Aged Care Australia Voice of the aged care industry Autumn 2010
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contents
National Update 3 CEO’s Report 5 Presidents Report 9 State Reports 16 A review of the Aged Care Act 1997 19 Congress 2010 21 26 29
Finance Benchmark Performance on Struggle Street Extra Service Allocations - Two Reviews on the Impact to the 2010 Aged Care Approvals Round Another Nail in High Care Bed Applications Extra Services Change Hits Growth of High Care Sector
Profiles 31 Angela Gifford 35 Kevin O’Sullivan
ACAA OFFICE HOLDERS PRESIDENT VICE PRESIDENT DIRECTORS EDITOR PRODUCTION
Bryan Dorman Francis Cook Tony Smith Mary Anne Edwards Viv Padman Geoff Taylor Kevin O’Sullivan Rod Young Jane Murray
36 39 41 43
Technology “We need an IT revolution in Medication Management in Australia” Aged Care IT Vendor Association Report Coping with Change: An update on the Smart Phone rollout by Silver Chain in WA ITAC 2010
46 49
Workforce Exciting Developments for Aged Care Organisations National registration for nurses, an opportunity or another burden to bear? (Part 3)
51 52
Sponsor Articles Notes from an Architect’s Diary – Aged Care Projects Senior First Aid and CPR training online
ACAA - NSW
ACAA - WA
PO Box 7, Strawberry Hills NSW 2012 T: (02) 9212 6922 F: (02) 9212 3488 E: admin@acaansw.com.au W: www.acaansw.com.au Contact: Charles Wurf
Suite 6, 11 Richardson Street South Perth WA 6151 T: (08) 9474 9200 F: (08) 9474 9300 E: info@acaawa.com.au W: www.acaawa.com.au Contact: Anne-Marie Archer
ACAA - SA
53 Reverse Auction Platform saving you money on energy costs… now and in the future! 54 CIS, natural justice and rights of review 57 60 64 67 70 72 74 75
76 Calendar of Events 79 Product News
Unit 5, 259 Glen Osmond Road Frewville SA 5063 T: (08) 8338 6500 F: (08) 8338 6511 E: enquiry@acaasa.com.au W: www.acaasa.com.au Contact: Paul Carberry
AGED & COMMUNITY CARE VICTORIA
FEDERAL
ACAA - TAS
AGED CARE QUEENSLAND
PO Box 335, Curtin ACT 2605 T: (02) 6285 2615 F: (02) 6281 5277 E: office@agedcareassociation.com.au W: www.agedcareassociation.com.au
PO Box 208, Claremont TAS 7011 T: (03 6249 7090 F: (03) 6249 7092 E: smithgardens@bigpond.com Contact: Tony Smith
PO Box 995, Indooroopilly QLD 4068 T: (07) 3725 5555 F: (07) 3715 8166 E: acqi@acqi.org.au W: www.acqi.org.au Contact: Anton Kardash
ACAA OFFICES
Editorial Two fascinating stories behind the ACAA annual awards EPC and Chronic Disease in Residential Aged Care End of life decisions – A good policy? The Power of ‘Hello’ – The Africa Connection (Part 2) Let’s talk about dying: what is appropriate care? Endeavour Awards Industry Feedback Noble exhibition reveals artists at any age
Level 7, 71 Queens Road MELBOURNE VIC 3000 T: (03) 9805 9400 F: (03) 9805 9455 E: info@accv.com.au W: www.accv.com.au Contact: Gerard Mansour
Aged Care Australia is the official quarterly journal for the Aged Care Association Australia
Adbourne PUBLISHING
Adbourne Publishing PO Box 735 Belgrave, VIC 3160
Advertising Melbourne: Neil Muir (03) 9758 1433 Adelaide: Robert Spowart 0488 390 039 Production Claire Henry (03) 9758 1436 Administration Robyn Fantin (03) 9758 1431
DISCLAIMER Aged Care Australia is the regular publication of Aged Care Association Australia. Unsolicited contributions are welcome but ACAA reserves the right to edit, abridge, alter or reject any material. Opinions expressed in Aged Care
Australia are not necessarily those of ACAA and no responsibility is accepted by the Association for statements of fact or opinions expressed in signed contributions. Aged Care Australia may be copied in whole for distribution among an organisation’s staff. No part of Aged Care Australia may be reproduced in any form without written permission from the article’s author.
www.agedcareassociation.com.au
www.adbourne.com
Front Cover: Staff from Anglican Retirement Villages (ARV), co-winner of the Employer of Choice Award at ACAA Annual Conference 2009
national update
CEO’s Report
T
hat is an interesting statement, however it does not necessarily define what it is that is meant by the words ‘consumer choice’. Indeed, when you discuss the issue of consumer choice with just about anyone else from the industry you are likely to find a differing view on almost every aspect and issue.
Rod Young CEO, ACAA
It is therefore useful to actually consider what it is that the industry mean by consumer choice and to debate whether there is some consensus. The ACAA Federal Board and the Campaign for Care of Older Australians Group (CCOAG) have both considered this issue in recent times as most organizations thinking about long term structural reform and changes to the care delivery models are soon faced with the issue of consumer choice and what exactly does it mean.
WHAT IS CONSUMER CHOICE? There has been a growing commentary on how to best service the needs and wishes of future aged care clients with the regular refrain being that all will be right with the world provided consumers have choice.
The list of items below appears to be a reasonably common and agreed set of positions about what it is that we are talking about when we write down what is consumer choice. 1. Choice by consumers of the types of services (including health and disability support, housing, community and residential care) they receive and the providers who deliver it; 2. Consumer confidence in the quality of services; 3. Separate Accommodation and hotel costs from care. Care price in residential and community care are aligned and reflect actual costs and appropriately indexed; 4. Flexibility in price and payment methods – hotel and accommodation (eg old vs. new accommodation etc.) and how to pay; 5. Entitlement based on assessed need: • Demand driven, rather than supply driven, services. • Freely available access (no quota) 6. Increased services and subsidies to ensure optimal care and support in rural and remote locations, in disadvantaged and vulnerable communities and for older people who have a history of complex needs – e.g. homelessness, enduring mental illness, substance abuse;
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It is useful to actually consider what it is that the industry mean by consumer choice and to debate whether there is some consensus.
”
7. Industry restructuring plan to sustain and extend supply as service system transforms to better meet community needs; and 8. A staged approach to deregulation, including relaxing supply and pricing controls, to open choice and competition. Readers may have a different view on your perspective of what consumer choice means. If you disagree with the items listed above in trying to define consumer choice then please feel free to write to the Editor (editor@agedcareassociation. com.au) and add to the list or disagree with this statement and provide an alternative view. n
aca Aged Care Australia | Autumn 2010 | 3
national update
President’s Report
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n 2011, the first baby boomers turn 65 and there appears no sense of urgency from this Government. 2020 is rapidly approaching and each day of delay by Government compounds the issues.
Bryan Dorman, President, ACAA
TOWARDS 2020! The opening of the current parliamentary year was on us, in the first week of February, and the focus was on the issues we must face with our ageing population; these necessarily included the economic and productivity impacts thereon; and, how to fund and meet the needs of the growing aged population in our community who are living longer and healthier lives?
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This Government is nearing the end of its electoral term but continues to offer little or no real options to an Industry that will be at the forefront of this country’s challenges for many decades.
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The PM received the NHHRC report last July, and announced that the aged care recommendations would be referred to the Productivity Commission. I believe the Productivity Commission is yet to receive any Terms of Reference from the PM. At the time, ACAA had congratulated the PM, when he signalled that in 2010 he would focus on Ageing & Aged Care. I ask when, and at what pace? This Government is nearing the end of its electoral term but continues to offer little or no real options to an Industry that will be at the forefront of this country’s challenges for many decades. Effectively, the needs of our Aged Constituents have been pigeonholed again. So, during this next decade of growth in demand for Aged Care services, what might our Industry require, to meet the challenge? As a primary objective, we must work with Government to develop a more seamless transition through the ageing process; between home, hospital and Aged Care Facility, and, seek a more effective customer focused service, rather than the very flawed process provided by the current ACAT system. Access to Capital is paramount! Simply put, just meeting the new and replacement Residential Care building stock over the next 10 years will require in excess of $21 billion in capital. Under the current Treasury funding structure, less than 1/3rd of that will be provided by Government. It generally takes about 5 years to design, develop and turnkey a new Aged Care Facility. Right now the Industry is well behind the 8-ball in meeting that challenge. Without constructive investment stimulus, it will fail to meet demand.
recent falling interest in ACAR rounds. The evidence is clearest in High Care, which continues to be treated as a whipping post brought on by political fears. Why does current policy discourage investment in High Care while stimulating short term solutions elsewhere? I suspect the right hand knows little of the left hands activities with decisions driven by Treasury, whose primary objective is a low cost Aged Care Industry, precluding efficiency or best outcome! Governments must also ensure our Aged Australians have a safe and caring place in a residential facility or in the home. Currently, this is all facilitated within the bureaucratic process, so, again, where are we now? The CIS legislation has failed the challenge and Accreditation management continues to occupy staff times disproportionate to outcomes. The Industry must seek a better and more efficient method of managing human resources (staff) dedicated to meeting compliance, accreditation and accountability. In conjunction with much needed wage parity, the Industry faces its most significant challenge. Only when these two critically important matters are addressed, will this Industry be seen as a desirable environment in which to work. For many years, ACAA has been saying to respective Governments, that policies in these key areas must be addressed proactively, not just through reviews and tinkering on the edges, but through formulation of positive outcomes. If the Industry is to deliver the services to the sector in the future, the key policy issues of funding for operating costs, capital and workforce must be targeted. Unless solutions for these form part of the long term policy and strategy, there will clearly be inadequate resource capacities to deliver up on what our Aged Community require and will also demand! n
Governments essentially perform a role in dispersing public funds appropriately and prudentially. Much has been said about
aca Aged Care Australia | Autumn 2010 | 5
national update
ACAA – SA Paul Carberry, CEO ACAA - SA
On any examination of the data available, it’s
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It goes without saying that it’s incumbent upon us to do everything we can, not just to attract and retain good-quality staff, but to do what we can to help them stay injury free, productive and happy.
”
to the numbers of people aged 65 years and
These trends will produce difficulties for all sectors of Australian industry as they struggle to attract the necessary people and skills. Arguably, however, aged care will struggle harder than others, because of our industry’s particular circumstances.
over, will be one of Australia’s biggest challenges
These include:
in this century.
The increasing competition for workers. This competition is not just with the acute sector, with which there is a clear disparity in wages, but with other industries with whom we have to compete for scarce workers.
clear that the shrinking of the workforce, relative
E
arlier this year the Prime Minister referred to this issue in several speeches where he spelt out the situation fairly clearly. In 1970 there were 7.5 people of working age for each person 65 and over. Today there are only five, and by 2050, the ratio will drop to 2.7.
The higher average age of the aged care workforce, compared to the Australian workforce as a whole. This means that our industry will feel the pinch of an ageing and shrinking workforce before other industries. Given the above realities, it goes without saying that it’s incumbent upon us to do everything we can, not just to attract and retain goodquality staff, but to do what we can to help them stay injury free, productive and happy. It’s for this reason that our association is seeking funding for a project which will help our members do just that. The workers compensation claims manager in South Australia, Employers Mutual Limited, is making funding available to associations for projects which will reduce the incidence and severity of workplace injuries and, where they do occur, to improve the rate and timeliness of returns to work. The project will take a holistic approach to workers well-being, addressing their physical and emotional health, with a programme designed by physiotherapy and psychology professionals. Our proposal is to develop and run a pilot wellness programme in a sample of aged care facilities. The object will be to develop a standard programme of intervention and worker support which can be implemented across the whole of the industry. At the commencement of the pilot stage, staff assessments will be conducted in the sample facilities to determine the staff ’s psychological and physical health profiles. This will establish benchmarks against which to measure the improvements in these factors achieved throughout the course of the programme. Although injury prevention will be the main focus of the programme, early intervention and injury management will also be addressed, to lessen the detrimental effects of those injuries which do occur. It’s clear the workforce challenges described above are not going to go away. However, we hope that this programme will make a positive and significant contribution to enhancing the well-being of aged care staff and, in turn, their productivity, and work satisfaction. n
national update
ACAA – NSW Charles Wurf, CEO ACAA-NSW
ACAA-NSW Congress 2010 As I write, the final program for the 2010 NSW State Congress is nearing completion.
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ur theme for 2010 is Guiding Lights to Safe Harbours: Practical Solutions to Today’s Issues, to be held on Thursday 20 May and Friday 21 May 2010.
After a period of considerable change for aged care through 2007 and 2008, and then the false dawn of multiple reviews for little change during 2009, the coming year seems to demand a return to core operational expertise. Our business of care has not had its substantial focus altered during all of the recent changes, and our responsibility to discharge quality care to our residents remains the primary outcome. This return to core operational expertise is the underlying driver of the theme of this year’s NSW Congress, and ACAA-NSW has fashioned a program around these core issues. Confirmed sessions include: •
Review of the Aged Care Act – Julie McStay, Hynes Lawyers
•
The Anchor on Inspirational Leadership – changing the culture of compulsory compliance
•
Celebrating the innovators for wellbeing and
•
Navigating public relations strategies in a competitive market
In addition, the NSW Congress will focus on the inevitable issues confronting the industry in the Economics of Aged Care, and will provide clearly targeted concurrent sessions on Staffing models and Quality frameworks for the post-ACFI and post CIS world in which we now operate. The final focus will be our workforce and the changes that 2010 promises. The new Fair Work industrial relations system has commenced and the soon to be legislated national registration system for health professionals will commence in July, with a need to prepare for the continuing professional development regimes that will be attached to national registration. The continuing need for recruiting, retaining, training and remunerating our workforce will maintain its high priority well into the future. A great program is in store and Congress will again sample a new venue in the Sheraton on the Park. The Sheraton delivers a marvellous venue with first class facilities for conference sessions and delegate networking.
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Our business of care has not had its substantial focus altered during all of the recent changes, and our responsibility to discharge quality care to our residents remains the primary outcome.
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As always, aged care conferences provide an excellent showcase for the industry to meet with its supplier networks, and the Exhibitor program is sold out again for 2010. We look forward to working with our industry suppliers in delivering a very positive showcase for the trade that supplies modern aged care. On behalf of the Organising Committee, we will look forward to welcoming delegates in May at Congress 2010. n
national update
Aged & Community Care Victoria Commonwealth National Hospitals and Health Reform Commission (NHHRC). ACCV Vision 2019, launched in October 2009, is an inspirational driver for our work over the next decade. Vision 2019 is underpinned by a clear and strong desire that:
Gerard Mansour, CEO ACCV
The 2010 Victorian State Budget provides a significant opportunity for the government to expand its support of high-quality services to older Victorians whether they live in cities, suburbs and regional centres, or in small, isolated and remote communities. The state government can support this by providing a range of supportive policies, programs and partnerships for viable care and support for older Victorians.
T
he release of the Third Intergenerational Report in January demonstrates the clear need for critical reform at both the national and state levels. The 2050 Report shows that the time has come to implement much needed reform as our current systems are simply not capable of meeting the needs of the elderly in the future. Increase support for the elderly and our aged care system is an urgent matter for governments today, not a long term issue for a far off date like 2050. In our 2010 Victorian State Budget submission, ACCV has pointed out there is a climate for change in the unprecedented shared agenda between the Commonwealth and all Australian states to deliver on the health and aged care aspirations of our community as reflected in the work of the
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Autumn 2010 |
aca Aged Care Australia
As we age, all Victorians will have the best possible quality of life supported by an aged care system that meets our lifestyle and care needs. In our State Budget submission, ACCV has called for the Victorian government to invest $283.7 million towards our vision of viable and vibrant services for all older Victorians. Underpinned by ACCV Vision 2019 and its five key goals, ACCV has identified the following priority areas in its submission: Goal 1: Positive ageing within our communities A climate for an inclusive age-friendly Victoria – $6.6 million ACCV calls for continued planning reform at the state government level and the continuation of the Aged Care Land Bank program. ACCV also calls for the sponsorship of two AgeWell public events to promote choices and options for ageing well. Goal 2: A responsive service system A climate for rural Victorian communities to thrive – $23.5 million ACCV’s proposed reform package will strengthen the connection between health and aged care with a key focus on public sector residential aged care to improve vital public sector patient flows. ACCV’s package is committed to supporting Victoria’s dedicated Remote Area Nurses in small and remote health services. Goal 3: A vibrant and capable workforce A climate for a career in aged care – $35 million ACCV calls upon the state government to implement a range of initiatives in response to the aged care industry chronic nursing workforce shortages, thereby ensuring a wellstaffed workforce that is responsive to the diverse needs of ageing Victorians.
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ACCV Vision 2019, launched in October 2009, is an inspirational driver for our work over the next decade.
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Goal 4: Financially viable and environmentally sustainable industry Adapting our community for climate change – $109 million ACCV calls for a comprehensive investment package to empower and provide practical support to communities of older people, aged care services and retirement communities to enable them to embrace, act and adapt in the face of climate change and achieve environmentally sustainable practices. Goal 5: An accessible and quality aged care system Coming home to public sector residential aged care – $109.6 million ACCV calls for a one-off urgent investment to provide high-quality homes to more than 6,400 Victorians to meet community expectations and needs. A partnership with ACCV’s Public Sector Aged Care Advisory Group must be established to oversee the development of a comprehensive nine year strategic capital investment plan for Victoria’s 195 public sector residential aged care facilities. We cannot fix the health system without first fixing aged care. Our aged and community care industry cannot cope with the growth predicted in the Intergenerational Report. We are now under very serious financial pressure and this will inevitably put at risk the level of services our industry can provide to frail elderly. We look forward to working with the Victorian government to address the priorities outlined in our State Budget submission and achieve our vision for older Victorians throughout 2010. n
national update
Aged Care Queensland Anton Kardash, CEO Aged Care Queensland
Aged Care Queensland has started the new year energized and focused upon achieving positive change for the industry.
