LASA Autumn 2013

The voice of all aged services Autumn 2013 | www.lasa.asn.au

Information Technology in Age Services – ITAC Special Edition

– Robotics: Keeping Families Connected 3 Million Reasons

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UK Digital Healthcare Policy

19

LASA Response:

48

OECD: 1st Expert Consultation

54

to Support our Age Services Workforce

Driving New Models of Care

Workforce Compact

on Integrated Services and Housing

The voice of all aged services Autumn 2013 | www.lasa.asn.au

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63 National Update 5 7 8 10 12 14 15

CEO Report Chair Report SA Report NSW Report VIC Report QLD Report WA Report

27 31 33 35 36 39 41

Profiles 17 Sci-Reality?

43 44

Technology 19 UK Digital Healthcare Policy Drives New Models of Care and Support 22 Integrating Clinical Data

EDITOR Patrick Reid PRODUCTION Justine Caines LASA Federal Patrick Reid CEO, Unit 4, 21 Torrens Street Braddon ACT 2612 Tel: (02) 6230 1676 Fax: (02) 6230 7085 Mobile: 0417 518 103 E: gerardm@lasa.asn.au LASA New South Wales/ACT Charles Wurf CEO PO Box 7 Strawberry Hills NSW 2012 Tel: (02) 9212 6922 Fax: (02) 9212 3488 Mobile: 0419 231 056 E: Charles.wurf@nswact.lasa.asn.au

QPS Benchmarking Report Measure IT eCase Medication The Gamification of our World Aged Care Industry IT Roadmap ACIVA Report Providers must lead PCEHR to facilitate Consumer Centric Care What’s in it for me?

ITAC 2013

GENERAL 47 LASA National Roadshow 48 Response to the Workforce Compact

52 Aged Care Reforms 54 OECD 59 What about men?

63 From institution to inspiration 66 Epilepsy Action Australia 68 NDIS could be a game of luck 69 RACF and assisted registration 70 Years of thought go into aged care 71 Book Review 72 Staffing Headaches?

73 Calendar of Events 74 Product news

LASA Victoria John Begg CEO Level 7, 71 Queens Road Melbourne VIC 3004 Tel: (03) 9805-9400 Fax: (03) 9805 9455 Mobile: 0417 562 579 E: peterb@vic.lasa.asn.au

LASA WA Beth Cameron CEO Suite 6, 11 Richardson Street, SOUTH PERTH WA 6151 Tel: (08) 9474 9200 Fax: (08) 9474 9300 Mobile: 0437 488 364 E: amarcher@wa.lasa.asn.au

LASA SA Paul Carberry CEO Unit 5, 259 Glen Osmond Road Frewville SA 5063 Tel: (08) 8338 6500 Fax: (08) 8338 6511 Mobile: 0403 809 713 E: ceo@sa.lasa.asn.au

LASA QLD Nick Ryan CEO PO Box 995 Indooroopilly QLD 4068 Tel: (07) 3725 5555 Fax: (07) 3715-8166 Mobile: 0418 881 538 Email: nick.ryan@qld.lasa.asn.au

Adbourne PUBLISHING

Adbourne Publishing PO Box 735 Belgrave, VIC 3160

Advertising Melbourne: Neil Muir (03) 9758 1433 Adelaide: Robert Spowart 0488 390 039 Production Emily Wallis (03) 9758 1436 Administration Robyn Fantin (03) 9758 1431 Marketing Tania Lamanna (03) 9500 0285

DISCLAIMER Fusion is the regular publication of Leading Age Services Australia. Unsolicited contributions are welcome but LASA reserves the right to edit, abridge, alter or reject any material. Opinions expressed in Fusion are not necessarily those of LASA and no responsibility is accepted by the Association for statements of fact or opinions expressed in signed contributions. Fusion may be copied in whole for distribution among an organisation’s staff. No part of Fusion may be reproduced in any form without written permission from the article’s author.

National Update | 5

Report from the CEO Patrick Reid Chief Executive Officer | Leading Age Services Australia

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n the last edition of Fusion, outgoing CEO Gerard Mansour reflected that he was confident that LASA is perfectly positioned to develop age care reform. I agree with Gerard and thank him for his dedication and commitment to the industry, and in particular, his role in establishing LASA as the peak body for all age services.

As a Registered Pharmacist, I do not come from the age services industry, however, from this work I have developed a strong understanding of the needs of older Australians and the challenges and opportunities facing providers. Having grown up in Canberra, I understand and enjoy the pace of the federal parliament, having many interactions with federal politicians in my role as National Vice-President of the Pharmacy Guild of Australia for over a decade.

