psychological and societal challenges. However, while most reviews showcase the positives of integrating social robots in aged care services, the authors note that most also neglect the unintended consequences.

The team’s analysis of 124 studies on social robots and paper (Un)Intended Consequences of Social Robot Adoption in Aged Care: A Hybrid Literature Review highlight the need to address both the benefits and challenges in future social robot research. The authors find the following six topics may receive significant attention in future studies about robots in aged care:

• privacy concerns

• social engagement

• medical monitoring

• adaptability and learning

• affordability

• companionship.

Despite any cons of using robots to combat loneliness in the elderly, Zhao says the positives remain.

“The robot can provide companionship to the elderly 24/7, as needed,” he says. “It can reduce the reliance on caregivers and the presence of relatives for support and this, in turn, can help lower the cost of healthcare and elderly care.”

Zhao thinks it won’t be long until robots are part of the furniture in aged care homes, especially as significant progress has been made in this area and robots are already available in the market.

“As the large language models, for example ChatGPT, have been well developed recently, particularly in their application to HRI, alongside AI technologies that enable robots to learn and adapt like humans, the communication and functionality of these robots are expected to improve substantially in the coming years,” he tells AAA

“I believe that within the next decade or two, robots will become a permanent fixture in residential care.” ●

Abi entertains mecwacare residents

Dr Liang Zhao

Not tech ready

Research indicates aged care nurses are unprepared for a digital future – but the benefits mean they should be.

JODIE WOLF reports.

“Including nursing voices is essential to ensure these technologies are used effectively.”

Better tools and training are required for nurses to manage end of life care in residential facilities digitally, an Australian study has found.

The paper – Technology in end-oflife care is very important’: the view of nurses regarding technology and end-oflife care published in BMC Nursing in November – calls for nurses to be more involved in the creation of digital tools meant for them.

To make sure technology works accurately for nurses and supports better care, nurses should be consulted from initial concept, through to integration and implementation, says lead author Dr Priyanka Vandersman.

“Right now, with the significant policy changes happening in aged care digital health, it is just as important for policymakers to include nurses in the conversation,” Vandersman tells Australian Ageing Agenda

will be using these tools every day, and their insights can make all the difference in getting it right.”

Vandersman and co-author Professor Jennifer Tieman interviewed nursing staff across 15 aged care facilities in three Australian states as part of the study.

Nurses are already utilising a range of digital tools, such as medication management portals and telehealth platforms, with the technology appreciated for increasing efficiency and accessibility in care delivery, according to findings.

“Including nursing voices is essential to ensure these technologies are used effectively and lead to better outcomes for those in their care.”

Nursing leaders, educators, and managers have a role to play too, says Vandersman, a senior research fellow at Flinders University’s Research Centre for Palliative Care, Death and Dying.

“We need to step up as advocates for digital health and make sure we are part of the discussions where these innovations are being designed and implemented,” she says.

“That might mean putting your hand up to join a technology project at work or giving feedback on new tools being tested. It is crucial for managers and leaders to involve frontline nurses in these processes. After all, nurses providing daily hands-on care are the ones who

The systems participants currently use are fragmented, meaning navigation of multiple platforms for various tasks, resulting in more administrative burdens and taking time away from hands-on care, the study finds.

But by equipping them with digital skills, it’s possible to empower nurses to work smarter, streamline workflows, and ensure they are fully supported to deliver the best possible care in a rapidly evolving sector.

Other findings include unreliable infrastructure, insufficient training, and time-consuming processes. Plus, a lack of support to use technology effectively and a need for continuing education to confidently implement digital tools into daily practice.

With over a third of Australian deaths occurring in aged care facilities, it is vital to comprehend how technology can aid in end-of-life care, Vandersman says. It’s also important to get the tech and human combination right, says Tieman, director of the Research Centre for Palliative Care, Death and Dying.

“With the digital reform agenda and the implementation of the new aged care standards, technology has a very important role to play, offering structured and accessible care solutions. However, its

Dr Priyanka Vandersman

Professor Jennifer Tieman

success depends on thoughtful implementation that supports, rather than replaces, the human connection central to compassionate

tracking care processes, automated medication management systems, and telehealth enhancements, as crucial to elevating

it will reduce errors, streamline workflows, and give nurses the freedom to focus more on interpersonal care.

to upskill digitally is “critical” and with technology such as electronic health records, telehealth, and AI tools becoming a big part of how care is delivered, it is “essential” to have strong digital skills.

“It is important to remember that it’s not just about keeping up, rather, it is about making sure we can provide efficient, highquality care for the people we look after in a digitally infiltrated health and care environments,” says Vandersman.

“In addition to that, the new policies and reporting requirements mean we need nurses to feel confident using these systems. By equipping them with digital skills, we can empower nurses to work smarter, streamline workflows, and ensure they are fully supported to deliver the best possible care in a rapidly evolving sector.”

By including digital skills in performance reviews and creating spaces for nurses to share their experiences, providers can foster a culture of learning and help nurses feel confident in using new technology, she says.

Providers can also help nurses upskill digitally by setting up mentorship programs, where experienced nurses guide others, and ensuring easy access to the tools and support they need.

“Our research shows that nurses highly value support and guidance when technology is integrated into care processes, especially when it’s rolled out service wide. At the service level, it is crucial to gather regular feedback from nurses when technology is being developed, modified, or introduced to ensure training is effective and systems are user-friendly,” Vandersman tells

“Providers should also collaborate with tech companies to ensure the tools meet nursing needs and consider offering incentives like professional development credits for nurses who complete digital training. By including digital skills in performance reviews and creating spaces for nurses to share their experiences, providers can foster a culture of learning and help nurses feel confident in using new technology.”

The research is part of the National End of Life Directions for Aged Care’s larger project on the ELDAC Digital Dashboard. With the ongoing aged care reforms in mind, Professor Tieman tells AAA they will be looking into “the next steps for digital innovations” in end-of-life care across both residential and home care settings over the coming months.

How technology can make life easier

Choosing

innovative technologies capable of improving care without burdening staff is essential, write DR CLAIRE GOUGH, ABIGAIL BAUTISTA, and PROFESSOR JENNIFER TIEMAN.

At recent national roundtables discussing the complexities of rehabilitation and reablement approaches in aged care, providers and carers recommended technology be integrated into practice to engage older people in activities they enjoy.

Dr Claire Gough Abigail Bautista Professor Jennifer Tieman

Reablement is the active process of maintaining, improving or regaining skills, and finding ways to adapt functional tasks. Innovative technologies, such as virtual reality and robotics, can help restore function and support older people to maintain independence. However, choosing technology capable of improving care without burdening staff is essential.

Despite clear potential, the sector has been cautious about integrating technology into aged care due to concerns around usability, acceptance, safety and service readiness.