T
his year is potentially an election year; the Prime Minister’s first major speech linked ageing with the well being of the Australian economy, we have a new Opposition leader and shadow minister for ageing, we are waiting for a number of significant reports whose recommendations will affect the industry. Looks like being a very interesting year. In the things that ACQI can directly control, we have also continued a period of change and renewal. ACQI was pleased to launch its brand new web site in early February, providing members and the general public with a tool to locate up to date information, communicate with the association, and interact with peers on important issues. Given the very clunky and rigid style of our old website the new feature packed web presence, will take some time to explore all its functions. It is our plan to introduce additional features over time to meet the needs of our members. Feedback from members has been encouraging with one member expressing the view that we hadn’t created a new web page but a new community. A great start in our quest to provide the value adds for members. There have also been some major changes in the name and brand of our training arm previously called Australian Institute for Care Development (AICD) has rebranded as ACQI Education Institute, aligning this key member service with the association’s name. In addition to a name change the institute offers a wider range of courses and is keen to tailor programs to members needs. At the Governance level, the ACQI Board has undertaken a strategic planning process and is keen to release its vision and plan to the sector in the near future. The Board has also convened a task group to review our existing constitution and its relevance to the new environment in which we are operating. 2010 is shaping up as a big year, one in which ACQI is keen to progress the arguments for positive change and to this end the association will be working closely with the national peaks. Locally ACQI will seek to work with members in their electorates to ensure the local members are well briefed on the need for aged care reform. n
national update
ACAA - WA Anne-Marie Archer, CEO ACAA-WA
WA aged care provider set to deliver community housing for seniors In a recent announcement Bethanie Housing Ltd, a subsidiary of The Bethanie Group Inc, outlined their plans to deliver 200 new community housing units for seniors in Mandurah and Dalyellup under a new partnership with government.
A
s a Registered Housing Growth Provider, they’ll be funded through Stage 2 of the Federal Government’s Nation Building Economic Stimulus Package and the homes are scheduled for completion by late 2010. In this announcement Mr Wayne Belcher, Chairman of Bethanie Housing Ltd, said the Agreement represented an important new partnership between government and the not-for-profit sector to ensure the provision of affordable seniors’ community housing for Western Australians. The new housing developments would comprise of 96 units in Mandurah and 104 in Dalyellup. The Mandurah site adjoins an existing Bethanie aged care facility and the design of the new complex comprises of two two-storey buildings each containing 48 units and separated by community open space.
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The development of Bethanie Housing is a strategic operational fit with their other services that will allow for a fully integrated model of accommodation and care service provisions in the future.
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Bethanie Housing sees these developments as a great opportunity to help ease the community housing crunch in WA. The development of Bethanie Housing is a strategic operational fit with their other services that will allow for a fully integrated model of accommodation and care service provisions in the future. Like all states we have an ageing population and a diminishing capacity to deliver aged care services, however, the recently announced initiative will allow for a high standard of accommodation and options for home care services if or when it is needed. Although this does not resolve the current and future shortages for high care and dementia services needed in the residential aged care industry – it will appease the crisis for those needing supported accommodation and low level care in the interim. There are many seniors living in community housing who are isolated in large homes on large blocks requiring a lot of ongoing maintenance, we hope the engagement of aged care providers to develop community housing for seniors will not only provide appropriately built and located accommodation, but a sense of community and access to care when needed. It is not often we have an opportunity to congratulate State Government initiatives when it comes to seniors, but on this occasion we must applaud the WA Minister and the Department for Housing and we eagerly await the new accommodation that is set to be available at the end of this year. n
national update
A review of the Aged Care Act 1997 Aged Care Association Australia (ACAA) and Hynes Lawyers are undertaking a review of the Aged Care Act 1997 (Cth)(Act). The first stage of the review, which involved an extensive consultation process with a large cross section of providers across the country, was finalised in late 2009. We are now entering the next phase of the review which is issuing the Survey.
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he Survey will be sent electronically to a large cross section of age care providers and other industry stakeholders by the end of February. The Survey can also be accessed by going to
http://thewebconsole.com/process/surveysRun. php?sId=102707 Additionally, a paper copy can be downloaded from the link and sent by post to ACAA at PO Box 335, Curtin ACT 2605. The Survey seeks to gather data to indicate industry preferences for the reforms necessary to the Act to allow the Act to continue to achieve its objectives while also allowing the industry to grow to meet current and likely future demand. The Survey focuses on the three key areas of the Act which providers unanimously agreed during the consultation process were in most urgent need of reform. They are: • • •
quality of care - which includes the accreditation process and the complaints investigation scheme; care fees and accommodation charges; and the allocation process.
The Survey is the next step in this very important process which is directed towards achieving much needed reform in community and residential aged care in Australia. Once the Survey is complete a report will be prepared to illustrate the proposed reforms to the legislation which have the support of the industry as identified by the results of the Survey. ACAA and Hynes will jointly submit the report to the Commonwealth Minister for Ageing and the Shadow Minister for Ageing. The report will identify the aspects of the Act which are currently impeding the continued viability and growth of the industry as well as identifying a pragmatic series of reforms. The information provided by approved providers in response to the Survey will form the basis of the report which will ultimately be submitted to government outlining the proposed reforms to the Act. Full industry support to the process is critical as the report will be more influential if it is based on the contributions and views of a large portion of the industry. It is only with action that reform is possible. Reform of the Act is required today if the community and residential aged care system currently in existence in Australia is to evolve to meet the needs of tomorrow. ACAA hopes that all approved providers will participate fully in the Survey and provide as much information as possible about their experiences of the Act. If you have any questions in relation to the Survey please contact Julie McStay of Hynes Lawyers on 07 3828 5530 or Jane Murray of ACAA on 08 9405 7171. The survey will remain open until 28 March 2010.
congress
ACAA 29th Annual Congress
15 – 16 November 2010 | Adelaide Convention Centre Target Audience More than 500 delegates are expected to attend, including key stakeholders in the aged care industry, Chief Executive Officers, Senior Managers, Operators, Industry Partners, Administrators, Directors of Nursing, Hostel Supervisors, Care Managers, Carers and Operational staff.
Call for Abstracts The Organising Committee invites prospective participants to submit abstracts relating to one or more of the listed topics. Presentations will be for 20 minutes including question time. See the enclosed flyer with further details or go to www.acaacongress2010.com.au for more details or to download the application form.
Congress Location – Adelaide, South Australia Festivals and food, arts and culture, shopping and sports. This is Adelaide – the Australian city where there’s always something on. With spacious boulevards and vibrant inner-city districts, sophisticated architecture and lush gardens, Adelaide is the perfect venue for all sorts of activities. You might want to immerse yourself in the culture of Adelaide’s North Terrace with its museums and city cafes. You might want to indulge in retail therapy while shopping at Rundle Mall, sample the tastes on offer at the famed Adelaide Central Market or sip award winning wines at the National Wine Centre. In Adelaide there is a brilliant blend of things to see and do.
Congress Venue – Adelaide Convention Centre The multi award winning Adelaide Convention Centre enjoys a global reputation for excellence and is consistently ranked among the world’s top convention centres. The Centre is leading the nation with its commitment to sustainability and was the first centre in Australia to achieve
Green Globe Silver Certification. The Centre has access from both North Terrace and the upgraded Torrens precinct and an expansive atrium links the exhibition halls, conference and banquet areas, with panoramic views over the river and parklands. There is safe, secure, undercover parking on-site.
Travel and Accommodation A range of accommodation options will be booked for the Congress. Accommodation options will be detailed in the Registration Brochure, available in June.
Social Program The social program will provide delegates with plenty of time to network and have some fun. The first official social function will be the Welcome Reception in the trade exhibition on Sunday 14 November. There will be an Exhibitors’ Reception for all Congress attendees offsite on Monday 15 November, and then the Gala Dinner, the social highlight of the Congress, will be held on Tuesday 16 November – this year’s theme is La Dolce Vita – the sweet life.
Trade Exhibition and Sponsorship Opportunities The trade exhibition will be a key feature of the Congress and is an opportunity for organisations to promote innovative products and services directly to decision makers within the industry. There are also a number of sponsorship opportunities for organisations who wish to gain a higher level of exposure. A sponsorship and trade exhibition brochure is available on request from Jane Murray, ACAA, Communications Manager, enquiries@acaacongress2010.com.au n
General and Delegate Enquiries Conference Solutions T: 02 – 6285 3000 F: 02 – 6285 3001 E: acaa@con-sol.com
Trade and Sponsorship Enquiries Jane Murray, ACAA T: 08 – 9405 7171 F: 08 – 9405 6585 E: enquiries@acaacongress2010.com.au
www.acaacongress2010.com.au aca Aged Care Australia | Autumn 2010 | 19
finance
Benchmark Performance on Struggle Street
By Max Hopkins, Director, Stewart Brown Business Solutions
The results for the June full year (and the September quarter) are in, and the trends are far from promising. Most providers are struggling with operating deficits and declining results, though the
CAP and ACFI has not been sufficient to meet the increased costs of staying in business. Whilst the survey averages of all facilities have deteriorated, the results for the benchmark groups (as can be seen from the following graph) have generally been maintained over the past 5 years.
benchmark facilities have fared better.
I
n this article we look at the results of the latest Stewart Brown Financial Performance Surveys, and in particular at the trends in benchmark performance.
The Survey for the year ended 30 June 2009 included data from 333 residential aged care facilities (342 in the September quarter) across Australia. Results are split into 5 income bands: High Care (bands 1 & 2), and Low Care (bands 3 to 5). Results are expressed per occupied bed day.
Deterioration of Results over Time The trend of deteriorating operating results has not occurred overnight. The graph below shows the survey average has been trending downward for some 6 years in high care and for the past 4 years in low care. Why has the benchmark group outperformed the rest? Read on.
Narrowing the Focus Whereas the survey averages showed operating losses in every band, the benchmark group, showed positive results in the table below. In this survey, Band 4 produced the best results, with a strong EBITDA. Top 25% by Income Band Extracts from Stewart, Brown & Co aged care financial survey for the year ended 30 June 2009.
Operating Income – Top 25% facilities in each Group Band 1 $
Band 2 $
Band 3 $
Band 4 $
Band 5 $
Total of Facilities 84
The graph also shows the seasonal fluctuation in results flowing from the annual funding boost in July, eroded by cost increases throughout the rest of the year. It also shows that the additional funding from
Income
182.18
160.35
140.06
108.50
Care Costs
112.44
94.25
73.76
40.55
90.60 35.05
Care costs as % of income
61.72%
58.78%
52.66%
37.37%
38.69% 47.19
Operational Costs
58.17
61.70
56.09
49.96
Total Costs
170.61
155.95
129.85
90.51
82.24
Net Operating Result
$ 11.57
$ 4.40
$ 10.21
$ 17.99
$ 8.36
Total Facility Result
$ 12.90
$ 3.80
$ 3.23
$ 18.27
$ 13.95
EBITDA per bed per annum
$ 8,122
$ 4,590
$ 7,705
$ 9,823
$ 6,364
aca Aged Care Australia | Autumn 2010 | 21
finance
We know that some of the participants in the 2009 benchmark group are relatively new to the survey, whilst others that have participated in the survey for many years have managed to improve their results up to the benchmark standard. We also know that some who were in the benchmark group 5 years ago have fallen back to the average. This indicates the changing nature of aged care results over time, and the need for constant attention to the fundamentals.
Comparison of Band 1 Extracts from Stewart, Brown & Co aged care financial survey for the year ended 30 June 2009.
Band 1 Results Top Quartile $
Survey Average $
Variance $
Operational Costs Catering
19.81
21.94
2.13
Cleaning
5.93
6.56
0.63
Laundry
3.46
4.59
1.13
Property & maintenance
9.24
10.35
1.11
Utilities
3.25
3.64
0.39
Administration
16.48
21.11
4.63
Total Operational costs
58.17
68.19
10.02
Total Costs
170.61
187.64
17.03
Net Operating Result
$ 11.57
($ 9.35)
$ 20.92
Total Facility Result
$ 12.90
($ 3.99)
$ 16.89
EBITDA per bed per annum
$ 8,122
$ 1,829
$ 6,293
Net Operating Result – June 2008
$ 12.71
($ 5.80)
$ 18.51
Net Operating Result – June 2007
$ 5.35
($ 9.53)
$ 14.88
In recent surveys we found that there had been a significant rise in administration costs. In March 2009 we did special survey on administration costs and it provided some interesting results. The respondents were divided into two groups: centralised (Corporate Model) and local (Facility model). We found no direct relationship between the number of clients serviced and the administration cost per client. However, we did find a relationship between the number of services and administration costs (see graph below). The graph above shows the changing results with the progressive impact of ACFI. In 2009 we saw declining results in bands 2 & 3, and slightly better results in band 4.
Drivers of profit The first point of difference between the top quartile and the survey average is the Care Cost to Income ratio. These care costs are mainly staff costs but also include continence, medication and therapy supplies. Using Band 1 (the highest income group) as an example, the survey average care cost to income ratio is 67.0% (61.7% for the top quartile) - a difference of 5.3% of income. This equates to $9.41 per bed day (based on survey average income) or $3,436 per bed per annum. For a 60 bed facility in this group that would be $206,160 in additional care costs. Note that there is also a difference of $10.02 per bed day in Other Operating Costs. These costs include catering, cleaning, laundry, property & maintenance, utilities and administration. The following table (top of next column) shows that the benchmark group has lower costs in all areas, but especially in administration and catering. What is not made clear by this data is how much of the difference is due to better management and how much of it is due to other factors – largely outside of the control of facility managers.
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The other interesting aspect to the admin survey was the relationship that appeared to exist between the use of computer systems and the level of increase in administration costs. Just over 70% of those organisations adopting the corporate model have implemented one or more new computer systems in the finance, payroll, rostering or clinical areas during the past 2 years. Their administration costs per client per day have risen by only $0.55 during that same period. In contrast, only 28% of the organisations adopting the facility model have implemented new computer systems during that period and their administration costs have risen by $6.55 per client per day. The main difference is in the increases in wages. The investment in systems has brought efficiencies such that they have not added additional staff to meet the increased compliance processes.
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Benchmark Performance on Struggle Street (continued)
maintenance costs declined during the period between 15 and 30 years of age. Much of this was due to lower depreciation on plant and equipment. However, we also found that the care costs to income ratio also declined during this period. Could this have something to do with how facilities were designed during that period? We need to do further research on that. We looked at single-level compared to multi-level facilities and found that the single level facilities have better results.
Building Design There are several aspects of building design that may have a bearing on profitability. Here we will look at three of these: single bed rooms, single level facilities and age of the building.
These results were also confirmed using the total facility result and EBITDA as profit measurements. Interestingly, the care cost to income ratio did not appear to be a major driver in this result. Again, these results just lead to further research into these issues, which we will do over the coming surveys.
As in past surveys, the facilities with a majority of single rooms are at a financial disadvantage compared to those with mainly multi-bed rooms. However, what was surprising in the data was the change in the results as the mix of these rooms changed.
Summary The benchmark groups appear to be better at managing the fundamentals, including: • maximising income collection through effective subsidy claiming processes • minimising care costs through better matching of staff to resident care needs and more efficient staff rostering • effective management of other costs, particularly administration and catering We also know that: • the results across the income bands continue to change due to the staged impact of the funding changes, and the changing needs of the residents • building design does play a part in being able to achieve benchmark performance due to the age of the facility and its configuration.
The age of the facility also provided some interesting results, as the graph above shows. On further analysis we found that property and
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A full copy of the June Highlights Report is available at www.sbbsolutions.com.au
finance
Extra Service Allocations - Two Reviews on the Impact to the 2010 Aged Care Approvals Round
Another Nail in High Care Bed Applications Bill Bourne
Manager – Financial Services ACAA – NSW
In the same week the Treasurer releases the 3rd Intergenerational Report DoHA changes the rules on Extra Service allocations and almost certainly the likelihood that most providers will refrain from applying for high care places in the 2010 ACAR. Is DoHA unaware that on 2011 the first baby boomers turn 65 years of age? Is DoHA unaware of the costs and risks providers take to acquire land and build new facilities? Is DoHA so far removed from the difficulties a provider faces in building new places that it simply makes major decisions of this nature without any consideration of the likely impact on the very real world of building new aged care facilities? The Department of Health and Ageing (DoHA) has implemented a “guideline” for determining whether the granting of Extra Service Approval would unreasonably restrict access for people who would have difficulty affording the extra service amount (concessional residents). This guideline is included in the “Information for potential Extra Service status applicants” included in the Extra Service page of the DoHA website for the 2009-10 Aged Care Approvals Round. This states: “The Minister for Ageing has determined under section 32-7 of the Aged Care Act 1997 that the maximum proportion of residential care places that may be Extra Service places in each state or territory is 15%. The Act requires consideration at the regional level of the effect of granting extra service status on access to aged care. In assessing applications for Extra Service status the 15 per cent limit at a state or territory level may also be regarded as a guide to the maximum proportion of places within a region and of high or low care places within a region. This is because access to aged care in practical terms is a matter of access within the region in which a person lives, and also people requiring high care cannot enter a low care place, so the proportion of Extra Service status within a care type (i.e. high or low care) is relevant to
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judging access to care. In the event that there is already close to or above 15 per cent of Extra Service places in a region, there would need to be clear evidence as to why a further increase in Extra Service status would not adversely affect access for people in that region who do not wish to enter an Extra Service place. A number of regions are already well supplied with Extra Service places, in particular high care Extra Service places.” http://www.health.gov.au/internet/main/publishing.nsf/Content/ageingrescare-ess-essprov.htm#top#top
ACAA has a number of concerns regarding the above. These are: 1. The regions for extra service are States and Territories not the Aged Care Planning regions; 2. Access to aged care is not simply restricted to the planning region in which the person lives; 3. Extra Service status does not delineate between high and low care; DoHA’s so-called guideline does not differentiate between regions that are at the top end of the socio-economic scale and those at the bottom end. Whilst the 15% in the planning region is a guide to the restriction of access the DoHA officer needs to actually consider the socio-economics of the area and not simply rely on the 15% benchmark. Unfortunately this so-called guideline has, and will become policy because it is an easy response as to why extra service status was not approved. In fact this office has been advised that it is not worth making application in the South East Sydney region as that region is well over the 15%. Going by that remark the guideline is already “unwritten policy”. It is interesting to note that the regions that DoHA considers to be well supplied, which cater for approximately 75% of the extra service places across the nation, usually have the lowest target area for concessional/supported residents in that particular State or Territory. It is also interesting to note that the number of concessional/ supported residents in aged care has been continually decreasing from 51% in 1999 to 37% in 2008. Given that occupancy is also decreasing this does not indicate any change in admission policy. This so-called guideline assumes that the provision of extra service should be uniform across all planning regions in each State and Territory. It assumes that there will be the same take-up of extra service in Alice Springs as there is in North Sydney. What DoHA is not taking into account is the targeted number of concessional residents in those areas. In North Sydney the level is 16% whereas it is 40% in Alice Springs. Surely then the guideline in areas should be
adjusted by the difference between its target and the top (40%) target for concessional residents, in the case of North Sydney 15%+(40%16%)=39%.
caveat on post 1/10/97 places approved for low care is for funding purposes only (payment at the default rate for low care) and not a ban on admission.