When I accepted this role, I understood that 2013 would be a pivotal year. The review of the Aged Care Act presents our industry with a huge opportunity. Combined with an election year, this review enables LASA to assess how Living Longer Living Better has performed and advocate for key legislative amendments to give providers greater certainty and allow them the space to nurture and grow their business. Such a comprehensive review of legislation occurs at best once in a decade. As a result, LASA partnered with Hynes Lawyers and brought you a national road show advising of the proposed changes to the Act, and the possible consequences and discussion regarding the way forward. I enjoyed meeting members from across the country at these very well-attended sessions and thank you for making the time to participate.

LASA now has a clear goal and will move ahead, meeting politicians from electorates all over the country, including those in key policy and decision making roles. The meetings in Canberra will be followed by meetings with our state CEOs and provider members in the electorates of federal politicians. LASA plans to lead the Act review process through the Senate Committee process, presenting evidence and solutions to address the uncertainty and difficulties of the reform process so far. LASA has developed a ‘top 4’ and feedback from the recent road show found you overwhelmingly agree that Bonds and Retentions,

Indexation and Accommodation fees (MPIR), Specified Care and Services and Community Care (Home care CDC) are issues we must vigorously pursue through this process, through to the election and beyond if required.

From now until September, the work here in Canberra and that of our state offices will dovetail to maximise our efficiency and effectiveness in achieving measurable outcomes for our members.

I have been welcomed by state CEOs and look forward to what will be a pivotal campaign to get the reform process on track and ensure you can provide care and services to meet the demand that continues to grow.

The Workforce Compact was announced by Minister Butler in early March. Whilst LASA participated in good faith, I do not believe the outcome will greatly assist in developing our workforce to the required level. It is true the Compact will give some workers a pay rise, but it comes with the burden of the funding being taken from care, along with the expectation that providers fund the on costs and gaps in the compact structure. With current and proposed age service funding not reflecting care needs, major pressure on the workforce will continue. LASA will continue to advocate for members in this regard, highlighting the inadequacies of government in meeting the outlined care needs of current clients and residents. I thank the NSW CEO, Charles Wurf, for his expertise and patience in representing LASA in compact deliberations.

The final piece to the puzzle for 2013 is engaging the industry workforce and general public to support our aims. Advocacy and influencing outcomes is a difficult process in Australia’s current political climate. There are hundreds of lobbyists, many armed with stockpiles of resources and powerful backers. LASA understands that, in order to meet the needs of older Australians, we must work at every level. Our Chair Peter Cosgrove will explain why the activity in Canberra and across every state needs to be supported across the age service workforce and into the lounge rooms of ordinary Australians. I look forward to working with you to achieve sustainable reform that addresses the needs of providers and works to build an industry that can provide care and services to older Australians now and into the future. ■

Prom

Q uality

oting

Better Practice conferences

Our Better Practice conferences are a proven ‘mustattend’ event. This year’s themes include human rights, loneliness and isolation and sexuality.

Sydney – Adelaide – Melbourne – Perth – Brisbane –

25-26 July 15-16 August 19-20 September 17-18 October 7-8 November

Information systems – keys to delivering quality care

Our one-day workshop explores how you can access and make use of the right information for the right person at the right time.

Parramatta – Brisbane – Mt Claremont (WA) – Adelaide CBD – Melbourne CBD –

15 August 26 June, 31 July 15 August 16 April, 30 September 30 April

Foundations for managing risk in aged care

Our one-day workshop looks at an effective risk management approach - based on the Australian risk management standard. It also gives insight into Accreditation Agency assessment data and the reasons behind not met expected outcomes and other key common risk indicators.

Mt Claremont (WA) – Brisbane CBD – Adelaide CBD – Parramatta – Melbourne CBD –

14 November 5 June, 23 October 7 May, 27 August, 2 December 28 May, 9 July, 5 September 20 June, 16 July, 11 October

Making the most of complaints

A one-day workshop about using complaints to your advantage and showing residents, families and staff that you value their feedback. Run by trained mediator Steve Aivaliotis.

Brisbane CBD – 8 July Adelaide CBD – 8 October Mt Claremont (WA) – 12 September Sydney CBD – 27 September Melbourne CBD – 2 May and 17 July

Understanding accreditation

We have entered a new partnership with industry associations to offer this three-day course that gives an insight into the process of accreditation and what assessors are looking for.

NSW 9-11 April 30 April – 2 May 21-23 May 18-20 June

Queensland 9-11 April 16-18 April 17-19 June 17-19 September

South Australia 30 April – 2 May

Western Australia (Mt Claremont) 28-30 May

Demystifying dementia

Download our updated flexible learning package, designed to be delivered in-house to your staff. It is designed to provide a better understanding of dementia for frontline staff.

Governance and Accreditation Toolbox

We have revised our Governance and Accreditation Toolbox to assist boards and senior management meet their obligations.

A list of approved facilitators to deliver the package for homes is available on our website. These facilitators all have experience working with boards in aged care.