Regardless of design features, technology use is dependent on human factors, the emotions, behaviours, cognition and understanding related to the use of healthcare technologies. Families of older people receiving care are often resistive to technology use, and for many older people, technology can instil fear of robots taking over the world. Therefore, technology integration is often complicated, as we consider each person as an individual with their own opinions, personal preferences, and digital literacy.

Practical use of technology

Integrating technology into aged care delivery provides an opportunity for clients and staff to improve their digital literacy

and work together to achieve reablement goals. This supports providers to deliver services at scale and accelerate impact important to meet the increasing demands on the sector.

Aged care staff are often familiar with technology as part of their daily work, documenting using digital devices as part of their daily routines. Technology is critical for accurate documentation, allowing care workers to raise concerns regarding clients’ changing health status, and ensure high quality, effective care is provided. Therefore, technology can increase carer efficiency and support meaningful social interactions with clients.

Aged care providers traditionally prioritise hiring individuals for their care skills, such as communication and empathy, placing reduced emphasis on the need for digital literacy. Technology training is generally provided during orientation to familiarise individuals with organisation specific systems. However, there is often no core training to support technology use with older people despite a clear need.

For older people and their families, the ubiquity of everyday technologies such as mobile phones, iPads and laptops, provides an exciting opportunity to teach clients how to use technology to access the information and care they need.

Using intuitive devices such as Google Minis, robotics and artificial intelligence can facilitate a client’s timely access to information and support. This will be important as we move towards aged care services that give older people choice over the services they need.

Empowering older people

There is an exciting opportunity to support clients’ health and wellbeing by incorporating activities that build their confidence using technology. This can improve both their safety and social connectedness as they use technology more regularly.

Teaching clients how to use technology can support engagement in meaningful activities and is a useful way to integrate reablement into service practice. Digital mentoring is an approach where older people are supported and upskilled by professionals who coach them to use technology safely and securely. Government-led initiatives such as Be Connected aim to increase the confidence, skills and online safety of older Australians by mentoring individuals to use digital technology.

From personal experience, Feros Care’s Let’s Get Technical Program, where specialist technical support officers were hired to support and train older clients to use technology was well received.

Clients found that using technology increased their confidence, helped with communication, and they learned life changing digital skills that made them feel socially supported. They acquired skills needed to manage their appointments, contact service provider staff, check service calendars, and self-manage a service roster. Many clients who participated in digital skills training expressed their interest in learning how to use, and keep up with, technology. In future, increased confidence may encourage clients to learn more about other applications and potentially reduce workforce burden.

Upskilling the workforce

Whilst there is clear potential to integrate technology into service delivery, both operational inputs into service design, and operational capacity and capability, are required for successful implementation of digital mentoring programs.

Staff training capacity needs to be carefully considered to ensure service resourcing. Shifting digital mentoring responsibilities from specialists to the general care team to scale up services can create competing priorities with other scheduled tasks.

It is essential to raise team awareness about the importance of technology integration so that digital mentoring is not deprioritised in favour of more traditional aged care services such as personal care. This is a particularly important consideration for interpersonal healthcare education.

Aged care technology: future care

As new innovative technologies emerge to support ageing, aged care providers need to ensure the workforce possesses adequate digital and technological skills, as well as the ability to coach clients in their use. A skilled workforce can help to realise the potential of technology to aid in not just care services, but also to integrate clients into a society where technology use is the norm.

Empower older people through technology:

“It is essential to raise team awareness about the importance of technology integration so that digital mentoring is not deprioritised.”

To improve future care, the scope of practice for existing aged care staff, particularly nurses and support workers, could be expanded by hiring individuals who are technologically inclined and can be trained to coach older people to use technology appropriately. In addition, providing specific education could foster continuous learning, enhance job satisfaction, and improve staff retention.

Recommendations

No one-size fits all approach works when integrating technology to enhance aged care delivery. However, service providers may want to consider the following when preparing their workforce to accept and use technology.

Empower older people through technology by:

• improving digital literacy

• offering digital literacy coaching

• communicating the purpose and benefits of new technologies. Ensure operational readiness for technology integration by:

• expanding the scope and digital literacy skills of the workforce

• upskilling staff to support digital literacy mentoring and coaching

• addressing the barriers to technology use

• participating in the design and development of new technologies.

In addition, aged care providers could consider engaging clients’ families to support technology use, as intergenerational coaching often occurs naturally within these networks, further enhancing the client’s ability to adopt and use digital tools.

Drivers of change

Policy directions promoting the value of new technologies and system architecture elements, such as working towards implementing digital clinical information systems and the assistive technology and home modification support for the incoming Support at Home program, provide drivers for change.

Both those providing care and those receiving care will need to be able to see the benefits of technology change and be part of the change process. ●

Dr Claire Gough is a research fellow at Aged Care Research & Industry Innovation Australia, and the Caring Futures Institute at Flinders University

Abigail Bautista is a manager of service design and innovation of community services at Feros Care

Professor Jennifer Tieman is director of the Research Centre in Palliative Care, Death and Dying at Flinders University

● improve digital literacy

● offer digital literacy coaching

● communicate the purpose and benefits of new technologies

Ensure operational readiness for technology integration:

● expand the scope and digital literacy skills of the workforce

● upskill staff to support digital literacy mentoring and coaching

● address the barriers to technology use

● participate in the design and development of new technologies

Bridging the gap with telephysiotherapy

The TOP UP Study improves mobility and reduces fall risk, finds

gerontological physiotherapist DR RIK DAWSON.

As a physiotherapist I have seen how mobility challenges and fallrelated injuries put pressure on care delivery in aged care. As a researcher I have seen how mobility and fall prevention cost the health care system. But as a grandson I have seen firsthand the devastating effects of fall.

My passion to reduce falls is at the heart of the TOP-UP – Telehealth Physiotherapy for Older People – trial, which I led as part of my PhD at the University of Sydney.

TOP UP connected older people receiving aged care services at home or in residential aged care with a physiotherapist via Zoom. It also provided them access to the TOP UP website where they were able to step their way through a series of fall prevention exercise programs with the support of trained aged care workers.

We were able to demonstrate that older people can successfully engage with telehealth, creating a platform for innovative, scalable and effective healthcare interventions in aged care settings. Here, I explore how this program is transforming lives and reshaping care for older people.

The need for innovation in aged care

Mobility disability affects over 35 per cent of adults aged 70 and above, increasing to a majority by age 85, research shows. Beyond the personal impact, these challenges place a significant burden on healthcare systems, as falls are a leading cause of morbidity and mortality in Australia.

I have extensive experience in aged care and have witnessed firsthand how traditional in-person physiotherapy programs, while effective, face significant accessibility barriers – particularly in rural and underserved areas and for individuals with mobility limitations who struggle to attend physiotherapy sessions.