One of the issues that DoHA has not taken into account in this unagreed and un-discussed so-called guideline which is clearly working its way into policy, is the fact that some extra service facilities cater for concessional/supported residents by setting a low extra service fee which is affordable under the pension.
The 15% in the State or Territory is not 15% of high care allocations and 15% of low care allocations, it is 15% of all places allocated in that State or Territory. Any attempt by DoHA to change the allocation to delineate between high and low care places will meet strong opposition from ACAA given the “blurring” of the edges that has taken place since the introduction of the Aged Care Act 1997.
The so-called guideline also assumes that all people entering aged care are accommodated in the planning region in which they live. This is not the case as it is so often the area in which the hospital is or the area in which their children live. Accordingly neighbouring areas must also be taken into account. DoHA has stated that there must be a further delineation between high care extra service and low care extra service. This is totally contrary to the legislation which promotes Ageing in Place. DoHA states that this is because people requiring high care cannot enter a low care place. This statement is totally untrue! Only low care place approved on or after 1 October 1997 have a condition which states that the aged care provided must be for people who, at the time of entry, have been approved as recipients of low care. Therefore pre 1/10/97 approved low care places CAN admit high care. Also the
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This is another case of DoHA changing the rules without discussion with industry. It also appears that DoHA either has no understanding of the consequences or is orchestrating the consequences for political purposes. The change denies the choice to residents and if it is thought through properly will simply mean that the take-up of high care places in this round and in future rounds is in dire jeopardy. If this is the case then there will be less and less availability of aged care places for an ever increasing aged care population. There should be no upper limit set for the provision of extra service status other than to allow for the already gazetted Concessional Resident Targets which, at latest print by DoHA were:
See table next page >
Another Nail in High Care Bed Applications (continued) State ACT NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NSW NT NT NT NT NT QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD QLD
Region ACT Central Coast Central West Far North Coast Hunter Illawarra Inner West Mid North Coast Nepean New England North Sydney Orana Far West Riverina/Murray South East Sydney South West Sydney Southern Highlands Western Sydney Alice Springs Barkly Darwin East Arnhem Katherine Brisbane North Brisbane South Cabool Central West Darling Downs Far North Fitzroy Logan River Valley Mackay North West Northern South Coast South West Sunshine Coast
% 19% 19.8% 20.5% 17.1% 21.6% 27% 28.6% 17.9% 23.8% 18.3% 16.0% 21.0% 18.6% 19.5% 26.7% 19.1% 29.8% 40.0% 40.0% 27.0% 40.0% 33.8% 16.0% 17.8% 26.3% 19.5% 18.1% 22.1% 24.3% 31.2% 17.8% 26.0% 25.0% 17.8% 18.1% 17.0%
Table 1: Concessional Resident Targets
State QLD QLD
Region West Moreton Wide Bay
% 21.4% 20.2%
SA SA SA SA SA SA SA SA SA SA SA TAS TAS TAS VIC VIC VIC VIC VIC VIC VIC VIC VIC WA WA WA WA WA WA WA WA WA WA
Eyre Peninsula Hills,Mallee & Southern Metro East Metro North Metro South Metro West Mid North Riverland South East Whyalla Flinders Far North Yorke Lower North & Barossa North Western Northern Southern Barwon South Western Eastern Metro Gippsland Grampians Hume Loddon-Mallee Northern Metro Southern Metro Western Metro Goldfields Great Southern Kimberley Metropolitan East Metropolitan North Metropolitan South Midwest Midlands Pilbara South West
23.0% 18.8% 21.7% 27.7% 20.2% 23.5% 19.5% 22.0% 21.2% 27.5% 16.8% 19.5% 18.7% 17.9% 18.6% 16.7% 18.2% 18.2% 18.5% 18.2% 23.4% 18.2% 24.7%
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Extra Service Allocations - Two Reviews on the Impact to the 2010 Aged Care Approvals Round
Extra Services Change Hits Growth of High Care Sector James Underwood Has the Department of Health and Ageing (DoHA) inadvertently slowed down the building of new High Care services in Australia? The Changed ES Approval Process At the end of January 2010, DoHA advised the results of the July 2009 Extra Services Approvals Round (ESAR) and then announced details of a March 2010 ESAR concurrent with ACAR 2009-10. The July 09 ESAR results were that almost half of all applicants failed, most because they were in regions now declared “well supplied” with Extra Services (ES) places. DoHA further announced that the number of “well-supplied” regions had increased from one to 19, (even though many regions had had no additional ES status approvals given since the previous ESAR when they were not considered “well-supplied”). Departmental policy has been clear on the issue of declared “wellsupplied” regions: Once a region has been declared “well-supplied”, no new ES status approvals have been granted for High Care, despite many repeat applications in subsequent ESAR’s (as has been the case with the long-time, “well-supplied” area of Queensland South Coast). Accordingly, we would expect to see no new ES status approvals for High Care in the 19 specified regions. The enormous decline in ES approvals is shown below:
of High Care residents, instead of the accommodation charge. The majority of ES approvals are for a part of a service only, leaving the remainder of the service places available for financially-disadvantaged (“supported”) persons. By charging bonds to a proportion of High Care persons in these ES places (plus to a proportion of Low Care persons in non-ES places), a service can budget to cover their capital outlays requirement (usually with a level of borrowing as well) and continue to supply places to financially-disadvantaged persons. Without these “Extra Services” bonds for some High Care admissions, many new projects are likely to stall or fail to go ahead at all.
How Wide is the Impact? The 19 regions that DoHA has determined are over-supplied in High Care ES places comprise only 27% of the 71 regions in Australia, but contain almost half of the aged persons in the country and 55% (or 3169) of the 5748 residential places offered by DoHA for ACAR 2009-10 are targeted. Why can’t a proportion of these new 3169 places attract bond-paying ES status for a part of their proposed new High Care places? Because the area is “well-supplied” with ES places already? Surely having at least 15% or 20% of new places offered as bond-paying High Care would be acceptable if it meant the other 80%+ were general places available to all, including financially-disadvantaged? In addition, DoHA has determined that some parts of other regions are “over-supplied” but not the whole region. This was seen with the failure of a recent application in NSW Southern Highlands. The government gazetted a state-wide maximum of 15% of places being ES. This was up from the original 12% in 1997. To this point, most states have not reached even 10% (even after including the many not yet activated ES approvals for new services), so >
GRAPH 1: New Approvals for Extra Service Places – through ESAR/ ACAR.
Do We Need Bonds? The residential aged care sector heavily uses ES status to help get enough bonds in to meet their budgeted capital outlay for new High Care services. ES allows services to charge bonds to a proportion
GRAPH 2: Approximate levels of ES places as a percentage of all places. (Including provisional approvals)
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providers had anticipated being able to continue to gain reasonable access to new ES approvals for many years.
How did the Assessment Process Change? DoHA has now advised that the gazetted 15% state limit for ES “may also be regarded” as a guide to maximum places in a region. This has not been the case before now. For example, Northern Sydney has ES approvals of closer to 20% of places in the region. Nonetheless, DoHA continued to approve new ES status places until this latest ESAR ( July 09). This was unsurprising, as Northern Sydney is an area of greater “advantage” with fewer financiallydisadvantaged persons. This high approval of ES in the region appeared appropriate and within legislative limits because many other regions in NSW has 5% or less of places approved as ES to give an average for NSW of less than 10%. This 20% level in Northern Sydney was reached well before the Dec 2008
ESAR, however, only now is it considered over-supplied. Why the change? DoHA advises that the 15% rule should now apply to both the High Care and the Low Care places in a region. Why? Because DoHA states “persons requiring High Care cannot enter a Low Care place”. This statement is not the case. Most Low Care places are “pre-97 approvals” that can be used to admit High Care persons. Does this happen? Yes, all the time. Many “Low Care” services only admit High Care persons to some or all wings. High Care is the area of greatest need for places in Australia.
Places for the FinanciallyDisadvantaged are Assured The government regulates and approves the amount of additional fees that residents of an ES place can pay. Many fees are a very low $12.50/day or less. Fees can often be paid through withdrawals from lump sum bonds, making the fees affordable to all bond payers
including full pensioners. Only one third of new residents in Australia are actually “supported” (i.e. financially-disadvantaged) Why is DoHA now seeking to keep 85% of places in a region as “un-bonded” for new High Care residents, when only one-third or less are needed to meet financiallydisadvantaged needs? In the 2008 Extra Services Approvals process, there were 132 new ES status approvals. Why so many? Because it was often the only way new services could get finance and be built. The majority of ES approvals in 2008 were for just one or two wings or a floor of High Care places. The average sized ES approval was just 34 ES places. By not allowing continuation of assessment of ES status applications within the 15% state maximum, and instead declaring 19 key regions as “over-supplied” with ES places, has DoHA severely impaired the capacity of providers to raise capital and build new services? n
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Private Live-in Care – The Angela Gifford experience from the UK Well, well, Kevin Rudd and his merry band have had a ‘Road to Damascus’ experience, or so it would seem. Makes you wonder if there was something in the communion wine over the festive season, because just after Christmas, the Prime Minister finally took it upon himself to warn Australians that ‘we face huge increases in health costs over the coming decades because new Treasury figures predict health spending on Australians over 65 will be seven times higher than current levels in 40 years’ time.’
H
ullo, when did he discover that? Haven’t he and his political mates been listening to the radio or reading the papers for the past few years? How many years is it that aged care peak bodies and many health professionals have been warning politicians and bureaucrats of the impending ageing tsunami? All you can do is shrug your broad shoulders and hope that the message has really got through and then hope that decision makers will consult and listen to the industry, as they develop plans of future action. Of course one of the solutions to our rapidly ageing population and associated financial crisis is through the introduction of new technology, such as the implementation of a nationwide Electronic Medication Management program. (See the article in this edition on page 36). Another brick in the care future wall could well come from the UK. One large provider of private, home based care is suggesting that Australia is 20 years behind the mother country in the provision of full time, live-in care, operated by private providers. That’s where Angela Gifford comes in. Angela is the CEO and co-founder of Able Community Care, one of the UK’s largest and certainly it’s most successful private care providers. I met Angela at a function just after the most recent ACAA Annual Conference. (It does pay to attend!) I was fascinated by what she told me about the care operation she runs and how it works. In 1980 Angela was a young mum and working in a bank in Norfolk, the county where she grew up. She had been working in the same bank for 16 years and was looking for something else to do with her life. In her local paper she noticed an ad for a cook/housekeeper to attend to two elderly ladies for a fortnight while they had a holiday at a nearby seaside resort. The advertisement
was so odd she could not get the idea out of her mind and decided to see if there was any company or organisation that provided such staff on a temporary basis. There wasn’t, Able Community Care was born. Angela soon discovered that the biggest demand for staff was from people who had elderly relatives who had high dependency care needs and could not be left for any length of time, but didn’t want to move into an aged care facility. She offered to help three of these elderly people in three differing counties, promising that she would provide a rotational, fortnightly, live-in housekeeper/carer service on a trial basis for three months. She told her new clients that if she could not get anyone to come, she or a friend would come to fill the gap. ‘I remember’ said Angela, ‘one client was a retired army Colonel who had never been married and could not make a sandwich, was becoming forgetful and his long time housekeeper had left. The second was an elderly lady with confusion who was sure she was somewhere in line to the throne of England and the third client; an elderly couple who did not want to split up and wanted to remain in their own home of forty years for the rest of their lives.’ Angela told me her new business venture was backed by the bank on the proviso that she found a ‘good’ accountant, a ‘capable’ solicitor and consulted Inland Revenue. She did all that and now runs a multi-million dollar business. One of the most salutary lessons she learnt from her bank days was not to borrow more than she could afford, that was a recipe for disaster and she is proud to say she hasn’t. Angela said ‘after our first three months, everyone had been continuously provided with housekeeper/carers who were returning on a regular rotational basis. We decided to not provide babysitters or cleaners and stuck to specialised, live–in care service as an >
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Those older people who are not wealthy, can have their care needs assessed, some may be provided free care; some may have to contribute on a means tested basis. Either way the care can be purchased from the independent sector either individually as a result of being given the money on a direct payment basis or can be purchased on an older persons behalf by their local state authority. All Angela’s carers are self employed, if the client doesn’t like them or get on with them, another person is found until the client is happy.
< alternative to having to move into aged care facilities.’
organisations in Australia researching the possibility of starting a similar project here.
Thirty years later the company is still owned and managed by Angela and has provided millions of hours of care and has enabled thousands of disabled and older people to have the choice to stay in their own homes for the rest of their lives.
So why should we bother, what’s in it for government, care providers and those of us who want to stay at home till the very end?
Some background on the UK situation as it was in 1980. Prior to the NHS and Community Care Act older people who needed care were told “what was available” and “this is who will provide it”. Younger, disabled people were mainly cared for by their families or placed in specialised homes and institutions, sometimes in aged care facilities.
Here are two examples of how it works in the UK.
Angela says it is her observation that this is largely the situation in Australia now. ‘There are pockets of innovative care but they are the minority from what I have seen,’ she said. ‘I have noticed that in Australia the present provision of care services reflects a centrally planned care service and not one of individual choice. ‘It is my experience from talking to many Australian care companies that the vast majority of their users have government planned and paid for services. They do not seek private customers and as a result there is very little private market provision,’ she said. Today in the UK there are a large number of private and not for profit home based care providers and Angela says there are
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Angela says ‘this system provides a person with a choice; one they make, one that is not made for them.’
(a) Elderly gentleman who had Alzheimer’s Disease died with his family around him and both his carers who had cared for him at home for four years. (b) Richard was in his late forties and suffering from MS, we were asked to care for him in his own home. For 15 years we provided him with continuous, live-in care. He died whilst his carer Sue was with him. Sue had been on a rotational live-in carer basis with him for 9.5 years. The UK based system works like this: Older and wealthy people pay for the care themselves. They receive a non income based allowance from the Government of approx $150 pw. They may downsize their home and with the surplus proceeds purchase an insurance policy which will pay for their care needs until they die. They may buy an insurance policy with their savings. They may take out some cash from their homes and use this to pay for care or to purchase insurance.
She warns of vested interests that might attack or try to stop this unique and cost competitive system being established in Australia. Angela’s business survived a protracted legal attack from Social Security and Inland Revenue. They went to court demanding nearly half a million pounds from her business, claiming her staff could not be ‘self employed.’ She won the case and then suffered an audit avalanche from a range of government departments as they tried to find some way of closing her down. Able Community Care provides live-in care to young people with a range of injuries or diseases: MS, CP, acquired head injury, spinal injury, Huntington’s Chorea and Friedrichs ataxia to name but a few, where their life costs of live-in care, housing, daily living costs and the cost of a vehicle are all provided by the state. The costs for younger people are much lower than if they were placed in an institution. Savings of forty thousand pounds every year can be made by using the private live-in care system. Angela told me she ‘came across one case recently of a young person in an institution which was costing about forty thousand pounds more than private care. No care was provided and the care ratio was not one to one as it is in your own home with a live-in carer.’ ‘The biggest benefit of live-in care is that you have chosen where you wish to live, you have maximum independence, you can have help at any time of the day with personal care. If it is a nice day you can say “blow the housework lets go out.” You can choose to have friends round, you can have a brilliant social life as you have someone
choice. Those less wealthy will pay less; some will pay nothing at all.’ Don’t know about you, but I’m in! n Background on Angela Gifford Since 1980 Angela has been involved in the care industry on a national basis from national government to local government, from working with the whole range of health and care professionals to individuals, their family, friends and advocates.
Lee suffers with emphysema and arthritis of the spine. Lee has lived in her bungalow since around 1984 and is determined to stay in her own home. Carer is Sam who has been with Able for almost six years.
Muriel, 79, had two hip replacements in the last 18 months. She has lived in her home for nearly 20 years and quite simply, wants to stay there. Carer is Susan who has been with Able Community Care for four years.
to drive and push you anywhere, rugby, concert or to the pub, to see friends, go to the cinema, go on a holiday, a weekend break, or just choose to watch TV,’ said Angela.
‘Nothing can happen without political will. Change will only happen when politicians sense there are votes to be had from a new policy like this. The costs have to be shared, the wealthy have to contribute or pay for
A Founding Member of the United Kingdom Home Care Association she was Chairman of the first Code of Practice Committee which wrote The Code of Practice for Home Care agencies which was launched at the Houses of Parliament and was the benchmark for home care agencies until the introduction of legislated care standards in 2003. Our ideas of change came about as a result of the Thatcher government. Her Government saw a vision where people could be given the dignity of choice if they were elderly or disabled and then set about achieving it. Political will started the ball rolling.
http://www.uk-care.com
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Kevin O’Sullivan It’s time to put on your best attempt at an Irish accent; ‘to be
times, but vivid in those memories is the time when tragedy struck one brother was lost in a drowning accident.
sure, to be sure’ with a name like
Mum and Dad are both alive and fairly fit.