Results and processes ‘app’

You can now download the Results and processes guide as an app on your phones (iPhone or android).

More information on all our education and training resources is available at

www.accreditation.org.au

National Update | 7

Message from the Chair 3 Million Reasons to have a campaign...

General Peter Cosgrove AM MC (Ret’d)

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s LASA planned for 2013, there was much deliberation around if a public awareness and industry building campaign would be successful and if the timing was right. Naturally, there were varied responses and much robust discussion.

We needed to think carefully and to plan. Together as an organisation, we did just that. Our expert communications staff, met with provider member representatives. Our CEOs met, and under my Chair our board discussed and assessed the merit of a broad education campaign. We decided that our members deserve their caring role to be highlighted and better understood, that our workforce needed to be acknowledged for the stellar role they provide 24 hours a day.

In order for ordinary Australians to value the age services workforce, they need to understand what they do. Too often, it is only when needing to utilise age services either for themselves or a loved one do people actually take notice of the services available or the issues facing them. From here, 3 Million Reasons was born. According to 2011 Census data, there are 3 Million Australians aged 65 and over. We thought this was a catchy name for a campaign, but also very appropriate. We are keeping it real by focusing on those who matter, older Australians and, of course, the workforce that cares and supports them.

Much of what LASA does to support age services happens behind closed doors; meetings with the Department of Health and Ageing, the Agency, federal and state politicians. While we keep you in the loop regarding all our activities and seek constant feedback, much of it takes place in Canberra and is removed from the heartland of age services, at your very facility or service, or the homes of older Australians.

With your support, 3 Million Reasons will place age services and particularly the development of the workforce and the security of our industry firmly on the political radar. In an election year, many different organisations, many with worthwhile causes, fight for their share of the media spotlight in order to spark the attention of politicians LASA is committed to lead this industry into a new world, but we need your help. There are 350,000 age services workers who need to be recognised and remunerated for what they do, who need sustainable and flexible work in order to achieve work-life balance, These are the people Australians rely on to care for their friends and loved ones and in time, themselves.

I ask that in your workplace or across your organisation that you sign on and support the campaign. It is as simple as recording your name, email and postcode. With your help, I will appeal to the wider population to join you.

In politics, those who are most effective are those with huge sums of money and power, and every now and then, those who are clever and creative. I know which one we are! The Aged Care Act review will change age services forever. With this momentum in the lead up to an election, we are in a perfect position to shape age services and grow the industry into a responsive and innovative force, able to cope with the demand we know grows every day.

I want our society to be known for how we care for older Australians. The very people that have given their lives to help our country grow, raised children and participated. I do not want us to continue to fail our elders, especially when they are vulnerable.

Support LASA’s campaign today, and together we will put age services on the political map in 2013. Jump on your computer right now www.3millionreasons.com.au â–

8 | National Update

South Australia Report THE LIVING LONGER, LIVING BETTER REFORMS Paul Carberry Chief Executive Officer | LASA South Australia

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t is now 11 months since the Living Longer, Living Better (LLLB) reforms were launched by the Federal Government.

There is still much detail to be announced, and the proposed legislation to underpin the new policies is yet to be sighted. We expect to see this brought into the Parliament in late March 2013.

Nevertheless, enough detail has been announced for us to review the “big ticket” items and discuss their impact on providers’ finances and financial outlook.

ACFI On 1 July, 2012 we saw the freezing of care subsidy rates at 2011-12 levels, as well as changes to ACFI scoring, which has reduced funding for some new residents, compared to pre-1st of July amounts. Further changes occurred on the 1st of February, 2013, and more changes are planned for the 1st of July, 2013.

The changes have achieved the Government’s objective of slowing the growth in care funding, with the daily average ACFI payment amount being virtually flat for the first five months of the year.

Economic modelling undertaken for LASA calculated that the losses to the industry from these changes will amount to $497 million over the first two years, and $1.1 billion over four years.

The effect this will have on individual provider finances will vary across the board, with those operating in the lower percentiles of financial performance likely to be placed under greater pressure.

Certainly, the redirecting of a large slab of funds away from care subsidies was, to say the least, an interesting way for the Government to kick off its long-waited reforms.

Changes to Means Testing and Accommodation Payments Part of the Government’s response to industry complaints about ACFI has been to suggest we look at the “whole story” of the reforms, including those which will affect accommodation payments and supplements.

Certainly, from the 1st of July 2014 there is scope for providers to receive a more realistic return on their investments in residential accommodation.

From this date onwards, facilities which meet the criteria for “significant refurbishment” will receive a daily accommodation supplement of $52.84 per day for supported residents, and will be

able to set the accommodation rates for residents who have the means to pay, subject to approval above specified levels.

All residents entering aged care will have the choice of paying a refundable deposit, or a daily fee, or a combination of these methods, thus removing the current restriction on payment methods, which depend on whether a resident enters as high care or low care.