Growing up in the country, I understand the challenges of travelling long distances to access medical care. As a former physiotherapy business

“It’s about empowering people to move better, feel better and live better.”

owner, I have always sought innovative ways to bring physiotherapy services to regional and remote areas, ensuring that more people have access to essential care.

The Covid-19 pandemic accelerated the adoption of telehealth, opening doors to alternative care delivery models. The TOP UP trial capitalised on this momentum, introducing a co-designed telephysiotherapy program supported by trained care workers and tailored resources.

My mum, Meg, and I, created a series of exercise videos that start in a seated position for 10 minutes and progress to challenging standing balance and strength exercise for 50 minutes. Physiotherapists involved in the trial and their clients highlighted the value of these videos as key to supporting them to exercise on their own safely.

The study: a closer look

Conducted across 25 metropolitan and regional areas in Australia, the TOP-UP trial involved 242 participants aged 65 and older, who were randomised into intervention and control groups.

We offered seven Zoom-based physiotherapy sessions over six months, complemented by exercise videos and local support from care workers.

We assessed the participant mobility using the Short Physical Performance Battery, with secondary outcomes including fall rates, pain levels, quality of life, and physical activity. The trial also measured implementation outcomes like adoption, reach, program completion and safety.

Our analysis found the TOP-UP program led to life-changing outcomes for participants.

We saw a significant boost in participants’ mobility. Those who received the intervention improved their SPPB scores by an average of 2.1 points. To put it simply, that means better balance, strength, and walking ability – key factors for maintaining independence. Compared to the control group, this was a standout improvement, making it clear the program works.

Western NSW aged care resident and TOP UP participant Darrell showing off his new Fitbit (left) with Dr Rik Dawson

The program also had a positive impact on falls, where the numbers speak volumes.

People in the intervention group had a 38 per cent lower risk of falling. There were fewer reports of multiple falls and fall-related fractures compared to those who didn’t participate in the program. For anyone who’s fallen, you know how life-changing this kind of prevention can be.

The program also helped with pain and quality of life in a big way. Participants reported a reduction in pain by 1.1 points on a 10-point scale. Even more impressive, quality of life scores increased by an average of 6.2 points.

Beyond the numbers, people shared feeling more confident in their balance and less fearful of falling – changes that ripple into every part of daily life.

There were also positive changes in physical activity.

On average, participants added 1.7 hours of strength and balance exercise to their weekly routines. Even better, they were 14 times more likely to hit their mobility-related goals. That kind of progress shows just how much of a difference tailored programs can make.

I think that the success of the TOP UP program is more than just numbers. It’s about empowering people to move better, feel better and live better. If these results are anything to go by, it’s a game-changer for those looking to reclaim their independence and confidence.

Voices from the field

Participants praised the program for its convenience, effectiveness and personalised support. On a 10-point scale, they rated the telephysiotherapy sessions at 8.7 and the overall experience at 7.8.

Local care workers – essential to the program’s success –received high marks from their clients for their role in ensuring that the program was safe and motivating.

Rita is a 95-year-old woman who was struggling to walk from her bedroom to the dining room at a aged care facility in Sydney. By the end of the six-month program she was able to repeat chair stand 20 times in a row.

She said: “I think it’s fabulous. I wouldn’t have imagined that I would be given the opportunity to do it. Physically, I can walk further. My breathing is better. I’m stronger, it gives you more independence.”

A broader impact

The success of the TOP-UP trial aligns with earlier studies on in-person physiotherapy, such as the SUNBEAM program, which emphasised structured intensity exercises for fall prevention using gym equipment.

TOP-UP’s telehealth model additionally addresses barriers like geographic isolation and limited access to physiotherapists and requires no equipment other than a sturdy chair and table or kitchen bench for balance.

The road ahead

I am working with my colleagues at the Institute for Musculoskeletal Health at the University of Sydney, our aged care partners and several trial participants to make the TOP UP website available mid-2025.

We are looking to seek further funding to expand TOP UP into an app to enhance the user experience and build more resources such as dance exercise programs for people living with dementia, and occupational and dietetics video resources. The team is currently writing up a publication about the impact of FitBits on exercise motivation in aged care populations.

As healthcare systems grapple with growing demands for aged care services, the TOP UP study offers a blueprint for leveraging

telehealth to address critical gaps. Its success highlights the importance of co-designed, scalable interventions that prioritise accessibility and individual needs.

For policymakers, care providers, and families, the message is clear: telephysiotherapy can be a game-changer for older people. With further refinement and widespread adoption, programs like TOP UP could redefine aged care, ensuring healthier, more independent lives for future generations.

For many aged care providers, access to timely and effective support for residents can be a daily challenge. One facility manager from a small residential aged care facility in remote north-western NSW, who supported the rollout of the TOP-UP trial, shared a real-world example of how programs like this can make a difference.

“We don’t have a local physio,” the manager explained. “This morning, one of our residents had a fall. I called the GP clinic to get an appointment with a physio, only to be told it would take six weeks. If someone has a fall like this, we just can’t wait six weeks.” ●

Dr Rik Dawson is a post-doctoral researcher at The University of Sydney and the national president of Australian Physiotherapy Association

Dr Rik Dawson and his mother Meg (pictured) created exercise videos

POSITIVE AGEING SUMMIT

HILTON ADELAIDE 28 & 29 MAY

Exploring a holistic approach to better ageing

With a premier list of speakers across a packed two-day program, the inaugural Positive Ageing Summit will be attended by experts, healthcare professionals, aged care providers, policymakers and many more from the industry.

JESSICA ADAMSON

MC

JUSTIN KEOGH

KEYNOTE SPEAKER

Associate Professor and Dean of Bond University

PETE WILLIAMS

KEYNOTE SPEAKER CEO, OneCare Limited

DR. CLAIRE GOUGH

Research Fellow, Aged Care Research & Industry

Innovation Australia (ARIIA)

ANITA HOBSON-POWELL

Chief Allied Health Officer, Department of Health and Aged Care

DR. CHRIS BOLLEN Director, Bollen Health

DAVID MORAN CEO, Southern Cross Care

DR. JENNIE HEWITT

General Manager, Clinical Research & Reablement, Whiddon

KATE WEGER

National Clinical Governance Manager, Hartmann Group

DR. TIM HENWOOD

Principal Consultant, AgeFit Solutions

DR. TUIRE

KARAHARJU-HUISMAN

Research Lead, Area Manager, HUR Australia

MORE SPEAKERS & SESSIONS TO BE ANNOUNCED

The med-tech revolution

By harnessing the vast amounts of data already being collected, there is no doubt digital solutions will transform clinical care. CHRISTOPHER KELLY reports.

Medication management continues to be one of the most complained about issues in aged care. Time and again it charts high in the regulator’s industry performance reports.