Kevin O’Sullivan, you could be
Kevin said ‘my Dad would match much younger blokes in a day’s hard yakka, as he’s as fit as a Mallee Bull, even though he is 84 years old. Mum has a bit of arthritis, but never complains about life and its associated problems.’
forgiven for thinking that there would be an Irish connection, would you not?
W
There’s no doubt that the Irish like a drink, a chat and a good time. Kevin and his family were well versed in that tradition, so it’s no surprise to discover that Kevin owns an Irish Pub in Melbourne. It’s also no surprise to discover it’s in Essendon and it’s called O’Sullivans. Kevin’s dad was President of the Celtic Club and some years later, Kevin spent time on its board.
You may well be asking ‘well who is this Kevin O’Sullivan bloke and why should I be reading this story at all?
‘Part of my philosophy on life,’ said Kevin ‘is to enjoy it while you can. Instead of sitting at home, watching the TV, why not go and catch up with friends for a drink, exercise or experience this great country’. Kevin has only just retired from competitive sport, tennis and squash, due to the premature ageing of his own body. He’s worn out his knees and so has some understanding of the arthritis process that a lot of the residents in our facilities suffer. ‘Life is far too short to spend wasting it away watching TV!’
ell there is, a very strong one. This bloke Kevin is as Irish as I am, well even more so, because my links to the island of green are a generation older. It was my Grandfather, bless his Gaelic soul, who decided that Australia held more hope and opportunity than the green and mist shrouded pastures of Ireland.
Kevin O’Sullivan is an Essendon boy and has fond memories of growing up in that working class Melbourne suburb. ‘I know Mum and Dad had to struggle when we were young, Dad always had a second job, carting rubbish, doing gardening, that sort of thing,’ said Kevin. ‘Hard work was no stranger to our family.’ Like many a young Melbourne boy, he spent Saturdays at the local football ground, in this case ‘Windy Hill’ the home of the Essendon AFL team. Getting to the ground at 9am , watching the under 19’s, seconds and seniors play. Kevin said ‘I would spend all day at the oval, running onto the ground for a kick at every opportunity, because we were allowed to in those days. Complete with soup and sandwiches from Mum, it was great. I also used to help Dad after school and sometimes on the weekends, or in school holidays, felling trees, sweeping leaves, clearing garden rubbish from other people’s homes.’ Kevin shared these times with four brothers and two sisters. His memories are of happy
‘I don’t think I will ever retire, I would need to keep my hand in something or I’d go mad,’ says Kevin. Well, he will have more than his fair share of business enterprises to choose from. Not only does Kevin run the Irish Pub, but he, like his parents before him, also owns an aged care facility, being a 40 bed residential aged care facility in Boronia. For those who don’t know their geography, that’s a suburb of Eastern Melbourne quite near the Dandenong Ranges.
‘We can’t afford to provide only high care, as we can not charge bonds in high care we have to be able to generate some income from other means to help fund the enormous building costs associated with aged care,’ says Kevin. ‘This is an investment of millions of dollars in aged care and it isn’t without its risks,’ he said.
It started 20 years ago. Today it’s a 40 bed High Care facility, expanding to 70 beds when the building expansion project finishes in May. The new facility will be flexible so it can provide different levels of care.
Kevin O’Sullivan is a member of the Federal Board of ACAA, Deputy Vice President of ACCV, and is also a member of both ACCV’s Finance and Audit Committee and its Executive Committee. n
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“We need an IT revolution in Medication Management in Australia” By Mike Swinson, with Suri Ramanathan and Rod Young “While aged care facilities in Australia deliver some of the best care and accommodation available anywhere in the world, with a workforce that demonstrates the highest levels of professionalism, skill, care and respect to older people, we need a transformation in the way we manage medication. Medication errors can and do cost lives, they cause distress to clients, families and staff. They bring negative media attention that overshadows the commitment of staff, adding to or creating low morale that compounds the problem of low workforce retention.”
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hat’s the essence of a submission to the Federal Government from Australia’s Aged Care Industry IT Council, arguing for the development and implementation of a nationwide Medication Management (MM) IT system. If you have ever wondered why MM is the first topic of importance to the relatively new Aged Care Industry IT Council (ACIITC), think about the misery of medication mismanagement. Endless stories of aged care nurses who go home at night, unable to sleep, kept awake thinking about, ‘did they get it right, right dose, right day, right medication.’ Of doctors almost breaking down as they relate stories of near misses, of nurses trying to read almost illegible scripts. So just what is proposed by the IT Council? The submission spells it out clearly and simply. “The proposed Electronic Medication Management (EMM) system will give all providers involved in the care of clients in Aged Care facilities access to a common electronic medication record, based on existing technologies. This will improve the
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quality of care provided and reduce the risk of errors caused by poor communication and errors in transcription and interpretation of medication information. It will complement the clinical systems already in use in RACF, GPs, pharmacies and hospitals. The project aims to provide information needed to optimise medication management processes and support the delivery of compassionate and high quality care for the frail aged. EMM will complement the existing professional standards and business processes of the aged care workforce.” (Quote:EMM in Aged Care, Executive Summary, page 6.) The Chairman of the IT Council, Suri Ramanathan, says he’s worked in the aged care sector for many years and knows that the possibility of medication mishaps has, and still does have, nurses concerned and sometimes worried. ‘Nurses are so critical to the delivery of care, and the use of paper-based medication management systems was and still is causing untold stress. Medication management is at the core of the work that we do in aged care,’ he said. Suri Ramanathan says there are two major issues in aged care; attracting and keeping a viable workforce and the safety and care of residents/clients. It’s the latter issue that is critically related to medication management. ‘The IT Council decided to tackle the hardest of the hard issues facing our sector and this is it,’ he said. Last year the IT Council ran a series of workshops across Australia. Doctors, pharmacists, nurses, aged care administrators came from far and wide to attend, to relate incident after incident, re-enforcing just how important the development of a national electronic Medication Management system is. The message was ‘it’s time to act.’
You know,’ says Suri, ‘our mission statement is not just about IT. It’s to improve care through IT. Our industry is full of people who care about other people, that’s what they do, day after day, week after week. They develop close friendships and relationships with residents and families, and almost without exception, no-one wants to hurt anyone else.’ ‘The aged care sector is committed to providing safe and high quality care to older Australians, and it is this commitment that is driving this project. This project represents a key step in the continuing transformation of the aged care sector, and will support health, aged care and workforce reform agendas,’ says Suri. The aged care industry is facing huge challenges, as politicians, including the Prime Minister have alluded to recently. More of us are ageing, living longer and fewer people will be in the workforce to provide the tax revenue to pay for the care and the employees to work in the sector. It’s as simple as that. Technology is part of the solution. In 2008 the Australian Institute of Health and Welfare (AIHW) released a report addressing the movement of patients between Residential Aged Care Facilities (RACF) and Hospitals. The report revealed that of the 39,466 people admitted to hospital from RACFs 30% were admitted as a result of adverse medication events, of which up to 75% were potentially preventable. The savings from a national electronic medication management system will be immense. It’s all about increased productivity, a key message from the PM. According to the submission to government, the EMM project will: • •
Deliver more effective healthcare Improve the co-ordination of medication management
• • •
Improve the quality of care Increase the efficiency of the sector Support a more sustainable workforce
(Project Objectives:EMM In Aged Care Executive Summary, page 6) Currently there are commercial systems that address electronic medication management from the pharmacy dispensing to administration at residential facilities. ACIITC fully support these Vendors and commends them to Providers. It intends to support these systems by providing key information with respect to Medications from Hospital Discharge, clinical notes, Prescribing and population health. EMM covers prescribing, dispensing, administering, monitoring, decision support and review. The IT Councils Report says, once an EMM system has been broadly accepted and implemented within the aged care sector, it wouldn’t be at all surprised to find comments like these from future users.
“It has made a huge difference to our processes for accepting a resident from hospital that we receive a complete discharge summary directly into our in-house system. It is a simple matter to have the resident’s GP authorise the necessary prescriptions based on the discharge summary and have our pharmacist deliver the medications in a care pack within one or two hours of the resident’s arrival instead of 3-4 days that it used to take.” - Residential Aged Care Facility Another: “The EMM system allows us to identify the resident from a photograph, and see the current medication chart online. When we are reviewing the resident’s care plan we can see at a glance all the relevant medication information, including what they may have been prescribed previously either in a different RACF, or in a hospital.” - Registered Nurse According to the Council, this is where the aged care sector should aim to be.
Rod Young, a member of the ACIITC and CEO of ACAA says there are an extraordinary number and variety of benefits that will flow to the aged care and health sectors from the introduction of a national electronic medication management system, including: • • • • • • •
Reduced Hospitalisation Reduced Medication Wastage from Medication-related Adverse Events, Reduction in minor incidents Reduced costs with fewer resources required for medication management Improvements in resident safety Improved health outcomes Improved information for families
(Benefits: EMM in Aged Care Executive Summary, pages 10 and 11) continues next page >
Electronic Medication Management
technology
The diagram provided (above) shows how the system will work for aged care facilities, for GP’s, for pharmacists and hospitals. This project will develop and provide a common medication record for each resident accessible by all sectors of interest. (Diagram: EMM in Aged care, Executive Summary, page 9) Here’s a brief example of how a future medication management software program would work for residents in care. 1. A note made by a care worker on the resident’s electronic file in the RACF, for later review by a medical or nurse practitioner. “While I was visiting residents in the ward, delivering a cup of tea and a snack, I noticed that Mrs Jones was very unresponsive. For someone who is always ready for a bit of a chat it surprised me that she has become so quiet”. 2. A second note on the file for all to see, this time from the Doctor to RACF care staff. “I have authorised a change in the prescription for Mrs Jones, and will include her in a consultative visit this Friday between 10-noon.” 3. Another note, this time from the Pharmacist to the GP through EMM. “The family of Mrs Jones has contacted me to indicate that she is quite prepared to accept the generic alternatives to her
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present medications. You might wish to confirm her choice and review her prescriptions at your next consultation.” Prior to EMM none of this was possible unless it was done using the slow and torturous paper based record system. Suri Ramanathan says the proposed EMM solution complements, but does not seek to duplicate, the information that is held in existing clinical systems. These systems provide clinical information needed to support choices about medication management from the point of deciding to prescribe a medicine through to its administration and monitoring. ‘Information on current medications and any known allergies will be available through the EMM system, which in conjunction with clinical examination and existing clinical history will support the decision to prescribe.’ he said. He is supported wholeheartedly by Rod Young, ‘EMM will streamline the documentation of medication requirements for the medication chart and prescription and allow this to be communicated electronically to the pharmacist for dispensing. EMM will provide an electronic medication chart that will support the administration of medications by providing access to GP information, enable alerts relating to the administration of medicine and ensure that the medication record is legible, reducing the risk of administration errors (eg a misinterpreted dosage). ‘
According to the IT Council, the future is already upon us, as we are already seeing increased challenges facing the aged care industry. The Council’s call for action is being driven by the serious challenges already faced by the industry: •
Demand for care rising: The population aged over 65 is projected to rise from 13.0% to 24.4% by 2044
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The workforce is contracting: Today there are 5.2 people in the workforce for every person aged over 65. By 2044-45 it is projected that this will fall to less than 2.7 people in the workforce for every person aged over 65.2
•
The proportion of high care reidents is increasing: The high prevalence of residents with complex and chronic care requirements is impacting the aged care industry, as it is other areas of the health system.
•
High rates of polypharmacy: As people age the risk of medication related adverse events increases significantly A detailed project brief is available as a pdf file from either the IT Council or the ACAA website:
www.agedcareassociation.com. au/medicationmanagement The EMM website will be available from 1st April 2010
technology
Aged Care IT Vendor Association Report Caroline Lee
Chief Executive Officer Kwiklee PL & Lee Consulting Australia PL
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n Tuesday 16th February 2010, another successful Aged Care IT Vendor Association (ACIVA) meeting was conducted with the Aged Care IT council initially, then members. Mark Brandon (national CEO) from the Aged Care Standards & Accreditation Agency met with the council and ACIVA jointly, to discuss the role of each organisation and potential ongoing collaborative efforts to raise
awareness of IT systems within the industry. Dialogue will continue between all bodies to support the further understanding of the role of software and hardware programs in the regulatory environment. A presentation from the Aged Care Industry IT Council (ACIITC) Chairman Suri Ramanathan regarding initial plans for the national Electronic Medication Management system was received well with Suri describing the equal role each software vendor would play in such a deployment. ACIVA’s commitment to the industry is to provide education to providers and staff
regarding a range of aspects related to Information Technology so that a greater take-up of these efficiency gaining tools can be utilised by all. For many years now, businesses have adopted IT systems to assist in the financial management of their organisations. The business sector underwent substantial change to incorporate IT programs into their everyday activities to obtain meaningful reports and provide risk management tools for improved monitoring of daily activities. Our goal is to demonstrate to the aged care industry that such ‘easy’ reporting can be achieved for all aspects of an aged care business operation – including care, lifestyle and staff/volunteer management, not just financial, in a secure and robust manner. n Below, L-R: Mark Audley, CEO Wecare, Caroline Lee, CEO leecareplus, Christopher Gray, CEO iCare, Paul Houlis, CIO Aged Care Standards & Accreditation Agency, Mark Brandon, CEO, Aged Care Standards & Accreditation Agency, Suri Ramanathan, Chairman, ACIITC
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technology
Coping with Change An update on the Smart Phone rollout by Silver Chain in Western Australia By Mike Swinson Last year, one of the most ambitious IT implementation programs began when Silver Chain in WA started rolling out over 2000 smart phones throughout its huge organisation.
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t the moment, the smart phones are being used by a wide range of staff including doctors, enrolled nurses, registered nurses, occupational therapists, care aids and home-help support staff. At any one time there could be over 700 people logged on to the database that runs the system. The business’s General Manager of Information Management, Allan Turner said the next phase will see clinical staff using the smart phones for wound management, a system that will go live in April this year. Almost anyone who has worked in, or been associated with, the aged care industry over the past few years would have heard of Allan Turner. Allan and another legend of the business, June Heinrich, were the inaugural inductees into the Aged Care IT Industry Hall of Fame. Allan’s induction into the Hall of Fame recognised his lifetime of service in various IT management positions and currently as General Manager, Information Management of Silver Chain, and one of the largest community care providers in Western Australia. ‘We have had this program on the books for some time,’ said Allan, ‘but it had to
be cost neutral and it wasn’t until smart phones arrived that we could see instant cost benefits and away we went.’ Silver Chain is a very large organisation, with over 2,500 employees and 400 volunteers, it services over 39,000 clients in locations from Albany, to Perth, East to Eucla and North to Carnarvon. Allan Turner is managing the million dollar rollout and already the project is attracting international interest.
Kathryn Mulligan
The benefits of the software/hardware project will become apparent in the next 12 months, but already staff are reacting positively to the introduction of the new technology. Take these two stories. Kathryn Mulligan is a relatively new casual employee, working as a Home Helper. Kathryn’s daily work involves travelling to clients homes and providing a basic home maintenance service.
Dale Kenning
‘My IT skills were not good. I had bought a laptop computer a few years ago, but that was for the kids more than me. I must admit I was anxious when I was told that I had to use this new smart phone.’ All new employees receive basic training; in Kathryn’s case it was a one week long induction program that included a full day on the use of the smart phone, now she loves it. ‘It’s very easy to use, and makes my life a lot simpler. I log on every day; check what work is scheduled and who I have to visit. I use the phone to record my mileage, my hours and who I visited. I can also use the phone to ring the office and tell them of any concerns or problems I might have. Kathryn said ‘Having this phone makes me feel valued and important and makes it very easy to keep in touch, it’s great. The kids think its “cool”, but they are banned from using my work phone!’ Dale Kenning is a long term employee; she’s worked for Silverchain for 11 years
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Allan Turner
‘That will mean we can track every clients wounds, how fast they heal, what they are, how severe and so on. It will give us the biggest statistical database on wounds in elderly people and how to manage them in this country, if not the world,’ said Allan.
providing Home Help in the metropolitan area of Perth and now in Bunbury. ‘In the old days I had to fill in a paper based time sheet, make corrections, fix mistakes and then post it back to Head Office. I used to receive my new time sheet with my pay advice in the mail. Now I do it all in the smart phone.’ Like Kathryn, Dale was also anxious when told she would be given a new ‘gadget’ to use. Her IT skills were very basic.
Below: Chantelle Hadley using the Smart Phone
‘I found that the more I used it, the more my confidence grew and now I couldn’t do without it. I was devastated the other day when the phone stopped working and I was without it for 2 days [this was a process problem not a phone problem]. All my apprehension is gone,’ she said. Dale’s advice to others facing the same situation is simple. ‘All I can say to others who have to cope with the introduction of new technology is to take it slowly, do a bit at a time, a bit more each day and gradually your fear will go.’ ‘We are already seeing the financial benefits of this new IT program rollout,’ said Allan Turner. ‘Every employee who uses one does all their time sheets on the phone, that’s where they find out what they are doing for the day and who they are seeing and when. It’s too early to quantify the savings, but I know they will be substantial. Savings are both in time, efficiency and money.’ He said ‘our people love it, because they get paid what they are owed, on time and there is nothing like a financial incentive to help us on the journey of new technology. Everyone’s life is made easier.’ By June 30th this year Allan Turner estimates the business will have deployed around 1500 smart phones. The Wound Management system will be hooked into the database and will go live in April.