These changes are both welcome and necessary for the level of aged care investment to meet future demand.

While these changes are implemented, retentions from aged care bonds will be eliminated. So, while accommodation charges will be allowed to more properly match the cost of investment, an important component of the current fees system is being removed.

Also, from the 1st of July 2014, providers will be allowed to charge for additional amenities and hotel services. This is positive move which will broaden consumers’ choices and diversify providers’ income sources. The proposed changes to Specified Care and Services will need to properly reflect those services which are “required” and funded accordingly, so that “additional” services can be clearly distinguished and charged separately.

So, looking at the whole picture, there are certainly positives.

However, the losses to provider income brought about by the ACFI changes are very significant and their impact is permanent.

The loss of the 1.6% index for 2012-13 will negatively impact all future care subsidy adjustments.

The other important thing to note is that the ACFI cuts have occurred a full two years before the changes to accommodation charges and additional services come into effect.

At the very least, the proposed changes to accommodation payments and supplements, changes to prescribed services and the ability for providers to charge for additional amenities should be brought forward to 1 July, 2013.

If it is appropriate for providers to receive reasonable returns on investment, it is appropriate not to delay it by another year.

The government’s legislation should be amended to reflect this earlier implementation.

It is also essential that retentions from refundable deposits be continued. The importance of this income, currently $3,876 per annum, especially to providers in rural and low-income areas, has not been properly assessed or understood by the government. ■

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10 | National Update

NEW SOUTH WALES Report Confidence comes with clarity Charles Wurf Chief Executive Officer | LASA New South Wales

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onfidence is a fickle thing. It can be earned over an extended period of time, and it can also be lost in a moment through reckless, inappropriate, or ill-informed comment or action.

This year, so much in age services depends on confidence, both in our elected representatives to deliver genuine and appropriately funded reform, and in ourselves as an industry association to ensure our members’ concerns are heard and addressed.

On this latter point, I am confident that in this election year, Leading Age Services Australia will be at forefront of engagement with elected representatives and Government. Since commencing in early February, the new LASA National CEO, Patrick Reid, has brought to us his energy and desire to have Government hear our industry’s concerns.

In February, both at the Tri-State Conference in Albury and at the LASA NSW-ACT Quarterly Luncheon, Patrick began to outline how LASA is campaigning on behalf of all our industry to gain greater consideration by Government in 2013 and beyond. We can expect more actions and updates about LASA’s campaign in coming days and weeks.

But this confidence in the ambitions of LASA to champion to the delivery of quality age services into the future does not immediately extend itself to the Federal and New South Wales Governments.

A common thread of member feedback is that the confidence that came to our industry through the release in 2011 of the Productivity Commission Report, Caring for Older Australians, has been dissipating since last year’s release of the Government’s response through the Living Longer. Living Better package.

Opinions vary, but a consistent fear is that Living Longer.

Living Better, rather than being a vehicle encompassing a range of needed reforms, instead has as its primary goal reducing costs to government into the future, through the transference of the

financial burdens of care to those who need it, and those who provide it.

As the changes outlined in Living Longer. Living Better are introduced into the Parliament in March, the appeal from many members is for the Government to focus on clarity in its communications and hear the concerns of providers, not just stick to a predetermined ‘message’.

The New South Wales Government can likewise look at how it communicates with and informs providers of changes in order to retain the industry’s confidence. The industry, despite the size of the challenges involved, accepted the Government’s changes for the mandatory installation of sprinklers in residential aged care facilities. The financial burden that would result from the fitting of sprinklers in some facilities has been tempered to a degree, as the New South Wales Government had been communicating with the industry in 2012 and was listening to concerns.

In recent months, the New South Wales Government has seemingly not been as forthcoming as it had previously with providing information. Much of the detail about the changes has been slow in coming and many providers are frustrated, as they try to make significant financial decisions without the necessary details. If the New South Wales Government wishes to retain the general confidence within the industry that these changes are achievable, then it needs to be more considerate with when information is released.

Confidence is a fickle thing. It is difficult to measure. Many providers of age services are continuing in their responsibilities more through hope for the future than in confidence. In this year of so many potential changes, be they in legislation or government, the clear message for all levels of government is the need to support the industry through appropriate funding and clarity in communication. Only through these will we have the confident age services industry older Australians deserve. ■

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12 | National Update

victoria Report Technology no longer an ‘optional extra’ for age services John Begg Chief Executive Officer | Victoria

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t a recent Aged Care Industry Information Technology Council leadership group meeting, I was interested to learn that, at present, approximately 50 per cent of Australian mobile phone users own a smart phone, enabling them to connect, access information and services, and make purchase decisions from the palm of their hand. What was more astounding to learn was that by 2016, this proportion is projected to be 100 per cent.