Which is why med-tech companies such as Australian-based BESTMED have been working hard to come up with innovative solutions to improve the medication administration process in aged care homes.

A common complaint is families are kept in the dark about what residents are prescribed and why.

“A lot of those complaints occur because an event happened previously that the family weren’t fully informed of,” Phil Offer – BESTMED chief executive officer – tells Australian Ageing Agenda. “Improving that communication and transparency is key to what BESTMED Connect is all about.”

“BESTMED Connect is an add-on module to the BESTMED medication management service and its principle is to improve communication with families when it comes to those key changes to medications and to understand what their loved ones are on.”

The standard BESTMED platform allows three parties access to an individual’s medication record – the doctor, the pharmacy and the aged care home.

“With BESTMED Connect, we’re adding a fourth pillar so the family – or the substitute decision-maker – has got access to what medications their loved one is on, and the reasons why,” says Offer.

BESTMED Connect has been piloted across a number of homes operated by Southern Cross NSW & ACT.

“The feedback was heartwarming, because it meets the needs of the product … it helps build communication,” says Offer. “It helps as a safety net and reassures. And for family members, they’re not having to chase information up – they’re getting that as it happens.”

Offer tells AAA, the app’s feature to confirm consent is proving especially useful in a live setting.

“Previously, if a change to medication occurred, the [aged care] home is having to confirm manually, on paper, that yes, consent was confirmed by the family. So it’s a big time-saver for homes [because] they’re not having to try and reach out to those families. And also the families have the information themselves. So that confirm-consent process has gone very smoothly.”

The BESTMED medication management platform is currently being used in more than 1,100 aged homes across the country.

“We’re now rolling out the new connect module for those homes that want to take it up,” says Offer. “You will also see BESTMED Connect expand out into the home care environment to the families and users as well,” he adds.

BESTMED Connect was codesigned with researchers from Sydney’s Macquarie University. Offer says such collaboration is vital.

“It’s a key priority for us that we build those connections to the universities – to help make it easier for them to do their research, so we can do it at more scale,” he tells AAA. “And when we’ve found something that works, we can roll it out to get that holy grail of impact. That’s a win/win for us.”

Associate Professor Magda Raban is a research fellow at Macquarie University’s Australian Institute of Health Innovation.

As she notes: “The recent rapid uptake of digital systems in aged care provides huge opportunities to improve care delivery. Macquarie University is exploring ways in which we can leverage this technology to improve medication management and safety.”

A key component of the research conducted at the AIHI is understanding the information needs of consumers and exploring digital solutions to meet those needs.

“With a panel of consumers, we are designing requirements for a digital platform for medication management reviews,” says Raban.

As she explains, currently, medication reviews are a disconnected process – patients, their families and carers, pharmacists, clinical and aged care teams rarely have access to the same information at the same time.

“This technology-based solution will bring together all stakeholders to improve engagement in medication reviews, and hence, lead to improved medication management outcomes. We are working with BESTMED to embed this within their IT system to ensure the solution has reach,” says Raban.

“Ultimately, this means aged care residents, their families and carers will have simultaneous access to their live medication list for the very first time.”

As well as ongoing communication issues around medication management, Raban tells AAA there are also problems with overprescribing. “For example, antipsychotics are used for prolonged periods in people with dementia as a form of chemical restraint; and antibiotics are overused and used for longer than guidelines advise in many cases. Our evidence synthesis estimated only 28 per cent of antibiotic courses were appropriately initiated.”

Technology has the potential to address many of these issues, says Raban. “We are working closely with consumers, aged care providers, GPs, IT vendors and government partners to design, implement and evaluate solutions to tackle them.”

By harnessing the vast amounts of data already being collected – making it accessible, actionable and timely – there is no doubt digital solutions such as BESTMED Connect will revolutionise clinical care in aged care settings. As Raban tells AAA: “This transformation is already underway, enabling more personalised, efficient, and responsive care for older adults.” ●

Phil Offer

Detecting deterioration

In November last year, Australia’s first electronic screening tool designed to detect risk of deterioration in aged care residents won another national prize –the Digital and Data Health Innovation Award 2024.

Developed by RMIT University and Telstra Health – in collaboration with the Digital Health Cooperative Research Centre – the AI software can rapidly screen electronic records for 36 evidencebased indicators of deterioration.

“It automatically scans the electronic record in residential aged care facilities and assigns a score and categorises a resident’s degree of frailty. And it tracks changes over time,” Vickie Irving, Telstra Health’s deputy chief health officer, tells AAA

As Irving explains: “One of the key value propositions of the innovation is that aged care workers and nurses are extremely busy – they’ve got very high caseloads. One of the key focuses of our project was to decrease the burden of data collection because those staff are already too over-worked.”

evidence-based markers of deterioration using data collected routinely at the point of every day care in aged care facilities.

“We scan everything from the daily notes that the nurses and care workers input into the care records – the observational data like [residents’] vital signs. We also scan the records of visiting specialists,” says Irving.

The AI tool is powered by an algorithm that has a massive data dictionary alert to key words associated with evidencebased markers of deterioration.

“It has additional smarts around being able to identify the context around those evidence-based markers,” says Irving. “It doesn’t just look for the word falls, it will look for the context around it so we can identify if an event has occurred.”

The tool differs from those used in hospital settings, explains Irving.

things like your heart rate, blood and oxygen levels, blood pressure and so on. Those sorts of markers don’t predict deterioration very well in an aged care population because the changes are much more subtle … until something catastrophic happens.”

Such as falls or injuries that require emergency transfers and hospitalisations.

Last year’s trial of a prototype tool –which scanned 66,000 records across 44 aged care homes – was, says Irving, “incredibly successful”.

The next step is for the prototype to enter the production phase, then regulatory assessments hopefully sometime later this year, she says.

“So we can release it – not only to our own customer base – but looking at being able to release it more broadly.”

Credit: Research Australia/Merlyn Reuter

Clare Russell (RMIT University), Dr Karin Verspoor (RMIT University), Dr Jennifer Beer (Telstra Health), Professor Nick Fisk (Research Australia award presenter), Dr Isobel Frean (Digital Health CRC).

Dentistry goes digital

Technology allows dentists to accomplish things they could only dream about a decade ago, practitioner and educator DR MARK WOTHERSPOON tells JODIE WOLF.

After a career spanning four decades and many industries, dental practitioner and innovator

Dr Mark Wotherspoon says his relatively recent foray into mobile dentistry for aged care residents is his most rewarding role to date.

The 62-year-old University of Western Australia graduate – class of 1984 – is taking time out during a visit to WA from his home in Wagga Wagga, New South Wales, to chat all things dentistry.

“It’s a very, very exciting time to be a dental professional,” Wotherspoon tells Australian Ageing Agenda

He has just wrapped up a meeting with a group of researchers at the CSIRO regarding “attaching AI to intra oral digital images” to use as a triage mechanism.