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The smart phone project began back in 2005 with 100 hospice nurses using mobile phones enabled with Silver Chain’s own ComCare software. The success was immediate and better than expected. It identified areas of concern, like the not so great mobile phone coverage in WA. ‘No matter what the Telco’s tell you,’ says Allan. It also identified areas of savings, increased staff productivity and client advantages. Do you remember what Allan said in the first article on this project last year? If not let me remind you! ‘This project could not be just cost neutral, which was the board’s stipulation. It will eventually mean multi-million dollar savings for Silver Chain due to better and more efficient processes and procedures. It will also mean we are finally a truly connected organisation, where we can reach every staff member instantly,’ he said. Allan added that ‘I don’t think many people understand the power of a connected network, what you can do with that technology. I think it’s a very powerful tool and will benefit us and our clients enormously as time goes by.’ n
CONTACT INFORMATION Mr Allan Turner General Manager, Information Management Silver Chain Mobile: 0419 907 357 Phone: (08) 9242 0293 Email: aturner@silverchain.org.au Website: www.silverchain.org.au
ITAC 2010
KEYONTE SPEAKERS Dr Michael Dahlweid Chief Medical Officer, iSOFT, Germany
ITAC 2010 Smart Aged Care – the eHealth Revolution 26 & 27 July | Sofitel Melbourne on Collins ITAC 2010 aims to provide something for everyone, from basic hints and techniques, with presentations from expert speakers covering the theme and dealing with the broader
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he conference will bring together local and international experts across the fields of community care, medication management, assistive technologies and offsite information systems delivery. These critical aged care topics will be discussed from a practical perspective, highlighting the information we need to know now to better manage and design aged care service delivery.
facing an industry grappling
The ITAC 2010 theme of Smart Aged Care – the eHealth Revolution incorporates the following information streams:
with the uptake of technology.
1. National Health Reform
business and strategic issues
2. Cloud Computing 3. Information, Documentation & Workflow 4. eTherapy and Fun Technology 5. Business Continuity/Disaster Recovery 6. Social Media/Social Networking/ Language of the Future 7. National Broadband Network 8. Community Care & Care in the Home 9. Infrastructure – The Future of Software Delivery 10. Electronic Medication Management
Dr Michael Dahlweid, iSOFT’s Chief Medical Officer is an accomplished speaker and presenter, his background as a practicing doctor in Accident Emergency and Trauma along with qualifications and experience in Medical Informatics, enables him to encapsulate his experiences in an intriguing array of perspectives reflected in the many papers he has written. With writings featured in a copious range of publications, Michael has taken on advisory roles for European governments and is a lecturer in Healthcare Information Management at various universities. Before entering the IT sector Dr Dahlweid was CIO for a German hospital group portraying his unique combination of skills that go beyond the medical knowledge and clinical experience such as encompassing extensive information technology, production and product management. Michaels experience includes for over 4 years in various roles at AGFA such as heading the product management team responsible for Product & Strategies for Enterprise IT in France, BeNeLux, Italy, Spain, US, Canada, Russia, Latin America, Germany, Austria and Switzerland progressing to become a Member of the Executive Committee of Agfa HealthCare and Chief Medical Officer Agfa HealthCare IT. Some of Michaels most memorable global experience that helped shape his career stems from being a part of a Leading driver to internationalize product and creating a true global product from scratch. Michael Dahlweid was appointed as iSOFT’s Chief Medical Officer in November 2008 and has responsibility across the group to maximise the benefits of patient safety for new and existing technology, ensuring iSOFT’s systems support clinicians in providing better, safer patient care. Peter Fleming Chief Executive Officer, NEHTA, Australia NEHTA Chief Executive Peter Fleming is tasked to lead the national vision for e-health in Australia. Prior to NEHTA Mr Fleming managed a successful tenure as the General Manager Technology, Business Integration, for National Australia Bank. He is also past CIO of Colonial Group and Mayne Group Limited. He has extensive experience in
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ITAC 2010
EXHIBITORS • Alchemy Technology • Aurion Corporation • Australian Ageing Agenda • AutumnCare Systems • Campana Systems - Goldcare • Clipsal - Vieo Aged care • Database Consultants Australia
26 & 27 July | Sofitel Melbourne on Collins
• Eclipse Computing (Australia) Pty Ltd • Epicor Software • Frontier Software Pty Ltd • Healthsolve
large scale technology transformation and stakeholder management. At NEHTA he is focused on orchestrating the uptake of e-health systems of national significance. This involves enabling the progression and accelerating the adoption of e-health by delivering urgently needed integration infrastructure and standards for health information. Dr Jay Parkinson Managing Director, MPH, USA He’s been called ‘The Doctor of the Future’ and one of the ‘Top Ten Most Creative People in Healthcare’ by Fast Company. Esquire Magazine included him in 2009’s ‘Best and Brightest: Radicals and Rebels Who Are Changing the World’ issue. He’s been featured in GOOD Magazine, CNN, Newsweek, and Health Affairs. The leading trade publication for hospital and system executives, Hospitals and Health Networks, dedicated a cover article to Jay entitled, Your Future Chief of Staff? Jay also appears in Seth Godin’s new book, What Matters Now. Instead of pills and scalpels, Jay uses creative design to improve health. He is a pediatrician and preventive medicine specialist with a masters in public health from Johns Hopkins. He thinks big picture and loves pleasant little details and elegant processes. He intuitively understands
aesthetics, our rapidly changing culture, and our health. He’s a sponge for new technologies, new business models, and new processes. And he’s able to use his experience to creatively approach health in a whole different way. He straddles lines - both pop culture and traditional healthcare have embraced his ideas. Jay speaks on an international stage - Pop!Tech, The Guardian Activate Summit, California Chronic Health Foundation, and the British Medical Journal. Axel Schultze Chief Executive Officer, Xeequa Corp, USA Axel Schultze is founder and CEO of Xeequa Corp. a social media software company, helping businesses to create a better customer experience. Prior to Xeequa, he was founder and CEO of Silicon Valley based BlueRoads, one of the most successful SaaS based PRM companies, where he invented a new method of lead distribution and was granted patent 9514997 by the US Patent Office in 2006. Before that he was founder and CEO of Infinigate one of the largest Internet Security provider in Europe, (today over $100 Million in revenue). In 1983 he was co-founder of Computer 2000, the most successful European computer distributor, which grew to $5 Billion in revenue and merged with TechData in 1998.
• iCare Solutions • i.On My Care • iSOFT • Kwiklee Pty Ltd • Locating Technologies • Management Advantage • Medicare Australia • Motion Computing • Neller • Procura • Questek Australia Pty Ltd • Raisoft Australia • TechnologyOne • WeCare (Australia) Pty Ltd
FOR FURTHER INFORMATION: ITAC 2010 Conference Office Health Informatics Society of Australia (HISA Ltd) 413 Lygon Street East Brunswick Vic 3057 T: 03 9388 0555 F: 03 9388 2086 E: itac2010@hisa.org.au
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workforce
Exciting Developments for Aged Care Organisations A New Year… A New Decade…Time For A Change… As you are no doubt aware, Aged Care Association Australia (ACAA) was the instigator and enthusiastic supporter of an Employee Benefits Program (EBP), designed specifically for the Aged Care industry.
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n an endeavour to continue the development of the Program and to enhance the service offering the EBP can deliver to its members, ACAA has entered into a new agreement with Presidential Card / Shoppers Advantage to provide an enhanced service to existing and future members. One thing that doesn’t change, however, is the face behind the EBP over the past 2½ years. I am now with the Presidential Card team, who are very enthusiastic about our new role in the provision of Employee Benefits to the Aged Care industry. So….who are Presidential Card & Shoppers Advantage? •
Presidential Card is an Australian owned & operated company based in Melbourne, with representatives across Australia. Established in 1980, we are Australia’s Largest Lifestyle Benefits Program with over 1.4 million members utilising offers at over 8,000 locations. We pride ourselves on having many well known, nationally recognized organisations on board….and we don’t plan on stopping there. Our aim is to add in excess of 10,000 new retail outlets across Australia this year!
•
Established in 1988 Shoppers Advantage is Australia’s leading membership based online retailer with over 20,000 products at ‘Guaranteed Lowest Prices’. For peace of mind, all of our offers are backed by a Guarantee.
What we aim to offer is improved service delivery, a wide range of benefits, and a complete co-branding package (from Personalised Welcome Packs for employees, to 75% of the Card face being dedicated to your corporate logo, to a dedicated co-branded website….all at no extra cost!!!). The company’s motto is “ACQUIRE, RETAIN AND REWARD”. These factors are significant issues in the operation of an Aged Care Facility. To assist providers overcome these issues, we have developed the Presidential Card Employee Benefits Program (EBP). The intent is to offer organisations an HR Strategy to assist in overcoming the high costs associated with employee turnover, which is a substantial burden to all organisations: •
Loss in Productivity
•
Advertising and recruitment costs
•
Interviewing costs
•
Disruption to routine for both employees and residents
It is said that the cost of replacing one employee can be as high as 100% of their annual salary – a large impost on any organisation. The Presidential Card EBP is designed to reward Aged Care employees and volunteers for their contribution in delivering care to elderly Australians. By implementing the Presidential Card EBP, your Organisation can deliver significant true cash savings to your employees and volunteers without any ongoing salary or FBT cost implications. An Industry Backed Initiative: ACAA has endorsed the Presidential Card Employee Benefits Program (EBP) as an effective HR strategy to assist in the attraction, retention and reward of employees within the Aged Care industry. Whether your Organisation has 50 or 5,000 employees, the EBP can assist in attracting, and ultimately retaining, quality employees. We believe Presidential Card can offer Aged Care organisations an additional avenue to nurture the most important asset in our industry...your employees. For full details, please contact me personally. n Brad King Manager Business Development Presidential Card 0413 839999 BKing@PresidentialCard.com.au
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workforce
National registration for nurses, an opportunity or another burden to bear? (Part 3 – continued from last issue) There is no doubt that national registration for nurses is coming and that some aged care organisations are getting prepared. Our enquiry rate at Moving ON Training has tripled in the last 4 to 6 weeks.
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ut there is also confusion, misinformation and anxiety. We have heard a number of comments and concerns. These include that states have the option to ‘opt in’ if they choose to, that the scheme will commence in July 2011 and that enrolled nurses are not included. Nurses have also expressed concerns about how they will meet the 20 hours minimum participation in effective learning activities as well having to provide evidence of learner outcomes, identifying learning needs and reflection on practice and learning. The Nurse and Midwifery Board of Australia has been appointed and the final proposals on mandatory registration standards have been submitted to the Australian Health Workforce Ministerial Council for approval(1) The CPD requirements have been outlined as well as the other requirements that include recency of practice, criminal history check, English proficiency and indemnity insurance. So what process needs to be put in place now to ensure that your nurses are confident to meet their registration requirements? What is the risk to your organisation if you do nothing and take the approach that license to practice is the nurse’s responsibility. For consideration: Give your nurses the information that they need. The Nurse and Midwifery Board
of Australia’s website is http://www. nursingmidwiferyboard.gov.au/. It outlines the specific requirements to meet the continuing professional development standard.(2) • Give your nurses the opportunity to discuss their concerns and be clear about what support your organisation is willing to provide • Look at the CPD options that are available. Do they meet the criteria for effective CPD activities and the criteria for national registration? • How will you ensure equity of access? Is it reasonable that some staff are supported to attend CPD activities while others are not • If you opt to provide in-house CPD will it meet the requirements and how will you deal with partime, weekend and night shift issues? Effective CPD according to the Australian and Midwifery Nursing Council is a range of activities that includes relevant online education, reflection on practice, developing policies, protocols and guidelines, participating in accreditation processes and participating in case reviews.(3) CPD must also be relevant to the nurse’s areas of practice and be based on identified learning needs. The advantage of online learning is that in addition to the topic content it can be used to promote or instruct your nurses to pursue other related CPD activities. For example a module on Nutrition and Hydration: • Is directly relevant to the nursing practice in aged care • Is an identified area of nursing competence under Standard 2 of the Aged Care Accreditation Standards • The information and knowledge gained can be used by the nurse to review and
be involved in developing policies and guidelines • The knowledge gained can be used to reflect on the current management of nutrition and hydration within the organisation • The information can be used in case reviews to ensure that best practice is being implemented. Online CPD allows nurses to assess and improve their current level of competence in a non threatening way. It gives nurses the opportunity to meet their CPD requirements and paves the way for other CPD activities. Supporting your nurses to meet their CPD requirements also has marketing, recruitment and retention benefits. Doing nothing may have financial, human resource and quality of care consequences. The risk can be effectively mitigated or be left to chance and result in another burden to bear. n 1. Health Practitioner Regulation National Law Act 2009 (Qld) (the national law) http:// www.legislation.qld.gov.au/LEGISLTN/ CURRENT/H/HealthPracRNA09.pdf 2. Nurse and Midwifery Board of Australia http:// www.nursingmidwiferyboard.gov.au/ 3. Continuing Competency Framework http:// www.anmc.org.au/userfiles/file/research_ and_policy/continuing_competencies/ Continuing%20Competence%20 Framework%20-%20Jan%202009%20 Final%20Doc%20for%20web.pdf This is the final article in this series. Please contact Moving ON Training or visit our website for more information regarding the introduction and requirements for national registration for registered nurses.
Deb Shearman Director Moving ON Training Pty Ltd deb@movingontraining.com.au Ph: 02 9999 1993.
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sponsors
Notes from an Architect’s Diary – Aged Care Projects The Briefing Experience Matthew Hutchinson
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he word Brief, with respect to a new building project, means different things to different people. Kicking off and running the briefing process for a new Aged Care Facility no doubt then happens in a myriad of ways. For an architect however the briefing stage of the project is everything - well almost. A good architect (GA – a new acronym… just for this article) wants to know more than just “How many beds are you proposing to build?” and “What is your view on inboard vs outboard ensuites?” A GA wants to know why the client is in aged care altogether and what is the vision, strategy, mission, philosophy of care and business plan for their whole organisation, be it for one or for 50 facilities. Once this has been articulated and understood then there is a context in which the bed numbers and choice of ensuite type, for example, makes sense. Some clients who have not had a history of strategic development or building projects and even some who have
can be surprised to be asked these sorts of questions. Sometimes clients need help and a bit of time to establish these core ideals for themselves. This is not to say that endless navel gazing is a prerequisite for a successful project but some form of reflection on the basis for their operation, if not already well known or documented, generally will help to reaffirm or test the decisions made through the briefing and design process. Setting the context for the brief early in the process ensures that decisions made are the right ones for that organisation. Invariably as the briefing and design process goes forward the building form and project value become more defined, more parties including design consultants are spending more time and therefore expense on refining this project or projects into something that can be submitted to local councils for approval (usually after lengthy discussions), tendered and ultimately constructed. The commitment to a particular direction grows and cost is incurred in doing so. To revisit the brief at the latter stages of the design process or worse during construction can be a very expensive activity.
There is an old expression that ‘lines are cheap’. Some clients paying architects and consultant fees may disagree but the point is made. Time spent up front to establish a brief which embodies the core ideals of a given aged care organisation, done properly with due tempering by an appropriately experienced and knowledgeable architect, means that the first few decisions made and lines drawn will be the right ones or within the zone of being right at least. In terms of getting the brief right a GA should also know when a client needs help to establish the brief. It is not always possible or reasonable to expect a client to articulate what an architect needs to know. Architects can provide (sometimes for a separate fee) what’s known as a Return Brief. In other words “Here returned to you, this is what I hear you saying you need. Is this right?” This is quite normal. There are other fantastic tools available to assist with the briefing and design process but we can talk about them another time. n Matthew Hutchinson is a Melbourne-based Aged Care Architect and a Principal of ThomsonAdsett.
sponsors
Senior First Aid and CPR training online
ACAA and e3Learning in collaboration with the Australian Red Cross have successfully launched both the CPR and Senior First Aid (Workplace L2) courses online.
S
taff can now be offsite for less time and get the best of both face to face training and online delivery. Using both methodologies hand in hand will improve learning outcomes. Ben Smith from the Red Cross, said: “The beauty of online learning is that it allows students to complete the course at a time, place and pace that is convenient to them. Students can do the entire course in one go, or in small sections in their spare time – lunch breaks, quiet times and after work, for example.” The courses provide the fundamental principles, knowledge and skills to enable the first aider to provide emergency care for injuries and illnesses, in the home or the workplace.
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Courses are completed online in the student’s own time, and can be followed by a practical skills instruction and assessment session at a Red Cross location with a certified Red Cross First Aid Trainer.
purchase via the redcross training portal (http://redcross.e3learning.com.au) or can be purchased on a company wide basis and delivered through a custom branded web portal.
On successful completion participants will be issued with a Statement of Attainment for the nationally recognised units of competency from the Health Training Package, either HLTFA301B – Apply First Aid or HLTCPR201A - Perform CPR.
The cost is $150 for Senior First Aid, which includes the 8 hour face to face session and $55 for the CPR course.
Course Prerequisites and Validity There are no prerequisites for either course. Current industry standard is for this course to be updated every 3 years with the CPR component being updated every 12 months.
To view an online demonstration of the Red Cross Senior First Aid online course, vist http://redcross.e3learning.com.au/ content/sfademo/index.html n
Course Duration The online training component can be completed in sections at the student’s preferred schedule. The practical instruction and assessment takes 8 hours for Senior First Aid and 30 minutes for CPR. Once registered, students have access to the course content for 12 months. Groups This training is available for individuals for
The courses feature audio, video, interactive demonstrations and online quizzes to make the material both educational and engaging.
For further information contact: Adam Dunkley Ph: 08 8221 6422 adam.dunkley@e3learning.com.au
Reverse Auction Platform saving you money on energy costs… now and in the future! last few percentages points out of the price offerings, revealing a clear winner. The process was transparent and viewed “on-line” at a scheduled time and date. The follow-up reports with the auction results were also easy to understand.
EnergyAction P/L is an Energy Auction House that trades contracts “on-line” through a reverse auction platform. We invite all energy retailers (AGL, Origin, TRUenergy, Country Energy, etc) to bid against each other over a 10 minute transparent window, viewed by the client, to win the lowest price for your current or future electricity contracts.
W
e take clients to auction up to 24 months prior to their contract expiration. i.e. future contracts fixed at today’s lower rates.
Instead of you spending time hunting for the best deal for your energy requirements, we bring the market to you in an efficient and transparent Live On-Line Reverse Auction that drives prices down. You can be confident that energy retailers compete for your business on a level playing field. There are no hidden charges and all processes are accountable and this process is at NO CHARGE. We are paid our 1.5% fee from the winning retailer.