I was equally blown away to learn the banking sector spends around 15 per cent of their revenue on Information Technology (IT) and around 2 per cent of the health sector. And age services?

Astonishingly, less than 1 per cent of revenue is estimated to be spent on IT. On hearing these two very different, but equally amazing, pieces of information, it became very clear to me that the age services industry is in danger of falling far behind when it comes to investment in – and the utilisation of – technology. I wondered if the small to medium sized businesses in our industry are aware of the need to invest now to stay ahead of the game. Are they aware that technology is no longer an ‘optional extra’ for any business, but critical to its ability to deliver quality services and understand its consumer?

Technology has the potential to have an immense impact on any business, and this can be overwhelming when considering where to start. It is important to take a step back and analyse all roles within your organisation. Ask what they aim to achieve on a daily basis and what tools they already utilise. Soon, both cross overs and gaps in ways of working will begin to emerge, and you can then consider what technological tools and products will improve efficiency and connectivity across your business.

As an example, here at LASA Victoria, we have started the process of analysing our business units and the roles and tasks required within them. We will then begin mapping where we are doubling up on work and where we are missing opportunities to capture content for our members and be more efficient in our day

to day working. We have already identified a need for and begun a full information technology review across the business, as well as revisiting our processes and procedures to identify where greater efficiencies can be made.

We are starting small, being mindful that reviews such as these take time. We may find that technology cannot fill all of our gaps, certainly within a short time frame. However, we will keep an open mind, research the options available and integrate technology when and where it is needed.

However, improving business practices is of course only part of the huge opportunities technology presents our industry. On a more individual level, it has the ability to empower all people, including older people, to manage their own health and wellbeing.

It can also empower people to create social networks and reduce social isolation, which research has found can be very detrimental to a person’s health.

At the recent Tri-State Conference, a joint collaboration between LASA Victoria, NSW-ACT and South Australia, delegates heard an exceptional presentation by Rachel Botsman, an author and Global Thought Leader. Rachel encouraged the industry to move away from traditional thinking around technology and how it can improve care, towards considering the vast opportunities to use technology for the development of networks, for collaboration and sharing.

As Rachel stated in her closing address, we are in ‘age of unprecedented change’ and this brings huge potential for the age services industry, starting with individual businesses, to use technology to connect people, products and services in ways that have not yet been considered or explored.

Technology, in all its forms, is undoubtedly providing the greatest opportunity for advancement and evolution the age services industry has ever seen. It is certain that it is no longer an ‘optional extra’ and should be considered and implemented wherever possible. ■

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14 | National Update

Queensland Report Advocacy in Action Nick Ryan Chief Executive Officer | LASA Queensland

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he Queensland Retirement Village Industry has worked tirelessly for many years to serve the state’s ageing population, with those in the industry doing so to ensure that older Queenslanders live well in their golden years.

Nationally, LASA Q has continued to inform the LLLB agenda with direct and ongoing input into the reform working groups and committees, particularly across the Residential Care and Community Care age services streams around: In the last decade, this has been evidenced by the low number of reported cases to the tribunal, and in the closures of only two small retirement villages.

Whilst negative press has sought to inflame passions and ignite debate concerning the industry on occasion, neither media attention nor industry critics have been able to point to any systemic industry failures and/or widespread dissatisfaction amongst village residents.

The decision by the Queensland Government (the Government) in 2012, to transfer industry responsibility to the Department of Housing and Public Works was, by-and-large, welcomed by the industry. In particular, the potential for a more consolidated approach to consideration of broader retirement village issues, such as industry sustainability and crossdepartmental policy coordination, was eagerly anticipated.

In late 2012, the Government announced a ‘timely’ review of the Retirement Villages Act 1999 (the Act), to which LASA Q provided both written and representational responses. These responses were exceptionally supported by the significant contributions of both our association and associate members.

In their tabled findings of the review of the Act, the Transport, Housing and Local Government Committee delivered 37 recommendations, most of which were disappointingly capricious and poorly thought through. In general, the recommendations sought to introduce more red tape, reduce viability for scheme operators, ignore regional and rural service providers and disregard market forces.

While the association has clearly articulated its commitment to working with a ‘can do’ approach to tackling industry issues, it must be a ‘can do without harm’ approach, particularly toward

an industry that works so diligently to meet the housing and care needs of older Queenslanders.

A call to action has since been activated amongst the LASA Q membership, to clearly communicate the problems associated with implementation of many of the review findings. In a dualfaceted approach, members have been encouraged to spell out their concerns via letter to their local members, while a series of meetings with key LASA Q staff and senior government officials and Ministers have been held.

Most recently, the LASA Q Retirement Living Manager, Geri Taylor, and I met with the newly appointed Minister for Public Works, Tim Mander. This meeting was extremely successful, with the Minister commenting on the strong industry representation from LASA Q (which also spoke for ACSA’s interests).