“We’re trying to use AI to improve access,” he says. “I think it’s going somewhere.”

Wotherspoon’s broad experience in dentistry includes general practice, public health, military health, and corrective services.

Current roles include locum work for the Army, Air Force and Navy, teaching roles with University of Sydney and Charles Sturt University, plus public health work through the Wagga Wagga Base Hospital dental clinic.

Eight years ago Wotherspoon felt called to improve oral health in aged care when some patients stopped coming into the practice to see him – because they were unable to get there.

Dr Mark Wotherspoon at work

“I did feel quite hopeless as to not being able to have the skills or the technology to go out and visit them and actually provide some support when they most needed it,” he tells AAA.

“I started looking at all different portable dental options; how could I go out and provide access?” His research included trips to Japan and the United Kingdom and

resulted in “a portable dental service that treats people in their own room.”

Wotherspoon can visit patients using lightweight equipment with “zero compromise” on core principles such as confidentiality and infection control.

He tells AAA it is the “most rewarding job” he has ever done.

“I say that hand on heart, honestly,

these people need help. They deserve help. And when they see a dentist come in who can fix their issue or prevent problems, it’s highly rewarding,” he says.

“People want the confidence and dignity of fresh breath. They want to be able to smile when their grandkids come to visit. When they get a chance to go out on a social occasion, they want to be able to have

conversations confidently; all the things that a nice smile and fresh breath are so essential for,” says Wotherspoon. “And to be able to chew their food is always important.”

With his portable equipment – which includes a camera the size of a pen to explore a patient’s mouth – Wotherspoon visits over 20 aged care facilities and private homes to provide dental care.

Treatments focus on conservative management and preventive care, such as general fillings and cleans, and exclude surgery and local anaesthetic.

When he’s not zipping between patients, the busy dentist is coaching others through various mediums including workshops for speech pathologists, presentations to aged care executives and boards and online sessions on palliative care.

His portable visitations aren’t always simple. One of the big challenges, says Wotherspoon, is getting everybody to take prevention seriously.

“When people are in an aged care facility, if you put a packet of biscuits in front of them, they’re going to eat it. I’m not going to walk in and take a packet of Monte Carlos out of someone’s hands,” he says with a smile.

“The downside is a lot of sugar in the diet, and I need to manage that because it’s very difficult to get the person to reduce that habit. Prevention is not necessarily in the front of everybody’s mind.”

Wotherspoon tells AAA another big issue is dignity of risk – when people fully appreciate the risks, but choose to go their own way, often due to a strong desire to stay independent.

“For example, one of the things I do at that first appointment is look in the mouth and say, ‘I want you to start using this toothbrush with this toothpaste and I want you to clean your dentures in this particular way and leave your dentures out at night’,” explains Wotherspoon.

“But if the person just won’t do it, or doesn’t see the benefits of it, or they just don’t want someone else cleaning their teeth for them well then we can’t make them.”

Many don’t want help or refuse help, even when they understand the risks, says Wotherspoon. Others are too exhausted by their illness or medication so they consume caffeine and sugar to keep going, he adds.

The impact of polypharmacy on oral health is also an issue, says Wotherspoon.

“A lot of medications are a major contributing factor in drying the mouth out. And when you don’t have saliva, then dental disease is turbocharged,” he says.

“The oral health message is so

Dr

“I did feel quite hopeless as to not being able to have the skills or the technology to go out and visit them.”

important, but the dental profession can’t improve oral health on its own. We need the nurses. We need the doctors. We need the families to understand the issues. And we need all health professionals – but especially speech pathologists and dietitians – to come on board because the problem of oral health is extensive, and it needs to be solved in a collaborative way.”

Hands-on training

The conversation moves to Wotherspoon’s latest love: Project Gordon. The mannequin-based training program is for aged care workers to learn oral health skills, supported by Australian company One Dental.

Wotherspoon is excited when he discusses the project, which is named after his 94-year-old father. Wotherspoon started developing the program when his mother Patricia went into aged care and he saw oral hygiene delivery “wasn’t up to scratch”.

He explains: “It was lacking. Aged care workers are living angels. I’ve never met one who doesn’t want to do the right thing but unless they have been given the handson workshop, and get their hands-on skills training, they can’t start applying what they know needs to occur.”

Project Gordon addresses the gap in hands-on clinical training. The program includes the five training stations.

 Practice practical dental procedures and care on the mannequins, such as dealing with dentures, accessing a person’s mouth, taking tele dentistry images

 Denture care

 Teach staff how to clean their own mouth via a mini personal dental oral hygiene lesson – if someone’s own personal dental hygiene is stronger, they’re more likely to deliver a higher standard of care for the people they’re assisting or who are in their care

 Apply above core principles to cleaning someone else’s mouth with specialised toothbrushes for aged care

 Learn how to deal with someone who’s resisting care or receiving palliative care plus end of life scenarios.

The news is spreading, says Wotherspoon, and dental providers and aged care facilities have started to adopt his training program and purchase mannequins.

“We’re getting the message out there.”

When it comes to talking about what’s next for dental health in aged care, Wotherspoon envisages a future where digital technology and artificial intelligence enhance dental care efficiency and accessibility further. And he’s excited about the possibilities.

For example, using AI to interpret a patient’s X-ray.

“Imagine having the 10 best dentists in the world reading that X-ray for you and giving you what they think in real-time –as opposed to someone who’s a first year at a University or even me who’s many years out of Uni. It is going to be better for our patients. A lot of pros and very few cons.”

Tele-dentistry – which is moving knowledge rather than people – has the potential to provide real-time information that will reduce the need for physical clinic visits, he says.

“We’re saving so much time, money and angst about having to get someone in an ambulance and take them to a fixed clinic, which is a very expensive and stressful situation,” he says.

“Digital technology allows dentists to accomplish things they could only dream about a decade ago.”

Other positive developments include digital scanning and 3D printing to create exact denture duplicates.

“If somebody loses, drops or breaks those dentures, we can then have a brand new, exact duplicate denture 3D printed and to that person in three days without any impressions,” he says.

He thinks tech also has the potential to attract people to the profession.

“When you get digital and AI, the next generation of dental professionals are excited as well. We need the younger professionals,” Wotherspoon says. ●

Mark Wotherspoon uses manikins to support skills development in aged care

Start the charge for action now

MARIE ALFORD shares her thoughts with Australian Ageing Agenda on aged care reform.

This poem by David Whyte always resonates with me, especially when I think about the last five years across the aged care sector. It’s a poem for change.

Start Close In

Start close in, don’t take the second step or the third, start with the first thing close in, the step you don’t want to take.

Start with the ground you know, the pale ground beneath your feet, your own way of starting the conversation.

Start with your own question, give up on other people’s questions, don’t let them smother something simple.