We envisage saving over $38,000 over 4 years with the results from the reverse auction platform. We were also pleased that EnergyAction offered an Energy Monitoring Program which allows them to check our bills regularly for any anomalies or overcharging and organise an on-site visit by their Engineers to provide some insight into our sites’ energy consumption trends and identify areas where the sites may be able to reduce its energy consumption. A comprehensive written report from the Engineers is provided. Overall, EnergyAction controlled the whole process. Whilst our involvement was minimised, the auction platform meant we were kept informed throughout the whole process and received immediate feedback. The best part was that it cost us nothing. EnergyAction charged the winning supplier a small percentage of the contract price and we got a great result.” n For more details on EnergyAction contact: Peter Naylor Ph 03-9832 0855 Fax 03-8677 9633 peternaylor@energyaction.com.au www.energyaction.com.au
In addition, EnergyAction will be with you at all stages providing energy management advice and help over the course of the agreement. We help you manage energy usage, billing inquiries, power factor, greenhouse emissions and more. Following are some comments from Churches of Christ Community Care: “In September 2008 we were in the market to procure a new Energy contract for the Havilah Hostel group and were aware that EnergyAction had offered their services to Aged Care Facilities. I consequently contacted Peter Naylor from EnergyAction in Melbourne and he advised me that they have been very successful in obtaining the best possible energy rate and consolidating various contract arrangements using the reverse auction platform for other Aged Care facilities, along with a myriad of other local businesses. The auction platform not only revealed the best retailer for Havilah Hostel needs, but also attained an even better result by squeezing the
aca Aged Care Australia | Autumn 2010 | 53
sponsors
CIS, natural justice and rights of review A determination made by
CIS determinations
•
the Aged Care Complaints
The functions of the CIS are underpinned by the Aged Care Act and the Investigation Principles.
CIS does not have to meet any standard of proof;
•
CIS is not required to consider any evidence proffered by either party;
•
CIS is not required to meet with either party; and
•
CIS is not required to give the approved provider an opportunity to consider the quality of the evidence to be relied upon by the CIS before they make their determination.
Investigation Scheme (CIS) that an approved provider has
is not made on that basis then
The Investigation Principles are generally considered to impose inadequate requirements on CIS to ensure that determinations are made in an appropriate way. The way in which the investigation will be conducted is entirely within CIS’s discretion. The Investigation Principles do not set out the evidence that the secretary must take into account or state the standard of proof which must be satisfied before the secretary can make a determination that an approved provider has breached their responsibilities.
this may provide a basis upon
Under the Investigation Principles:
which to apply to review that
•
breached their responsibilities under the Aged Care Act 1997 (Cth) or the Aged Care Principles should be made in accordance with the principles of natural justice. If a decision
decision.
CIS is not required to give the approved provider an adequate (or any) opportunity to be heard;
However, because of the nature of the decision, the decision should nevertheless be made with procedural fairness. If CIS make a determination that an approved provider has breached its approved provider responsibilities without consideration of any objective evidence (if for example the matter is determined on the basis only of materials contained in a complaint and without any or any appropriate investigation or without providing the approved provider with an opportunity to respond), then this is a decision made without procedural fairness and probably provides grounds for review.
Procedural fairness It is well accepted that when a statute confers a power upon a public official to make a decision which has the capacity to affect a person’s rights or interests that the rules of procedural fairness must apply to regulate the exercise of that power unless the legislation in question plainly excludes that intention. There is nothing in the Aged Care Act or Principles to exclude the application of procedural fairness. Accordingly while the Investigation Principles provide inadequate direction to ensure that a determination made by CIS that an approved provider has breached their responsibilities is made in an appropriate way, such a determination must still be made in accordance with the rules of procedural fairness (or natural justice). The Aged Care Commissioner (Commissioner) supports the proposition
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that decisions made by CIS must be made with procedural fairness.1 The Commissioner has stated that she will recommend a decision of the CIS be confirmed if the decision is supported by evidence that a reasonable person might accept as adequate to support the conclusion reached and will recommend the original decision be varied when some aspects of the decision can not be supported or ‘where the Commissioner is convinced that a fair minded person, with the same facts before them, could not have reached the same conclusion as those arrived at originally’.2 The rules of procedural fairness are detailed below: •
A right to be heard.
Where the legislation is silent about the extent of the right to be heard (as is the case here) the standards expected of a decision maker are determined by reference to what seems appropriate given the context within which the decision is made. This might vary depending on the circumstances from a full legal trial/hearing to a procedure which simply allows an affected person the right to make a written submission in response to a vaguely formulated statement about an intended decision.
•
A right to know the matters considered by the decision maker.
•
The person who is likely to be affected by a decision must be informed of the kind of matters the decision maker will take into account (although they need not necessarily be informed of the precise nature of the matters which the decision maker might take into account).
•
The decision maker must be (and appear to be) unbiased.
•
The decision must be based upon logically probative evidence.
If the rules of procedural fairness are not followed then this is likely to provide good grounds to request a review of the determination.
Rights of review The Aged Care Commissioner If CIS determines that the approved provider has breached its responsibilities under the
Aged Care Act or Principles, CIS must give the relevant provider written notification of the breach and a statement that it may apply to the Commissioner for examination of the decision under Part 6 of the Aged Care Act. CIS may also give the relevant provider a notice of required action. An approved provider may within 14 days of being told by CIS of a decision, apply to the Commissioner for examination of any of the following decisions: (a) a determination by CIS under section 16A.15 that the relevant provider has breached its responsibilities under the Aged Care Act or Principles; (b) a decision by CIS to issue a notice of required action; or (c) a decision by CIS setting, adding or varying conditions of a notice of required action. The Investigation Principles provide that the Commissioner may examine the decision in the manner the Commissioner considers appropriate. The Commissioner can recommend that CIS reconsider their determination but he has no power to overturn a decision. A failure by CIS to ensure that the determination was made with procedural fairness would provide good grounds for a review. Commonwealth Government Ombudsman The Commonwealth Government Ombudsman also has power to review an administrative decision, such as a determination made by CIS.
If an approved provider believes that a determination made by CIS was made without procedural fairness then, subject to our comments below the approved provider should consider making an application for judicial review under the Administrative Decisions (Judicial Review) Act 1977 (Cth) (ADJR Act). The ADJR Act establishes a right to apply for judicial review of ‘a decision of an administrative character made, proposed to be made, or required to be made, under an enactment’. A determination made by CIS is a reviewable decision under the ADJR Act because: •
it is a decision made pursuant to the Aged Care Act and therefore made pursuant to an enactment;
•
it is a decision which affects the approved provider individually and is therefore administrative in character; and
•
it is not a decision which is excluded from the operation of the ADJR Act.
Under the ADJR Act an application for review can be made by a person who is aggrieved by a decision on a number of grounds, relevantly including: •
That a breach of the rules of natural justice occurred in connection with making the decision.
•
That there was no evidence or other material to justify making the decision.
•
That the decision was made following an improper or unreasonable exercise of the power which might include:
The Ombudsman will examine whether the administrative action is unlawful, unreasonable, unjust, oppressive, improperly discriminatory, factually deficient, or otherwise wrong. At the conclusion of the investigation, the Ombudsman can recommend that corrective action be taken but he has no power to overturn the decision. While an application to the Ombudsman could be made an application for judicial review is probably a better alternative. Judicial review Judicial review in short involves an application to the courts to review a decision made by an administrative body.
– taking an irrelevant consideration into account; – failing to take a relevant consideration into account; or – failing to have proper regard for the merits of the case. There are potentially three ‘decisions’ in respect of which an application for review could be made under the ADRJR Act. They are: •
a determination made by the CIS that an approved provider has breached their responsibilities;
aca Aged Care Australia | Autumn 2010 | 55
CIS, natural justice and rights of review (continued) •
a recommendation by the Commissioner that CIS should vary or set aside a decision that an approved provider has breached their responsibilities; and
•
a decision by CIS to vary, confirm or set aside their original determination.
Given that the Aged Care Act and Principles include an internal review process (namely the application for review by the Commissioner) this review process should be followed before attempting to utilise the review provisions under the ADJR Act. Accordingly the application for review should be made only after the Commissioner has reviewed the decision and CIS has confirmed, varied or set aside the decision. Applications to review administrative decisions under the ADJR Act involve complex jurisdictional issues. An approved provider should obtain legal advice specific to their particular circumstances to determine whether an application for review under the ADJR Act is the most appropriate review mechanism to use in respect of a determination made by CIS and to advise on the prospects of success of such an application. n 1.
Annual Report of the Aged Care Commissioner, 2008- 2009; http://www. agedcarecommissioner.net.au/pdf/08-09-annual-report.pdf.
2.
ibid.
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editorial
Two fascinating stories behind the ACAA annual awards By Mike Swinson Anglican Retirement Villages (ARV), co-winner of the Employer of Choice Award at ACAA Annual Conference 2009 ‘Our staff turnover rates have plummeted as have our injury rates since the introduction of our new industrial award. The results from this award have been phenomenal; it makes you proud to work for such an organisation.’
T
hat’s the view of Mark Aros, the Compliance Manager for Anglican Retirement Villages, (ARV) cowinner of the Employer of Choice Award for 2009. Mark says ‘we are doing a lot of work improving our structures and processes that staff at ARV work with and it’s paying dividends already.’
‘Let me give you an exciting example, well it’s exciting to me! I was in one of our facilities recently and talking to two women; both in their 40’s who are carer’s. In the last 18 months, they were identified as being high performers, reliable and enthusiastic. They have now finished initial training and became clinical supervisors. That’s not all there’s more!’ he said.
easier when what you do is backed by that philosophy,’ said Mark.
•
Staff retention: Pre agreement turnover was at or above 25%. Now it’s down to below 10%
Mark Aros said one of the women is talking seriously about training to become a registered nurse, the other wants to go to university and do Psychology.
•
Injury rates were high, now they are below 3%. Workers Compensation premiums were going through the roof, now with injury rates dropping to low levels premiums will drop.
‘That’s the juice of life to me, it’s exciting to see people motivated, and it’s wonderful to work in an organisation that provides that level of support and encouragement.’ He said there are similar stories from staff at other facilities, others who are closer to 50 years of age, talking about going back to educational institutions to improve their qualifications. ‘Our organisation prides itself on doing the right thing, which makes my job a lot
To the facts and figures that are available from ARV, given that the new award is only 18 months old.
Mark says ‘people are really chuffed about winning the ACAA award, but we also know we are not a perfect organisation. Like anyone we like to be recognised and when it happens resonates throughout the business.’ ‘We are known as an organisation that is always trying to provide better care for our residents and better conditions for our staff. We can’t look after our residents properly if our staff aren’t happy and looked after equally as well,’ he said. >
Like many other employers in the aged care sector, ARV was trying to cope with a staff turnover rate of around 25%. That’s one in four employees leaving every year. The costs of that statistic alone are huge, because it takes a lot of money and time to constantly train new staff, only to have many leave after just a few years. ‘This is not a glamorous industry, it’s hard to attract and keep staff, so we have to make sure that we look after the people we have as best we can. It’s doubly hard because this is not a business that is flush with funds,’ said Mark. In 2008 a new industrial agreement was signed, covering staff from the CEO to casual cleaners and gardeners. Mark Aros says for the first time there are defined career paths for almost every frontline staff member.
aca Aged Care Australia | Autumn 2010 | 57
editorial
Baptcare, co-winner of the Employer of Choice Award at ACAA Annual Conference 2009 ‘We have spent a lot of time positioning Baptcare as an employer of choice because we realised how important our staff are to us. It’s not easy in this industry we are very lean we don’t have surplus funds and we cannot compete with some of the staff benefits that wealthier organisations and other sectors of the economy can.’
M with staff.
eet Thera Storie, the General Manager of HR at Baptcare. It’s a big organisation with over 1,000 employees and like ARV, it’s tough for bigger organisations to keep in touch
Thera says ‘we have worked hard to improve staff satisfaction, to improve our Occupational Health and Safety outcomes. We focus on induction training, performance management that is positive in outlook and on leadership development, combined with organisational life-long learning.’ Life-long learning is one of Thera’s favourite topics. She gets more than a little excited when she shares with me the commitment her organisation has to improving the skills of their people. ‘We employ a full time nurse educator, who visits facilities to train and upgrade staff skills. We also offer centralised leadership training for frontline staff and senior management. It’s about improving their personal leadership abilities,’ she says. Baptcare have a twofold approach to lifting leadership and skill levels. It offers a Diploma in Frontline Management in association with the prestigious Melbourne Business School. The organisation bears all the costs, staff don’t pay anything at all to attend. 60 people have been through the courses and each one takes about 10 working days out of the year. Thera says ‘they give our people a lot of confidence in their ability to lead, because in this industry a lot of supervisors and others are ‘home grown.’ Sometimes they need support to do the job better and to understand just how effective they really can be.’ Thera tells me about the positive reaction of staff to the provision of this type of training. ‘Staff feel incredibly positive because they get a diploma from the Melbourne Business School, that’s no mean feat in itself.’ Baptcare is a broadly based business, providing a wide range of services including; community aged care, residential aged care, a family services division that focuses on foster care, looking after kids with disabilities and families in crisis. The organisations buildings and facilities are geographically scattered. ‘In most cases these managers don’t see each other or know each other. Once they come together in courses like these they become connected and can benefit from sharing experiences and so on,’ says Thera. ‘That cross cultural exchange and connection is vitally important to the success of our business.’ Baptcare have also put 20 managers at DON level through a Graduate Certificate of Management. It’s a post graduate qualification and is recognised if anyone wants to go on and do a Master’s degree. It’s run through the AIM as well. It’s all a part of what Thera says is Baptcare’s commitment to lifelong learning. ‘We also salary package as much as we can, we can’t pay salaries or wages as high as the public sector but we can do our bit to maximise what we can pay. We also offer a truly flexible working environment particularly to parents who want to work part time when their kids are younger. Just like me. I’m part time, although sometimes I do end up working full time when the need arises.’ n
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editorial
EPC and Chronic Disease in Residential Aged Care Carley Strain
Accordingly, effective prevention and management of chronic disease is a key policy and objective of the Australian and all state and territory health systems.
VIVIR Podiatrist and QLD Clinical Manager (cmqld@vivir.com.au)
What is a chronic disease? This paper provides an understanding of the Enhanced Primary Care (EPC) program and its relationship with
The Australian Institute of Health and Welfare (AIHW) provides the following list of elements to define chronic diseases: • •
aged care facilities to provide more preventive care for
•
their residents and improve
•
coordination of care for those with chronic conditions and complex care needs.
P
rofessor John Horvath AO, Chief Medical Officer, Australian Government Department of Health and Ageing wrote in his foreword to the National Chronic Disease Strategy 2005: The World Health Organisation warns that the global burden of chronic disease is increasing rapidly, and predicts that by the year 2020 chronic disease will account for almost three quarters of all deaths. In Australia, the burden of chronic disease and its consequent effect on disability and death is growing in line with this trend. Australia’s health system must be able to respond in an appropriate and cost effective way to this challenge. Failure to prevent, detect and treat chronic disease at an optimal stage in its course impacts on affected individuals and their families and carers in terms of pain and suffering, and on the whole Australian community in productivity losses and high health care costs.
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• •
have complex and multiple causes, usually have a gradual onset, although they can have sudden onset and acute stages, occur across the life cycle, although they become more prevalent with older age, can compromise quality of life through physical limitations and disability, are long term and persistent, leading to a gradual deterioration of health, and while usually not immediately life threatening, they are the most common leading cause of premature mortality.
A chronic medical condition is usually one that has been (or is likely to be) present for six months or longer. It includes conditions such as asthma, diabetes, heart disease, CVD, musculoskeletal conditions and stroke.
What can we do to reduce the burden of chronic disease? With most residents in Residential Aged Care Facilities (RACFs) suffering from one if not many chronic diseases, these statistics warrant continuing action from all involved parties to further improve the quality of life of our residents and to reduce the burden of chronic disease. In 2005, A National Chronic Disease Strategy was formed to focus on preventing and/or delaying the onset of chronic disease and the implementation of best practice prevention strategies. As part of this national strategy, the Enhanced Primary Care (EPC) program was introduced to provide more preventive
care for older Australians and improve coordination of care for people with chronic conditions and complex care needs. The program provides a framework for a multidisciplinary approach to health. It allows a relationship between the GP, the patient/resident and the allied health professional.
EPC explained Residents in RACFs may be eligible for Medicare rebates for allied health services, where a GP has contributed to an aged care resident’s multidisciplinary care plans. This contribution is recognised by Medical Benefits Scheme (MBS) Item 731. Through this contribution, residents may be eligible for up to five allied health visits per calendar year. In Summary:•
Maximum of five (5) services per patient each calendar year. • Medicare rebate of $50.05* per service, with out-of-pocket costs counting towards the extended Medicare safety net. • Patient must have an Enhanced Primary Care (EPC) Plan prepared by their GP. • Patient’s GP will decide which allied health service will be of benefit. • Allied health professionals must be registered with Medicare Australia * Medicare rebates are indexed on 1 November each year. http://www.health.gov.au/internet/main/ publishing.nsf/Content/health-medicarehealth_pro-gp-pdfallied-cnt.htm
MBS Item 731 Item 731 is available for GPs to contribute to a multidisciplinary care plan for a resident of a residential aged care facility. The Australian Government-funded aged care residents are already required to have a care plan prepared for them by the aged care facility (usually on admission or soon after arriving at the facility), so it was deemed appropriate that
the GP’s input to a resident’s care be made by way of contribution to the initial care plan and review of this plan as required. For the GP to be able to contribute to the resident’s care plan and claim Item 731, the resident must have a chronic medical condition and complex needs requiring care from a multidisciplinary team. Once a GP has contributed to a resident’s care plan and item 731 has been claimed on Medicare, the resident is eligible for Medicare rebates for up to five allied health visits each year. The need for allied health services must be identified in the resident’s care plan. It is up to the GP to determine that the resident has a clinical need for allied health services and to determine the type and number of services required by the resident. The recommended frequency of contribution to Item 731 is every six months, with a minimum time between claims being three months.