The Government’s response to the Committee’s review of the Act is to be tabled in Parliament on the 28th of February. We look forward to a reasonable position from the Government, as well as the re-establishment of formal consultation processes with industry, of which LASA Q will be prominent.

Still, there remain many challenges on the horizon for Queensland and for the retirement village industry.

Among them is the emergence of the retirement village industry as a provider of low care and support for our older citizens – a result of the gradual cessation of low care provision in residential aged care facilities. Considerable analysis of this market shift will need to be conducted before any new policy and regulation is considered, and this will be exacerbated by a lack of industry research as a foundation.

While celebrating the fact that so many older Queenslanders are living longer and living better, providing adequate, appropriate and affordable housing for them will test governments and market resources.

The current reality is that the overwhelming majority of older people retire and remain in their own homes, but for those whose accommodation and care needs are different or change, there must be alternatives. This is where the value of the retirement village sector lies. ■

National Update | 15

WESTERN Australia Report Times of Change Beth Cameron Chief Executive Officer | LASA Western Australia

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t has been the end of an era in the LASA-WA office this quarter, with the departure of long time CEO AnneMarie Archer. Anne-Marie has been appointed as the CEO of the Leeuwin Ocean Adventure Foundation and is enjoying her time near the ocean working on the important projects that the foundation undertakes.

I am thrilled to have the opportunity to join LASA-WA. It is a privilege to work with the intelligent, committed and passionate members we have in Western Australia. I look forward to utilising my experience in government and advocacy to deliver results for our members.

We work in such an important and growing sector. The challenge of ensuring that a high quality of care can be delivered to an increasing number of elderly is one faced by many countries at the moment, and the most effective legislative and regulatory framework is yet to be determined. Of course, the best people to ensure that new policies are practical, financially sustainable and effective are the people working within the sector, our members.

Like all LASA offices, it is a very busy time for us as we work to ensure that clear messages are being delivered on our assessment of the policies being developed in Canberra and their possible impacts. It is a critical and complex time for the sector.

In the lead up to an election with a very full legislative agenda, political priorities will change, time frames will be short and decisions will be important. What happens in the next six months will determine the political landscape that we work within for the foreseeable future.

This is a critical period for all members. Your voices need to be heard, your feedback needs to be targeted and delivered to decision makers and the public. This is the best way to ensure that high quality, individualised care can be provided to older Australians into the future. I encourage any members with concerns, views or ideas to make them known to your LASA offices, fellow members and Board.

Caretaker period is expected to start on 12 August. We are on the home stretch.

It is very important to me that LASA be as helpful and accessible to members as possible. I look forward to hearing your views on the industry and working with you all to achieve positive results for the sector. â–

Technology | 17

Sci-Reality?

Robot interaction no longer fantasy

By Tom Johnson

Professor Wendy Moyle, Director, Research Centre for Clinical and Community Practice Innovation at Griffith Health Institute, School of Nursing and Midwifery, Griffith University.

Professor Moyle will be presenting on Robotics and Dementia: Using Technologies to Encourage Emotional Response at the upcoming ITAC Conference in Melbourne.

F

or most elderly Australians, the idea of robots communicating with humans would only have been found in science fiction stories. That fantasy, however, is finally becoming reality, thanks to ‘Gerry’ the robot, from Griffith University.

Gerry’s human-head-sized screen will enable dementia suffers to communicate with their family through Skype.

Professor Wendy Moyle hopes that the robot will help dementia suffers to interact with their family when they are not able to be by their side.

“Gerry’s main aims are to improve the quality of life for the person with dementia and to increase our understanding of this very prevalent condition,” Moyle says.

The robot is portable and uses advanced Face Reader software that can interpret the emotional responses of people with dementia. Despite his sophisticated technology, Gerry is still easy-to-use and can converse for an hour at a time before needing to recharge.

“Once the person with dementia has been informed by Gerry, that person only needs to push one button to get started,” Moyle says. “From there, a family member will be able to have a good chat with mum, who can show her the flowers in the garden or ask her to point out her medications.”

According to research by Griffin University, people with dementia living in a nursing home usually receive between two and 28 minutes of human interaction each day, making Gerry’s presence highly appreciated.

The technology was originally developed in Denmark as a tool for health professionals wanting to remotely communicate with patients.

Gerry is not without his issues, though, as overheating has become a common problem during Australia’s harsh summer months.

Although Gerry is the first of his kind outside of Europe, the team has already planned a range of improvements to the clever robot.

“We have added additional video-monitoring equipment, and an external modem,” Moyle says. “Also, we are working on adding

additional sensors so that the family or user can see more readily obstacles within the nursing home environment.”

Lifestyle Manager Robin Pickworth, of the RSL Care Talbarra Retirement Community, is ‘very excited’ about trails of the robot in nursing homes. “Technology often really scares our residents. This technology offers a great way for them to connect with their family members,” Pickworth says.