To find another’s voice, follow your own voice, wait until that voice becomes a private ear listening to another.

Start right now take a small step you can call your own don’t follow someone else’s heroics, be humble and focused, start close in, don’t mistake that other for your own.

The landscape of reform

It was the 25th of January 2020 when the first case of Covid-19 was detected in Australia, before too many deaths in aged care – of residents and workforce. It was a time when the Royal Commission into Aged Care Quality and Safety, which lifted off in October 2018, was ramping up.

It was before the release of 148 recommendations, the calls for a system underpinned by a rights-based Act, needs-based funding, stronger regulation and transparency, and the National Dementia Action Plan.

Here we are now, well and truly into 2025 and standing on the precipice of what’s being called a once-in-a-generation aged care reform. It is time to acknowledge that the struggles across the last few years have changed the sector forever and perhaps now more than ever, it is a time of hope.

Turning vision into action

The NDAP provides an accountable platform for dementia policy. The development of the plan was long and so it should have been due to the importance of hearing the voices from people across Australia living with dementia, the carers and families who provide the much-needed support whilst trying to maintain their relationships, the workforce charged with delivering on the plan, and ultimately the state and territory governments who will, in partnership with the Commonwealth, create better policies, services and systems to serve our communities.

Alongside this we have the new Aged Care Act beginning on 1 July, and with it, the strengthened Aged Care Quality Standards and Support at Home program.

But back to the poem.

Marie Alford

The new standards keep the person rightly at the centre of all we do – focused on dignity and respect, diversity and independence, choice and control and safety, autonomy and inclusion. Start right now take a small step.

This aligns with the NDAP key actions of promotion of equity and human rights. How we deliver on this in community care and residential care will require the voice of people with dementia being heard in all we do.

People with dementia, even at late stages can and do tell us what their preferences are. The subtle changes that are sometimes mistaken for behaviours indicate likes and dislikes and need to be a core foundation on which we develop our care plans.

So, as David Whyte says, we start close in. We leave ourselves behind to understand the experience of those we care for. The obligation for truly inclusive care informed by relationship and trauma has never been stronger.

Transparency in care

In the new standards we hold our services responsible for the delivery of care. People living with dementia and those that care for them can expect more transparency and feedback from those that support them. As a workforce we need to be proactive in identifying when things go wrong – but also recording when things go right.

How wonderful it would be if rather than just calling family when there is an adverse event, we call them to tell them of the small wins, the engagement and the laughter.

The stories splashed across the media over the last few years –which have rightly exposed the worst of aged care – should also celebrate the amazing care and experiences that happen every day.

Let’s redefine communication as part of our obligation in this new standard and embrace the opportunity to openly and transparently share the good – and the not so good – and work together to address how we can improve care.

Creating environments that matter

those that need it. For workforce it might be the step you don’t want to take – it is unfamiliar, and perhaps you feel outside your depth.

Our organisational responsibility is to empower our workforce to deliver care, so take a small step you can call your own.

The Australian Government’s investment in dementia supports and training is unique internationally and we should embrace these opportunities to develop ourselves and our people.

Dignity of food and choice

In 2010 Dr Stephen Judd wrote about the issue with eggs in aged care, that is poached eggs cooked at 62 degrees for 17 minutes. He said, “that’s not a poached egg, that’s an organic piece of pottery that’s been fired and come out of a kiln”. It started a ground swell of conversation and action, including from our favourite cook Maggie Beer.

Yet, here we are, a little like the design guidelines and principles finally coming into the limelight still struggling to ensure that people living with dementia have access to food and drinks that they enjoy.

For the first time, the new standards recognise dignity of risk in food and nutrition. This shift aligns beautifully with a more homelike environment. More fresh cook kitchens in aged care mean fewer large commercial kitchens, making way for snacking when you’re hungry, choosing what you eat, and deciding when and where meals happen, just as it should be.

Start with your own question. If this was me, what would I want? Then ask and understand those that we care for.

Connection and purpose

“Now is the time for our sector to bold and to be brave.”

And finally, the standard reflecting the residential community takes us back to where we started. To connection. To relationships. Access to things that offer purpose and engagement – which will be different for everyone. Communal living is not what many of us would choose – or certainly not communal living with strangers in an unfamiliar environment –but connection to those we love and spaces that enable privacy for intimacy if it is what is desired.

Last year we also saw – after decades of knowing what was right – the launch of the National Aged Care Design Guidelines and Principles. The standards also reflect the importance of environment.

It is important to remember that design is personal and residential care living is communal, so the challenge is the integration of these concepts into practical solutions. Start with the ground you know

To do this we must know the person we care for. How can we hold our services accountable to ensuring that the person living with dementia feels safe when receiving care and services if we don’t know the person – their preferences, their likes and dislikes.

The notion of spaces that are flexible to meet the changing needs, the demographics (socio and ethnographic) of those that live there. The ability to stay in place when care needs change or at least stay within familiar footprints and care models.

As care needs change, our care plans need to change too. This includes the requirement to ensure clinical care is provided where needed.

Does that always mean nursing staff? No, it doesn’t. They are pivotal in the delivery of all aged care services but the care worker who works alongside the person living with dementia daily will sometimes be best placed to identify those changes when more care is needed.

Additional training for our workforce that lifts from foundation knowledge is needed now to ensure we continue to provide care for

Spaces that connect the people we care for to the outdoors –easily and freely, dignity of risk and safety aligned. No compulsory activities. But familiar activities. Be that domestic or artistic.

So, in a time of massive change after years of nothing but change, now is the time for our sector to bold and to be brave. To be agile and responsive.

HammondCare chief executive officer Andrew Thorburn implored our teams recently to “remain laser-focused on the dignity and needs of the older people we serve – the residents, patients, clients and their families.”

And I think this is a message for the entire sector. The charge for action for change starts right now – post NDAP and headfirst into new standards and the Support at Home program. Start right now take a small step you can call your own don’t follow someone else’s heroics, be humble and focused, start close in, don’t mistake that other for your own. ●

Marie Alford is general manager of growth and innovation at HammondCare

Australian Ageing Agenda’s regular dementia section is guest edited by The Dementia Centre, HammondCare. For further information contact hello@dementiacentre.com

Evidence on vision

A recent evaluation assesses and informs an entertainment and engagement platform’s ability to support residents’ health, wellbeing and safety.

CHRISTOPHER

KELLY reports.

The aged care sector is fast adopting digital technologies to support the drudge of dayto-day admin. But while there are various platforms available to increase efficiency, improve staff outcomes, and streamline work processes “there is a need for this technology to enhance the quality and safety of resident care”.

So says Dr Kathy Heathcote – a public health and aged care consultant – who tells Australian Ageing Agenda: “The technological innovations that industry could be supporting are those that are aimed at improving the experience of older people, their health and wellbeing, and their safety.”