ITEM NO 731
SERVICE DESCRIPTOR Contribution to a Care Plan or Review of a Care Plan
BRIEF GP GUIDE
- GP contributes to a RACF Care Plan for
resident’s care and records involvement on the Care Plan OR - Reviews a Care Plan and records OR - Contributes to a resident’s discharge care planning by a hospital - If GP has contributed to Care Plan patient is eligible for free allied health services such as physio in RACF - If GP has contributed to or reviewed plan, GP can refer patient to a dentist or dental prosthetist.
MBS REBATES *****
http://www.nevdgp.org.au/files/primarycaresupport/enhancedprimarycare/
Can an allied health professional or family member request an item 731 for a resident?
what their contribution should be. It should not be assumed that all residents of RACFs are eligible for item 731. Eligibility is at the discretion of the GP.
It would not be appropriate for a third party to either request the GP’s contribution on behalf of the RACF or to direct the GP on
A contribution to a care plan for an aged care resident must be at the request of the aged care facility or the discharging hospital.
EPC and Chronic Disease in Residential Aged Care (continued) < Based on the resident’s health care needs, it is the GPs decision to determine the type and number of allied health services required by the resident.
Are high care residents eligible for Medicare allied health services? Some high care residents are eligible for Medicare allied health services. If a high care resident is assessed as having a chronic condition which requires complex care needs then the standard allied health services provided under government funding may not be sufficient for their care needs. EPC allied health visits are intended to augment existing services and add to the health care referral options for high care residents with chronic conditions and complex care needs. They are not intended to replace any standard services that are required to be provided by the RACF as a requirement of the Aged Care Act 1997.
Are low care residents eligible for Medicare allied health services? Yes. Under the Aged Care Act 1997 RACFs are required to assist low care residents to access allied health/therapy services. They are not, however, required to pay for allied health/therapy services provided to low care residents. Low care residents can therefore access the full range of allied health services under Medicare.
Who are the eligible Allied Health Professionals? • • • • • • • • •
aboriginal health workers audiologists chiropractors diabetes educators dieticians exercise physiologists mental health workers occupational therapists osteopaths
• • • •
physiotherapists podiatrists psychologists speech pathologists
Economic benefits of EPC Some economic benefits for residential aged care facilities may include: • Up to five allied health visits per calendar year billed to Medicare rather than RACFs. • Low care residents may be able to claim five treatments per year allowing some residents who may not have accessed allied health previously due to financial reasons, the ability to seek assessment and treatment and receive a Medicare rebate for these visits. • Utilising the services of allied health professionals to help meet accreditation standards. • Allied health professionals can also be useful in pain and chronic wound management. If you would like any further information on anything discussed in this paper, please email info@vivir.com.au. n This article first appeared in the ACAA-NSW eChronicle February 2010
Discover the Cater Care difference.
editorial
End of life decisions – A good policy?
Julie McStay Hynes Lawyers
during the decision making process. While the process is
End of life
undoubtedly difficult for family
decisions are
members it can be equally
extremely
upsetting for employees. This
I
t is imperative that aged care providers have comprehensive policies and procedures in place relating to decisions to withdraw and withhold life sustaining measures. It is also imperative that staff members know and understand the content of those policies. In this article we provide a broad summary of the types of matters that should be considered when developing such a policy.
difficult. The role of an aged
issue is only exacerbated when
care worker towards the end
there is confusion amongst
of life is to provide support
management, employees and
Scope of the policy
and care to the resident,
family members about how
their family and their friends
decisions can be made.
While each state and territory has legislation which deals with the right of substitute decision makers to make health care
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decisions on behalf of person with impaired capacity not every state has legislated to specifically provide the parameters in which decisions about life sustaining treatment can be made for persons with impaired capacity. Accordingly, the policy must accurately reflect the laws in relation to withdrawing and withholding life sustaining measures that apply in the jurisdiction in which the approved provider operates.
Euthanasia and assisted suicide The policy should clearly set out the difference between withdrawing and withholding life sustaining measures, which is lawful, and euthanasia and assisted suicide which are not. A decision to withdraw or withhold a life sustaining measure is a decision to withdraw or withhold treatment which is futile but without which the person will die. Euthanasia and assisted suicide involve deliberate acts or omissions undertaken with the intention of ending a person’s life. The policy should clearly state that euthanasia and assisted suicide are crimes in Australia and that it is no defence to these crimes to allege that the patient gave their consent to the treatment.
Consent and Capacity The policy should: •
Define capacity and set out the procedures to be followed to determine if the adult has capacity to make the decision themselves.
•
Define consent and acknowledge that the way in which consent (including consent for a decision to withdraw or withhold a life sustaining measure) is given is dependent on whether the adult has capacity to make the decision.
•
Acknowledge that decisions about withholding or withdrawing life sustaining measures are complex decisions and the adult’s capacity to make such decisions should be correspondingly high.
Decision making - adults with impaired capacity Generally decisions about medical treatment for adults with impaired capacity are made in one of three ways: • • •
in accordance with an advance directive completed by the adult before they lost capacity; by a tribunal or a court; or by a substitute decision maker.
As stated above, the law in each jurisdiction in Australia with respect to the specific ways in which decisions to withdraw or withhold life sustaining measures for adults with impaired capacity can be made, differ from state to state. To the extent to which advance directives can be used for decisions to withdraw or withhold life sustaining measures in the jurisdiction in which the provider operates, a comprehensive policy and procedure should state: •
that the directive will only operate when the adult lacks capacity;
editorial
End of life decisions – A good policy? (cont’d)
Palliative Care
•
the validity of any advance directive;
There is often confusion about the consent procedures that should be followed once the resident has entered the palliative stage of their care. The policy and procedure should confirm that palliative care is medical treatment and consent is required for all types of palliative care which can include decisions:
•
a valid exercise of power by a substitute decision maker; or
•
any dispute or conflict as to who has power to make the decision on behalf of the adult.
•
to withhold life sustaining measures (such as CPR);
•
to withdraw life sustaining measures (such as artificial hydration and nutrition);
the treating medical practitioner records the basis on which the decision to withdraw or withhold the life sustaining measure was made;
not to commence new treatments (such as the administration of antibiotics); or
•
the following documents be kept on the resident’s file:
to take or not take particular course of action (such as calling an ambulance).
•
notes of all discussions with the resident, their family members or substitute decision makers;
•
all case management and case conference notes;
•
particulars of all correspondence and recommendations made by the resident’s health practitioner; and
•
if applicable, a copy of the advance directive.
the minimum requirements for a valid directive; and
•
•
any limits on the circumstances in which the advance directive can be used in the particular jurisdiction.
to commence new treatments (to achieve greater pain relief or allay anxiety);
• •
•
•
•
•
Details of any limitations particular to the jurisdiction in question on the circumstances in which a substitute decision maker can make a decision about withdrawing or withholding a life sustaining measure. A direction to staff to ensure that they understand that substitute decision makers must be given honest information about the resident’s condition and about the consequences of any decision to withdraw a life sustaining measure in language they will understand. Details as to who might be eligible to act as a substitute decision maker and if the relevant legislation sets out a hierarchy to be followed to determine who might be eligible to act, details of that hierarchy. A direction to staff as to how a dispute between two or more apparently eligible substitute decision makers should be resolved. In some states there is specific direction in the relevant legislation as to the process that should be followed in these circumstances.
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The policy and procedure should state that if the adult has capacity then all decisions made about palliative care (including decisions to withdraw or withhold life sustaining measures) can be made by the adult and if the adult has impaired decision making capacity then the decision needs to be made in accordance with an advance directive (if there is one) or otherwise by a substitute decision maker.
The role of employees The policy and procedure should confirm: •
The policy and procedure should set out the requirements with respect to record keeping. Again the requirements will differ between jurisdictions but as a minimum providers should direct that: •
•
To the extent that there is provision for a substitute decision maker to make a decision about withdrawing or withholding a life sustaining measure in the jurisdiction in which the provider operates, a comprehensive policy and procedure should include:
Documentation
That under no circumstance can an employee, volunteer or agency worker: •
act as a substitute decision maker for any resident; or
•
consent to the provision or the withdrawal or withholding of any medical treatment for any resident.
•
That the role of the employee is to provide support and care to the client, their family and friends during the decision making process.
•
That employees should inform their line managers if there is any instance in which there is uncertainty as to: •
a resident’s capacity to make a decision to withdraw or withhold a life sustaining measure;
The laws relevant to end of life decision making are complex. Providers should obtain legal advice before implementing a policy or procedure which covers this topic to ensure that the content is compliant with the laws in the jurisdiction in which the provider operates. n
1.
Guardianship Act 1987 (NSW); Guardianship and Administration Act 2000 (Qld); Powers of Attorney Act 1988 (Qld); Guardianship and Administration Act 1993 (SA); Guardianship and Administration Act 1995 (Tas), Guardianship and Administration Board Act 1986 (Vic); Medical Treatment Act 1988 (Vic); Guardianship and Administration Act 1986 (Vic), Guardianship and Administration Act 1990 (WA); Guardianship and Management of Property Act 1991 (ACT), Medical Treatment (Health Directions ) Act (ACT) 2006; Adult Guardianship Act 1988 (NT).
2.
Guardianship and Administration Act 1998 (Qld) s42.
The Power of ‘Hello’ The Africa Connection Part 2 of this fascinating story Mike Swinson
conference, to raise much needed money for the EMSENi African home.
This remarkable story continues
Judy said she realised that the home, and others like it, needed far more than just a brief injection of funds. ‘They needed support and encouragement, as well as some financial support.’
to unfold and grow.
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s I wrote in a recent ACAA magazine, it is a story of chance, of goodwill, of connection, of the power of story telling and is a classic example of how fast our world is shrinking. In case you are new to what has gone before, let me go back in time and paint you a brief picture of what Judy Martin, Business Development manager with architectural firm ThomsonAdsett, and the organiser of the well respected SAGE Aged Care Tours, was doing in Africa, and why you should read on. The chance meeting that occurred in a remote part of Africa has led to the development of an International Aged Care global partnership program. It all happened near the stunningly beautiful Drakensburg Mountains. Judy Martin, her husband Peter and teenage children Josh & Jess were visiting an area known as ‘Rorke’s Drift’ the site of an historic battle between British soldiers and Zulu warriors. Judy and Jess were walking along a dry, dusty road and met two Zulu women, who were walking to work at a nearby aged care home. Judy’s husband, Peter, had gone off in the vehicle to visit the nearby battlefield. All it took was one of the Zulu women, Jabu, to say ‘Hello’ (in Zulu) and the remarkable connection began. Judy’s family was invited to go over and visit the Old persons home, which they did. While there, they discovered that the home’s matron was being sent to the same international aged care conference in London that Judy was going to a week later. To cut a long and intriguing story short, Judy and the Australians on the SAGE Tour got together and ran a ‘chook raffle’ at the
The EMSENi home’s matron, Marigold was booked to showcase a poster presentation on her aged care home at the conference. Those who visited the exhibition were visibly and emotionally affected by the images they saw. ‘Marigold’s humble commitment to care for the poor and elderly in rural South Africa is amazing. She runs a home in an extremely remote area and provides “meals on foot” to rural villages, meals at night for children orphaned by AIDS and a community health program with little or no funding,’ said Judy. ‘But she provides all this with an enormous passion to help. I thought, as did others, that it was time to organise some long term support.’ Inspired by this turn of events IAHSA are now building on the opportunity by establishing an International Global Linking Program through which organisations across the International Ageing network can link up to help those Aged Care Homes that are less fortunate. This story is not just about money. While monetary input would make a huge difference to the way this, and other aged care homes operate, what Judy Martin and the growing band of supporters hope to do, is to transform the human spirits capacity to persevere against the odds. Judy says ‘now they know they are not on their own, doing what they do, it will make a tough life seem easier.’ The Global Aged Care Partnership Program has been launched out of IAHSA Head Office in Washington. Already Australian aged care providers are lining up to be involved.
•
Arcare. Kay Foster, the Chief Operations Officer said ‘we want to be involved in this exciting program. We are very lucky in this country and our team of 1500 staff are very keen to share what we can. It’s early days yet, we will certainly become closely involved with the aged care home, in South Africa that we have been linked with called EMSENI.’ >
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editorial
The Power of ‘Hello’ (continued)
•
St Joseph’s from Sydney and its CEO Lyn Bruce. (Lyn is the lady behind the organisation of the ‘chook raffle’) ‘We have raised over $2,500 at Xmas, equipment we don’t need is being put aside, and we are investigating staff transfers,’ said Lyn. ‘We are not flush with funds, but we will do what we can.’ St Josephs have been linked to the Issy Geshen Lamont home in Durban and already correspondence is flowing back and forth across the Indian Ocean.
•
Eldercare from South Australia have said ‘we are in.’ Klaus Zimmerman, the CEO said ‘we have about 1000 staff members and looking at providing equipment, staff transfers and financial support to the Elon Wabeni home in Kokstad.’
•
The Aged Care Channel is another organisation investigating possibilities.
‘We all keep saying “the world is a smaller place” …and it is!’ says Judy. ‘Since the trip I have been involved through emails and teleconferences with the CEO of IAHSA in Washington, Ginger Nuessle and with Margie van Zyl from one of South Africa’s peak aged care bodies. ‘It’s made me realise that I cannot email EMSENi, the aged care home we are supporting- they don’t have that facility available. A computer is too expensive to own. The only way I can contact them is through snail mail, a good old fashioned letter, envelope and stamp and it can take weeks to get there,’ said Judy. ‘We have some of the best care facilities in the world, so establishing linking or pen pal’s or even sending volunteers over to Africa to help in these small, impoverished nursing homes could make an amazing difference in their capacity to survive and the provision of basic care. Not to mention the extra financial support we can provide where possible,’ says Judy. As we mentioned in the first story, in Australia the channelling and matching of facilities is being done through the industries two peak bodies, ACAA and ACSA. Internationally it will be handled through IAHSA. In the next magazine I will talk extensively to Margie Van Zyl from South Africa and to Ginger Nuessle from IAHSA. I know we can expect exciting developments. Now comfortably back in Australia, Judy Martin still marvels at the chance encounter that’s opened so many doors and the power of a brief ‘Hello!’ ‘It’s amazing to think that a single unplanned, random conversation on a dusty road in the middle of nowhere can be a ripple that starts a global outreach. If we get this right, that one lucky encounter can change the way we care for older people all over the world - and change it very much for the better. ‘Just imagine how good that could be,’ she said. If you are interested in being part of this special program, email your industry peak body, either ACAA or ACSA. n
editorial
Let’s talk about dying: what is appropriate care? Prue Power
Executive Director Australian Healthcare & Hospitals Association
The Australian Healthcare and Hospitals Association (AHHA)1 has recognised the importance of this fundamental issue and invited Palliative Care Australia (PCA)2 to join with us in discussing End of Life issues at a Think Tank held Friday 19 February.
A key step to building an effective health system is a change in culture and attitudes: better planning for end of life, better support for the right care options, and better resources to enable access to that care. Ken Hillman puts the problem like this: we have developed conventional medicine over centuries. More recently, the preventative health sector has attained equal status. But to complete the cycle, the system also needs to include a sector for ageing, dying and death. However, this does not mean that another specialisation should be developed. Rather, palliative care must be woven into all professional practice and training.
All Australians ought to be able to expect to die with their preventable pain and other symptoms well managed, with the people they wish to be present, and whenever possible, in the place of their choice.
A properly resourced aged care sector is central to ensuring many people do receive appropriate care at the end of life. People are entering aged care in a considerably more frail state and, on admission, many relatives say they just want their family member to be comfortable and pain free. However, when an episode occurs, often the family is called and they make the decision to send their loved one to hospital. Aged care facilities need to be supported to provide the full spectrum of care at the end of life when possible, with additional funding required to employ more staff with specific skills, and more on-call back-up from primary and community care. For example, GPs could provide access for writing orders (eg around medications) and an afterhours service if the facility does not have a doctor on site. With such supports in place, the family can be confident that their loved one will die in their preferred space with the best care available. Hospitals should be the last resort.
Our guest presenters at the Think Tank, Professor Jane Ingham and Professor Ken Hillman3, are highly experienced in these issues and led a discussion around what reforms are required to ensure that people die
Hospitals are NOT the appropriate setting for the dying. Hospital doctors and other clinical staff have a duty of care, which in hospitals is about curing people and keeping them alive.
T
he National Health and Hospitals Reform Commission report recommended reform of services for the aged and chronically ill at the end of life. But the final recommendations have not gone far enough, especially in relation to articulating the impact on service integration and demand for care. In an era of increasingly complex medical technologies and consequent choices, it’s time to refocus the debate on the right of all Australians to receive high quality palliative and end-of-life care regardless of their diagnosis or prognosis, location, age, income, and social and cultural background.
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“
It’s time to refocus the debate on the right of all Australians to receive high quality palliative and end-of-life care
in the most appropriate setting where care gives comfort, support and relief from pain.
”
Of course, there are many other issues which must be considered in making serious reform and space does not allow me to go into detail here. These include professional training, workforce development and relevant data collections which measure appropriate indicators and set benchmarks for improving care at the end of life. As a society and as health professionals we need to overcome some of the more difficult concepts around mortality and quality of life, and actually start talking openly about it as consumers, professionals and family members. n 1.
The AHHA is the voice of public healthcare. We are the only national organisation representing the public healthcare sector across the continuum of care, including hospitals, area health services and community health services.
2.
PCA is the national peak body established by the collective membership of eight state and territory palliative care organisations and the Australian and New Zealand Society of Palliative Medicine.
3.