Although Gerry may not feel emotions or have thoughts of his own, he can bring these essential elements, via technology into the lives of older Australians by connecting loved ones remotely. ■

Technology | 19

UK Digital Healthcare Policy Drives New Models of Care and Support

By Kevin Doughty

Dr Kevin Doughty, Co-Director of the Centre for Usable Home Technology at the Universities of York and Newcastle and e-healthcare specialist UK Trade and Investment. Dr Doherty will presenting on Policy and Practice in ‘Introducing Technology to Support Older People – International Perspectives’ at the upcoming ITAC Conference in Melbourne.

T

he number of people in the UK benefiting from telecare equipment and services is rapidly approaching 2 million. The vast majority have a connection to a remote monitoring centre, but others link to family members or directly to homecare services or to out-of-hours medical response teams. The range of devices available for inclusion within telecare plans is also increasing, so that service planners can offer users more choices whilst ensuring that services match their individual assessed needs and risks to independence.

A Randomised Controlled Trial – The Whole System Demonstrators (WSD) – introduced remote alarm and vital signs monitoring to nearly 6000 people in Cornwall, Kent and Newham (the location of the 2012 London Olympics). The outcomes are being reported in a range of refereed papers in learned journals.

The headline outcome figures for people who suffer from long term conditions such as diabetes, congestive heart failure and chronic obstructive pulmonary disease, are impressive in that compared with control groups, they show: • A 15% reduction in A&E visits; • A 20% reduction in emergency admissions; • A 14% reduction in elective admissions; and • A 45% reduction in mortality rates.

However, the results also show that the benefits apply only when the most appropriate service is provided to each service user. Significant efforts are therefore being made by service providers to ensure that different models of telecare are developed and understood, and that services are targeted at those groups for whom the impact of the services are likely to be the greatest.

Policies are now being aligned to support these models, leading

to improved training and best practice principles in the form of industry Codes of Practice. Community monitoring services are also being more proactive in ensuring that patients who are discharged from hospital following particular treatments are not readmitted within 30 days. Hospitals that are forced to readmit these patients are effectively fined. In the same way, local authorities are providing reablement services (often with a digital component) free of charge to people who are at risk of requiring long term care.

These policies, and the significant competition between different telecare service providers is having the effect of advancing the technology opportunities for introducing web-based activity monitoring and assessment services. Systems such as iCare, ADLife, Just Checking and Sensormind can continuously collect movement data as well as a domestic log which can be viewed remotely by care providers or by family members.

Problems can thus be seen as patterns of activity, often during the night, that can either show risky behaviour or indicate that an individual is coping well. Some of the more sophisticated systems can also monitor trends in activity levels, number of visitors and sudden departures from the norm, enabling an appropriate response to be made. By adding worn devices, and by using mobile telephony, systems can monitor energy expenditure both inside and outside the home, making systems more accessible to people who are able to spend time out of doors, including those people who suffer from mental health problems As more people receive an always-on or broadband communication system, the opportunities for providing remote video monitoring and interaction are being realised. The systems

Technology | 21

are overcoming problems of social isolation and loneliness felt by people who are in residential care homes or who live at a distance from their families. Special user interfaces (such as Red Embedded) enable people to operate teleconference facilities over their domestic televisions in an intuitive way which needs very little training. The quality of life of the individuals improves significantly while the distances that formal carers have to travel in order to support their needs also reduces.

However, the area where UK policy has driven greatest change is in supporting people with cognitive impairments using digital technologies. Reminiscence software such as My Life, and Finerday can help both informal and formal carers to use pictures, movies and music to provide a personal memory book for patients to enjoy and to remember their past. Safety and security

issues can be addressed inside and outside the home using either combinations of sensors in a telecare alarm package or by using GPS locator technologies such as Buddi and Vega. Indeed, for people who live in supported housing, nursing homes or retirement housing schemes, there are next generation systems such as Canary and My Amego that can help manage difficult situations by providing a tracking function.

The telecare industry in the UK is mature compared with other countries, both in terms of the number of people supported, and in having a long track record of success helping people to stay independent at home. The models of care that are now routinely offered could be applied in any country that has an ageing population and which is progressive in seeing the potential of technology to improve the health and well-being of its people. â–

22 | Technology

Integrating Clinical Data – A Practical Approach Removing the Paper Trail

By David Cox David Cox is the Managing Director at Embleton Care Group, Western Australia.

David is presenting on Implementing a Small Scale I.T Solution in a PCEHR Environment at the upcoming ITAC Conference in Melbourne.

Western Australia’s Embleton Care recognised the need to integrate all paper records into a clinical care system to avoid errors and enhance communication amongst team members, and introduced processes that enabled staff to access all clinical information from a single database.