Technologies such as Swift Access – software that sits within a device that is external to the TV, making it possible for aged care residents to access content that supports their health and wellbeing.

“Technology that can curate programs that enable residents to participate in physical exercise, to connect with their community and their families and their friends – even if they are confined to their room – and promote therapies that support their mental health and wellbeing and cognition to me seemed fairly important,” says Heathcote – also a non-executive director sitting on the board of notfor-profit provider Feros Care.

Which is why when Heathcote was approached by Swift to examine how the next generation of its platform can support residents’ psychological and physical health, she readily agreed.

“The research around this area is not very well developed,” she says. “What struck me is the lack of good quality scientific evidence as to what works

“I have a family member in aged care so I was thinking about her experience.”

well in terms of innovations and technology for people in residential aged care.”

As Heathcote explains, her evidence-based research – which she approached “with a fairly independent perspective with no real conflict or vested interest” – spanned three stages.

Stage one studied the clinical benefits of the platform’s health and wellness content; phase two sought feedback from providers to gauge perceptions of the product; and phase three examined whether usage data obtained from the software could enable providers to monitor compliance against the quality standards.

For stage one, Heathcote leant on the expertise of award-winning academic and physiotherapist Jennifer Hewitt. Also general manager, clinical research & reablement at regional aged care provider Whiddon and a specialist in falls prevention, Hewitt was asked to closely consider the health and wellness content for its evidence-based benefits.

Hewitt determined that the featured exercises could play a part in improving, among other things, residents’ range of motion, coordination, breathing and posture. She found the content also addressed frailty – which is an upstream causation of falls.

“There was a good evidence base for the seated weights, the tai chi, and the yoga but they really needed to be seated exercises for people in their rooms and ideally conducted in group sessions with physiotherapy engagement,” Heathcote tells AAA

Hewitt also found clear clinical outcomes could be derived from the low sensory/relaxation channel, says Heathcote. “For residents that are getting a bit agitated and anxious – particularly people with dementia – this content could be prescribed for residents in the care plan.”

Dr Kathy Heathcote

When consulting aged care executives for phase two, “We were looking at overall satisfaction, the clinical benefits, the capacity to support clinical care and compliance and also the delivery of healthcare efficiencies,” explains Heathcote.

“We captured a lot of rich information about what they thought were the good things, what they thought was not so good, what they thought wouldn’t work and I collated that information and presented a report,” she adds. Provider feedback will inform how Swift develops and enhances future upgrades of its product.

For phase three, an independent adviser – John Moore from Aged Care Advisory Services – was invited to examine the data the Swift software collects and map it against the seven quality standards.

Data was mined from Swift’s three main channels: exercise/ wellbeing, family/community, and low sensory/relaxation. “It was using the technology to see if it could help providers with their high-level reporting purposes and show progression toward the aged care standards,” says Heathcote.

Stressing the data is de-identified, Heathcote adds: “It’s looking at what their watching and how long they’re watching for.”

When analysed, the data showed the content did indeed meet various standards. For example, exercise/wellness can be mapped to partially address four standards: The Person (Standard 1), Care and Services (Standard 3), Clinical Care (Standard 5) and The Residential Community (Standard 7).

The family/community channel also aligns with four standards: The Person (Standard 1), Care and Services (Standard 3), the Environment (Standard 4) and The Residential Community (Standard 7).

While the low sensory/relaxation content addresses five standards: The Person (Standard 1), The Organisation (Standard 2), Care and Services (Standard 3), Clinical Care (Standard 5) and The Residential Community (Standard 7).

Data was also analysed to show residents’ engagement with other features of the product – such as in-house communications. “Instant messaging was really important for health-risk mitigation,” says Heathcote.

Heathcote tells AAA: “There’s a whole lot of health promotion activities that can be incorporated into those messages. From my public health background I can see benefits there – particularly when there’s an outbreak or when there are hot conditions.”

A dashboard with metrics displaying how the contents and features are meeting a provider’s quality standard requirements will now be incorporated into the Swift Access system.

“It’s not answering every question that an auditor might want to look at but it would be answering some questions,” says Heathcote.

Swift plans to start beta testing the next generation of Swift Access in April 2025 ahead of rolling it out via a software update in June 2025.

When conducting her research, Heathcote tells AAA she had a particular person in mind. “I have a family member in aged care so I was thinking about her experience,” says Heathcote.

And while the young swerve traditional TV viewing in favour of online platforms such as YouTube and Tik Tok, and the watch on-demand streamers, “the box” still remains popular with older people, such as Heathcote’s relative.

So exploring ways to use the medium in aged care homes to promote healthy ageing makes sense, says Heathcote. “TV is an important part of older people’s entertainment and engagement in residential aged care – everyone has a television in their rooms.” ●

Holistic and person-centred

DR MIIA RAHJA – an occupational therapist, senior research fellow at Flinders University and post-doctoral researcher at ROSA Research Centre –answers our questions on reablement and dementia.

How is reablement relevant to dementia care?

Because it offers a personalised, resource and goal-directed approach to improve or maintain a person’s participation in daily and social activities.

Reablement focuses on enhancing functional abilities, promoting autonomy, and ensuring dignity, all while addressing the interconnected cognitive, physical, and social challenges people with dementia face. Importantly, reablement complements medical treatments, which typically focus on the cognitive aspects of dementia, by improving overall quality of life.

What are the barriers to adopting reablement approaches in aged care?

One key challenge is the lack of understanding and acceptance of reablement as a viable approach for dementia care. Many healthcare professionals still prioritise pharmacological treatments or focus predominantly on cognitive assessments, often overlooking the importance of functional rehabilitation and social engagement.

Additionally, service models in many regions are not designed to be flexible or person-centred, making it difficult to implement reablement tailored to the unique needs of people living with dementia. Funding and resource limitations also present obstacles, as reablement requires dedicated staff, training and time.

There is also a need for greater awareness and training within the aged care workforce. Staff may not have the necessary skills to implement reablement effectively, and family caregivers may lack the education and support needed to participate in the process fully.

Finally, there is a lack of robust, long-term evidence on the benefits of reablement in dementia care, which can hinder buy-in from policymakers, funders, and service providers.

What’s needed to expedite adoption?

First, stakeholders – including healthcare professionals, policymakers, and funders – must embrace a biopsychosocial approach to dementia care. This means recognising dementia as a disability that requires functional rehabilitation to enhance the person’s quality of life and participation in society in addition to medical treatment.

Service models must be redesigned to be more holistic and person-centred, focusing on an individual’s strengths and needs rather than only their medical condition. Models should adopt resource-oriented approaches that maximise available support, such as community resources, caregivers and family networks.

Workforce training and capacity-building are essential to equip care staff with the necessary skills and confidence to implement reablement effectively. Ongoing professional development and support structures are crucial for fostering a sustainable workforce.