Professor Jane Ingham is Director of the Cunningham Centre for Palliative Care, St Vincent’s and Mater Health Sydney, and Professor of Palliative Medicine at the University of NSW. Professor Ken Hillman is the Clinical Director, Area Critical Care Services, Sydney South West Area Health Service, Liverpool Hospital. Ken is also Professor of Intensive Care, and Director of The Simpson Centre for Health Services Research, affiliated with the Australian Institute of Health Innovation, at the University of New South Wales.
editorial
Endeavour Awards The Endeavour Award is the Australian Government’s internationally competitive, merit-based scholarship program providing opportunities for citizens of the Asia-Pacific, Middle East, Europe and the Americas to undertake study, research or professional development in Australia. Awards are also available for Australians to do the same abroad.
A
ustralia’s leading healthcare professionals and academics have a unique opportunity to combine research or professional development with a rich international cultural experience through the Australian Government’s Endeavour Awards. This internationally competitive, merit-based scholarship program provides generous funding for up to 6 months for candidates to undertake postgraduate or postdoctoral research in any field of study. The Endeavour Awards also allow candidates to undertake professional development across the region for a period of up to 4 months through the Executive Awards. These awards focus on building skills and knowledge through professional development activities such as intensive management training, peer-to-peer learning and short-term courses. Host organisations can include but are not limited to government agencies, research centres, universities, VET providers, private companies and not-for-profit organisations. Being a host institution can enhance and strengthen your organisation’s international networks and develop professional and academic linkages for ongoing professional collaboration. Australian organisations are also able to host international candidates for the above awards. Professionals from the Aged Care sector are encouraged to apply, with the 2011 round opening on Monday 5th April 2010 and closing on Saturday 31st July 2010. Visit www.endeavour.deewr.gov.au for further information.
ENDEAVOUR CASE STUDY: Dr Dilhani Bandaranayake – Endeavour Executive Award Dr Dilhani Bandaranayake is the Manager of International Relations at the Office for Global Health at the University of Sydney. She has been working consistently over a number of years in the field of health research both in Australia and New Zealand, having completed postgraduate study in Public Health and a PhD in skin cancer research. Dr Bandaranayake applied for an Endeavour Executive Award in a bid to build on existing relationships with key figures in health, policy and education in East Timor. She was hosted for six weeks by the Dili National Hospital (Ministry of Health) while she conducted an in-country assessment of a critical care training program the Office for Global Health is implementing in collaboration with Dili National Hospital and the Institute of Health Sciences.
Dr. Dilhani Bandaranayake with President Jose Ramos Horta of East Timor.
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Besides a series of high-level meetings with government officials and health professionals, Dr. Bandaranayake also was involved in the co-ordination and running of the University of Sydney’s critical
care skills workshops at the Dili hospital. The workshops went so successfully that she had a meeting with President Ramos Horta to discuss the possibility of expanding the program or initiating other similar programs. On top of all this she also had the opportunity to take Tetum language classes!
ENDEAVOUR CASE STUDY: Leigh Williamson - Endeavour Research Fellowship Leigh came from a background in international development having completed an undergraduate degree specialising in Development Studies. She had a particular interest in public health within the context of international development. Leigh also had an interest in mental health issues which led her to complete counselling training through Lifeline.
Leigh pursued her interest in public health policy in relation to mental health issues by becoming involved with BasicNeeds, a non-government organisation (NGO) working out of India addressing the health and development concerns of people affected by mental illness, including access to necessary treatment and addressing social discrimination. She went on to apply for an Endeavour Research Fellowship, to conduct research on behalf of the organisation, and also to form a basis of her PhD, which she is currently completing. Leigh was hosted by the National Institute of Mental Health and Neuroscience (NIMHANS) in Bangalore for six months. The fieldwork that she undertook included a number of interviews with community workers and psychiatrists and focus-group discussions with family members of mentally ill individuals. The focus of her work was the gendered issues of the Indian mental health system, in a bid to contribute to more
“
This program provides generous funding for up to 6 months for candidates to undertake postgraduate or postdoctoral research in any field of study.
�
gender-sensitive community- based mental health programming.
Since having completed her award, Leigh has returned to Australia to continue her PhD, but has maintained close connections with her co-workers in Bangalore. She hopes to return to India to work with her former supervisor, who has expressed keen interest in collaborating on further research. She has also been in contact with an NGO in the hope to implement workshops for women dealing with the issues of mental illness in the near future. n
editorial
Industry Feedback ACAA have embarked on a new and exciting section in this
Dear Janene, Brenda and staff of Ashleigh House
magazine that will allow you,
I would like to thank you all so very much for the loving way in which you all contributed to the care of our mum, nanny and great grandmother, Patricia. Right from the start when she entered Ashleigh House for respite care I knew that she was going to be well cared for. It was not easy for mum and dad when it all began almost two years ago or as Des says 22 and a half months ago! However, both quickly adapted to the loving and caring environment of Ashleigh House and there began what proved to be the final chapter of their love affair.
our readers, to share ‘Good News.’ Feedback letters from clients, happy staff emails, it can be anything that is to do with our business, the business of caring for frail and older Australians.
T
his letter comes from Craig Sutchbery, General Manager – Sale Elderly Citizens Village (Ashleigh House Residential Aged Care Facility):
Dad has always spoken most highly of the care provided not only to nanny but to all residents in general. I operate a program where I teach in Melbourne which takes errant behaving boys to local nursing homes to visit residents. This proves to be a very positive experience for these boys and gives them a different take on life to what they see in their daily lives. Nursing home / hostel care in Melbourne varies greatly in the way it is conducted. I am yet to find one that has the same sense of feel about it as does Ashleigh House. There are bigger, new and more expensive ones in Melbourne but they lack the spirit which one finds at Ashleigh House. I can honestly say that in all my visits to Ashleigh House there was never anything which gave me cause for concern about the care mum was receiving. So thank you all once again for all of the time, care and love you gave to mum. Thank you for the freedom which you gave to us who visited her. Thank you very much for the 500 or so cups of tea and coffee and the Monte Carlo biscuits which were mine and mum’s favourite!!!!!!!!!!! May God continue to bless you all in your work. Take care of yourselves as you do of your residents. Peter and Leigh Surkitt and families.
ACAA would like to encourage anyone who works in the industry to submit their positive feedback received from clients and their relatives for publication in future editions of Aged Care Australia. ACAA will be recognising the best client response at the 29th Annual Congress to be held in Adelaide on 14 – 16 November 2010. Submissions can be emailed to editor@agedcareassociation.com.au
Noble exhibition reveals artists at any age Art exhibitions are often impressive enough. You might think, “how did they learn that”, “I could never do that” or “I can’t paint.”
S
o what if the artists had never painted before… and are residents in an aged care home? The exhibition becomes a noble and magnificent achievement indeed! TLC Aged Care’s Noble Manor in Frank Street, Noble Park held its second annual weeklong art exhibition from November 25 - December 2, 2009, featuring the works of many residents who have never painted before. As well as many individual pieces, a group painting – titled Up, Up and Away – will be unveiled featuring bright and colourful hot air balloons with the faces of the contributing residents set inside the balloons. The painting is set to become part of the décor at TLC Aged Care Noble Manor.
Jenny is Bert’s Siede’s daughter and while Bert is no longer with us, the Memorial Prize recognises his love of painting. “When dad came to Noble Manor,” explains Jenny, “knowing his interest in painting I suggested we could perhaps paint together. In a short time there were other residents interested too and soon we had a regular class underway.
Mrs Jenny Leaper, (TLC Director and owner), Ms Ingrid Williams (CEO) and Mrs Jenny Croom (Art teacher and volunteer) present the Bert Siede Memorial Art Prize to resident Peter Highland
The TLC Aged Care activities and lifestyle team is behind the exhibition supported by volunteer artist and teacher Jenny Croom.
“The residents are wonderful and it’s terrific to see the excitement and pleasure that can come from doing a painting. I’ll often hold the finished work in front of a commercial piece on the wall to show them what it would like on the wall and in a frame.”
Residents who participate in the exhibition also receive a certificate acknowledging their efforts.
“We have a regular Tuesday afternoon painting class with some music playing in the background,” explains Jenny, “with between six and 15 people attending, depending on how they’re feeling. None of the people coming to class have any background in painting; so saying ‘I can’t paint’ isn’t a problem. I say we’re not trying to do a painting but just make a bit of a mess and have some fun,” she laughs. The exhibition includes the annual Bert Siede Memorial Art Prize for the best piece of art submitted and the 2009 prize was awarded to resident Peter Highland.
The exhibition opened on November 25 with many of the frames donated by friends, family and TLC Aged Care Noble Manor. “There are many semi-abstract pieces and these works come up beautifully when framed. If they were professionally framed and hung in an art gallery, I’m sure they would sell for high prices. Some residents have contributed two or three pieces, while others have got the painting bug and completed ten and 12 pieces,” said Jenny.
“There’s quite bit of subdued pride and excitement among the residents. These are people who’ve never painted before and now here’s something they have painted that’s very impressive,” said Jenny. “It’s fabulous that people in their later years who are no longer living at home are able to start something new.” The art classes have gratefully welcomed the help of students completing work placements. As class numbers have grown, Jenny’s talents have been stretched so with some keen students on hand, residents have some extra artistic help when needed. n
aca Aged Care Australia | Autumn 2010 | 75
events
2010 Calendar of Events 16 – 18 March
16 – 18 April
16 – 18 April
ACQI State Conference & Trade Exhibition
Ageing with Attitude Expo
The Inaugural International Advance Care Planning Conference
T: 07 - 3725 5588 F: 07 – 3715 8166 E: events@acqi.org.au www.acqi.org.au
Claremont Showgrounds Organised by True Blue Exhibitions in partnership with Aged Care Association Australia WA T: 08 9387 5979 M: 0417 969 126 E: mareene@trueblue-exhibitions.com.au
Melbourne Contact: Arinex Tel: 03 9417 0888 Fax: 03 9417 0899 www.internationalacp2010.com
20 & 21 May
17 – 18 June
26 & 27 July
ACAA – NSW Congress
ACCV State Congress
ITAC 2010
Sheraton on the Park, Sydney T: 02 – 9212 6922 E: admin@acaansw.com.au www.acaansw.com.au
Melbourne T: 03-9805 9400 F: 03-9805 9455 E: events@accv.com.au www.accv.com.au
Information Technology in Aged Care 2010 The eHealth Revolution Contact: ITAC 2010 Conference Office Health Informatics Society of Australia E: itac2010@hisa.org.au T: 03 9388 0555 F: 03 9388 2086 www.itac2010.com.au
14 – 16 November ACAA 29th Annual Congress Contact: Conference Solutions T: 02 6285 3000 E: acaa@con-sol.com www.acaacongress2010.com.au
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Such Wealth! Silver in the Hair Gold in the Teeth. Stones in the Kidneys Sugar in the Blood. Lead in the Feet. Iron in the Arteries. And an inexhaustible supply of Natural Gas. We never thought we’d accumulate such wealth.
product news
FM Innovations
W
ith much anticipation FM Innovations has just released WSMenterprise version 4.6. This new software release builds on the already robust foundations to create an innovative solution to meet your facilities needs. With FM Innovations new Contract Management module no matter what the area your property is in need of improving FM Innovations has solution to meet your need. FM Innovations® is the only facility management software company to take your facilities and property management objectives, develop measurable key
performance indicators around them and customise a building or property management software system that measurably helps you achieve those objectives. FM Innovations® develops sophisticated management software solutions that are easy to use in order to manage the ever-increasing complexity of the FM and property management industry. Determination, commitment to quality and our innovation has put us at the forefront of the FM software industry. If you are a Aged Care Provider, Government Organisation or Not for Profit, FM Innovations have a designed our WSM software solution to suit your current and future needs. FM Innovations® have built into WSM “implied intelligence”, creating
a new benchmark when it comes to facility management software. WSM delivers automation, information flow, and detailed operational statistics with graphs for executive level reporting in a customisable database that is easy to use. Each WSM module has an intuitive interface and user-friendly design that is robust enough as a standalone operation, integrates with each module and/ or integrating with your existing systems. At FM Innovations we proudly provide solutions to suit your needs. Contact us now for a FREE demonstration of WSMenterprise 4.6 direct to your desktop now on 03 9600 1646 or sales@fminnovations.com.au
TIME TO SHINE FOR AUSTRALIA’S BEST NURSES
Strait Islander child in her care begins life at the starting line, and not behind it.
J
Melbourne’s Jamie Rutherford won the Innovation in Nursing category for his work slashing dialysis times for ABO incompatible transplant patients, and Tasmania’s Stav McDevitt won Graduate Nurse of the Year.
udging for the 2010 HESTA Australian Nursing Awards has now commenced.
A total of $25,000 in prizes across the categories of Nurse of the Year, Innovation in Nursing and Graduate Nurse of the Year is being provided by major sponsor ME Bank. HESTA CEO, Anne-Marie Corboy, is excited to say that more than 1,400 nurses Australia-wide have been nominated since the awards began in 2007. “This is the fourth year of the HESTA Australian Nursing Awards and the calibre of the nominations continues to impress,” Ms Corboy said. “The nominees demonstrate the skill, inventiveness and courage to be found in the nursing profession. “The awards also tap into a community desire to thank nurses for the extraordinary work they do every day.” Last year’s awards finalists included a children’s heart transplant coordinator from Melbourne, a graduate nurse who developed an Aboriginal mental health service in Adelaide, and a rehabilitation nurse who become a respite carer for a teenage assault victim in Darwin. The Australian Nurse of the Year award went to Victorian Lyn Olsen, a midwife working to ensure every Aboriginal and Torres
Prizes include a $5,000 travel voucher and $5,000 education grant for the Nurse of the Year, a $10,000 research grant for the Innovation in Nursing winner, and a $2,500 travel voucher and $2,500 education grant for the Graduate Nurse of the Year. Finalists will be flown to Melbourne for a gala awards event at Crown Entertainment Complex on Thursday 13 May 2010. HESTA has more than 650,000 members and $14 billion in assets, and is the fund more people in health and community services choose. ME Bank is proud to support the event for the third consecutive year. “The awards allow ME Bank to formally recognise those who excel in the critical and demanding occupation of nursing,” said ME Bank Head of Corporate Affairs, Tony Beck. To purchase event tickets, visit www.hestanursingawards.com Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL 235 249 regarding HESTA Super Fund ABN 64 971 749 321.
aca Aged Care Australia | Autumn 2010 | 79
product news
Food Safety Compliance made Easy
H
ow do you know that the food you serve your clients is safe to eat and free from any contamination? Vulnerable people in our community such as the elderly, the sick and the very young, must be protected from poor practices in food handling that can result in food poisoning incidents. Food safety training is a critical component for any food business to make sure that all staff know how to follow procedures that ensure the safety of food. All aged care facilities, hospitals, hostels, and Meals on Wheels organisations, need to have an accountable process from the purchase of raw ingredients to the finished meal. They
CFT International is a leading provider of food safety training throughout Australia and specialises in food safety training for the health and community services industry sector. CFT delivers training online, in face-to-face classes, in-house classes and by distance learning. Training is delivered to make sure that all the important and required issues are covered, but in an easy-to-learn manner to make it suitable for all students to understand and complete. Nationally-recognised certificates are issued to successful participants with the codes of HLTFS207B, HLTFS310B and HLTFS309B. These three units combine to qualify staff as the Food Safety Supervisor in the health and community services industry sectors and are mandatory most Sates of Australia.
A
recent study done in Perth through Alzheimers WA has shown that Wu Tao Dance which uses a combination of dance, music and relaxation techniques, reduces symptoms of agitation in people with moderate to severe dementia. Residents (with dementia) from a low care facility in WA, participated in a series of weekly Wu Tao Dance sessions in early 2009 and were monitored to identify changes. The results were impressive with participants showing a significant decrease in agitation symptoms and an increase in relaxation and sense of well-being. Wu Tao Dance Therapy has now been introduced into a number of aged care facilities in WA with both residents and staff enjoying the benefits of its unique combination of dance, music and meditation. As baby boomers age and the senior population swells, more people than ever before are being faced with the impact of aging on the brain. Finding non pharmaceutical methods of treating the symptoms of dementia is fundamental to successful management of dementia care and the health and well-being of the person with the disease. Why is dance a good form of exercise? Recent research has shown that dance is associated with a lower risk of dementia (published New England Journal of
Autumn 2010 |
aca Aged Care Australia
Experts in Occupational Hand Hygiene
D
eb has recently released a new skin care range dedicated to the Aged care sector.
The range consists of a mild foaming hand soap, Alcohol Foam hand sanitiser, moisturising cream and a complete 3 in 1 shampoo, conditioner and body wash. All products are designed to be used in easy to use dispensers. Deb Australia & New Zealand Tel: (02) 9794 7700 www.deb.com.au
Contact CFT International at online@cft.com.au or phone 1300665 633 for more information and assistance.
Wu Tao Dance Training Course now Available
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need to keep records and traceable processes which meet compliance requirements.
Medicine 2005). The mentally challenging aspects of dancing, ie following dance steps, moving and staying in time with the music is believed to be responsible. The study involved a group of men and women over the age of 75. Wu Tao is a dance therapy developed by Australian dancer Michelle Locke. Based on similar principles to Tai Chi, it increases energy flow through the body, stimulates blood flow and reduces stress. Wu Tao is easy and enjoyable to do. Wu Tao is a treatment option that can be easily incorporated into the lives of older people, with benefits that can enhance the lives of all involved. Wu Tao can now be easily integrated into the therapy or activity program of any facility through the Wu Tao Stretch and Relax™ Program. The flowing exercises have been developed to give participants a gentle, energising physical and mental workout in approximately 40 minutes and helps participants to increase body awareness through movement, stimulate blood and energy flow, increase muscle tone, strength and flexibility, reduce stress, depression and anxiety, increase relaxation and improve cognitive ability. The Stretch and Relax On-line Training Course has been especially developed for health professionals working with people who may be experiencing physical challenges, cognitive impairment, dementia and other symptoms associated with aging or disability. The training can be done in your own time and doesn’t require you to take time out of work. As well as improving the health of your clients, Wu Tao will also improve your physical and mental health returning you to a state of inner peace, balance and well-being. Wu Tao is a therapy that improves the health and well-being of people everywhere. Call Michelle 0417 989 397 email info@wutaodance.com for more info. Refer to ad on page 74 of this issue.