In addition, active involvement of family caregivers is key. They need to be educated and supported in reablement principles so they can work with professional care teams to achieve the best outcomes.

Finally, we need robust, highquality, long-term research to provide strong evidence of the effectiveness of reablement. This will help reinforce its value, gain broader acceptance, and secure the necessary funding and policy support to make reablement a standard part of dementia care.

What support does the aged care workforce need to make this approach successful?

Staff must be equipped with the knowledge and tools to understand the principles of reablement, including its emphasis on functional improvement and engagement in meaningful activities. This includes training on communication techniques, person-centred care approaches, and how to involve family caregivers in the process.

Ongoing support and mentoring – particularly important for those implementing reablement in complex environments like residential care – could involve creating networks of support where staff can share experiences, troubleshoot challenges, and celebrate successes.

Reablement requires staff who are motivated and passionate about person-centred care, and efforts should be made to ensure that the workforce is supported with adequate resources, career development opportunities, and incentives to retain skilled staff.

How else can aged care providers support increased adoption of reablement?

Fostering a culture that values and prioritises person-centred care is key. Incorporate reablement principles into organisational policies and procedures and ensure reablement is a core component of the service model.

Providers should also allocate resources for staff training, provide access to the necessary tools and equipment for implementing reablement, and establish clear pathways for collaboration with family caregivers. Integrating reablement into care plans and assessments will help ensure that it becomes a standard part of care provision.

Aged care providers should also collaborate with external organisations, such as dementia advocacy groups, academic institutions, and funding bodies, to secure the necessary resources and evidence to support the adoption of reablement approaches. By demonstrating the benefits of reablement, such as improved quality of life and reduced reliance on long-term care, providers can make the case for greater investment in these programs. ● Read our recent paper: doi.org/10.2147/JMDH.S484069

Dr Miia Rahja

Why wellness and reablement is the future of aged care

Pierre-Jules Renard, a renowned French author, famously remarked, ‘It’s not how old you are, it’s how you are old.’

In Australia, this sentiment is reflected in the growing emphasis on promoting ageing with greater choice, dignity and independence. Central to this vision is the Australian Government’s commitment to embedding wellness and reablement into organisational practices and service delivery.

Funded by the Department of Health and Aged Care, Keep Able is a national digital platform based in Western Australia. Developed by Independent Living Assessment (iLA), it offers free, evidence-based resources to support community aged care providers in delivering wellness and reablement services.

Client resistance due to deeply ingrained beliefs about ageing, illness, or injury, which may result in preferences for passive care

Facilitating wellness and reablement: The role of Keep Able Keep Able offers a range of resources designed to help organisations excel in integrating wellness and reablement into their service delivery. Through these resources, Keep Able supports organisations in: Overcoming implementation challenges

• Embedding the ‘doing with’ rather than ‘doing for’ approach into daily operations

• Tracking and reporting their progress

• Aligning their services with the Aged Care Quality Standards

Keep Able is making the transition to wellness and reablement as easy as possible. The free learning resources available on the website can help providers promote their clients’ abilities, independence, and quality of life while preparing for upcoming industry reforms, such as the new Support at Home program scheduled for July 2025.

Defining wellness and reablement

Wellness and reablement represent a proactive, holistic framework for aged care that aims to empower older people to remain in their homes and communities for as long as possible. This approach prioritises maintaining independence, autonomy, social connectivity, and wellbeing through:

• Targeted, short-term interventions that address specific barriers to independence, such as loss of ability or confidence

• Strength-based, person-centred care that actively involves individuals in decision-making and tailors support to their unique capabilities

• Encouragement to engage in daily tasks and community participation, promoting physical, cognitive, and mental health while fostering a sense of purpose

The US Centres for Disease Control and Prevention (CDC) highlights the importance of maintaining independence, linking it to improved quality of life in later years. Engaging in everyday activities enhances physical and cognitive health, nurtures confidence and foster connection, aligning with the broader goals of wellness and reablement.

Challenges in implementing wellness and reablement

The CHSP 2023 Wellness and Reablement Report, which looks at service providers’ progress, suggests that providers recognise the value of these approaches but face significant challenges. These challenges include:

• Time and resource constraints limiting the capacity of providers to prioritise long-term wellness initiatives amidst increasing demand for aged care services

To achieve these goals, Keep Able offers a variety of engaging formats, from tip sheets and care templates to eLearning modules and team presentations. Our resources help you:

• Train staff to communicate effectively with clients and build their acceptance of reablement

• Equip your teams with quick, practical lessons to strengthen wellness and reablement practices

• Engage clients in meaningful daily activities – from cooking and cleaning to socialising and joining community groups – to boost their physical, cognitive, and social wellbeing

• Show clients why staying active and engaged matters for their wellbeing

• Choose and implement assistive technology that enhances independence

• Plan person-centred care that puts wellness and reablement principles into action

• Stay current with industry reforms

• Make confident decisions backed by clear evidence summaries Designed in collaboration with sector stakeholders, these practical resources address the unique needs of time-constrained organisations while promoting meaningful client engagement. For senior managers, CEOs, and board members, Keep Able empowers you to:

• Excel in quality and compliance

• Streamline operations: with efficient wellness and reablement reporting tools

• Strengthen your workforce: with ready-to-use training

• Improve client outcomes: through proven strategies

Upcoming Conference: ‘Reablement in Reality’

To further support providers, Keep Able is hosting a Wellness and Reablement Conference, Reablement in Reality: Practical Strategies in a Changing Industry, on Wednesday, 9 April 2025. This free online conference will offer actionable insights and tools to enhance care delivery for support workers and managers alike. ● For more information, contact Keep Able at keepable@ilaustralia.org.au or visit keepable.com.au/conferences/

Dementia-friendly home guide

Dementia Australia has unveiled a new digital video guide with practical tips on how to improve accessibility in the home for people with dementia. Free to access, the video guide includes tips for several types of rooms, with many of the suggestions being low-cost changes so that people with dementia can live independently at home for as long as possible. Go to dementia.org.au

Digital tool for new standards

The Aged Care Quality and Safety Commission has recently refreshed a digital tool they developed to assist providers looking for tailored guidance on the strengthened Aged Care Quality Standards. With the tool providers can find information on the strengthened quality standards categories and how to apply them in practice, as well as information on the different outcomes they should be achieving. Go to agedcarequality.gov.au

NACDA now online

The National Aged Care Data Asset brings together data collected across aged care, health and community service settings so that government and non-government researchers can access de-identified person-level data. NACDA was developed by the Australian Institute of Health and Welfare in response to the aged care royal commission recommendation that reliable and comprehensive data be made available for research. The data will be updated regularly, and new datasets will also be added over time with the aim of helping to answer important aged care research and policy questions. Go to aihw.gov.au

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