R

esident data takes many forms. While many organisations have electronic systems to document progress notes and care plans, care staff still negotiate paper records in many formats in their daily work.

External records from hospitals, outpatient and specialist doctor visits will remain in hard copy format for the foreseeable future until the Personally Controlled Health Record (PCEHR) becomes an accepted source of data. Medication scripts and, in most cases, medication charts also remain in paper format.

Clinical and administrative staff go to great lengths to maintain clinical software records and, in most cases, a hard copy file of paper records.

The Productivity Commission report highlighted the vital role that technology has in improving the quality of aged care and in “reducing the strain on care workers” but the adoption of technology remains sporadic. Clinical systems are currently not used to their capacity. While document databases, calendars and communication tools form part of many clinical systems, providers rarely use them.

External records from hospitals, outpatient and specialist doctor visits will remain in hard copy format for the foreseeable future until the Personally Controlled Health Record (PCEHR) becomes an accepted source of data. Medication scripts and, in most cases, medication charts also remain in paper format.

Clinical and administrative staff go to great lengths to maintain clinical software records and, in most cases, a hard copy file of paper records.

The accuracy of documentation is dependent on having systems in place to manage both hard copy and electronic records. This requires a familiarisation with a variety of systems and reliable systems in place to access and manage the paper records at all times. The reality remains that hard copy files

are rarely accessed and rarely used in the development of a comprehensive plan of care.

In a review of 20 sites of various sizes using clinical systems, not one site stored external documents electronically using the software’s data storage features, only 5% of sites utilised a messaging system to communicate with staff and only 5% utilised a calendar function to schedule clinical tasks.

Sites interviewed that had not fully implemented all available modules of care systems had not installed all modules because of (a) comfort with existing systems in place, (b) staff compliance during the introduction of module, (c) staff burn out during the introduction phase or (d) additional costs incurred with the introduction of integrated medication modules.

Embleton Care in Perth’s inner North East has introduced processes to ensure that staff fully utilise the care system, where information is readily available and used to enhance care delivery.

David Cox, Managing Director at Embleton Care, states that, while the organisation utilised electronic systems for finance, human resource management and some components of care services for some years, there was a need to introduce a new care system and management processes that encapsulated all aspects of clinical care, including integrated medication management and the incorporation of all external records into a single system.

Facility audits highlighted a disconnect in communication.

Hospital discharge summaries were filed in resident files before staff had actioned discharge orders. Residents returning from hospital or out patient appointments did not have recommended treatments consistently implemented. Medication changes were not always appropriately documented or updated resulting in high medication incident rates attributed to prescription and documentation errors.

The facility now has a fully integrated system where all clinical records are kept electronically. Clinical staff review paper records

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24 | Technology

before they are scanned and accessed as part of progress notes and the document library. All historical files have been scanned and hard copy files shredded. Electronic medication profiles are shared with the pharmacy and medication delivery records are integrated with progress notes and the electronic profile. “This solution provides our staff with a clear view of the information required to make informed care decisions and hence provide the highest quality of care to our residents.” David Cox said.

The integrated medication management system has enabled the accurate delivery and tracking of medications. “Nonsigning medication errors fell from 205 to 1 in the first month of

implementation and have remained low since the introduction of the system. Medications can no longer be missed as the system prompts you to provide a reason before you log out of a medication round as to why a medication was not administered.”

David said.

“Monitoring the effectiveness of PRN medications administered was extremely difficult when using a paper based system. It relied on staff remembering that they had administered a PRN and if there was a shift change ensuring they communicated it to the next staff member. This prompt is fail safe for ensuring administered PRNs are evaluated.” David said.

Technology | 25 David notes that the use of the scanned document ability has enabled the improved treatment of residents post admission, hospital transfer and medical review, as staff are easily able to access laboratory results and medical orders and respond to changes.”

“Communication between staff members has been enhanced with the use of the daily message board and the use of scheduled tasks that prompt staff to undertake specific care or administrative tasks at each shift ensuring resident care needs are always met.”

David explained.

David identifies stakeholder buy-in as the most critical part of the implementation of any clinical system. The facility ensured that all members of the team were involved in the procurement process and were made aware of change prior to the implementation of the system. David believes that the use of posters, memos and staff meetings that highlighted the benefits of functions such as the document library, scheduled tasks and message board assisted in widespread adoption of these features. Education tailored to the individual needs of staff ensured that the system could be used by all staff before its planned introduction.

Embleton Care’s GPs were surveyed to ascertain the difficulties of operating the current paper based system. They were frustrated that they could not access information on medications

TA R G E T I N G

Y O U R

M A N A G E M E N T

N E E D S

and laboratory results on a single system and that they wanted a system that could integrate with their existing medical practice software to avoid duplication of information entry. David explains, “All GP’s were contacted personally once the system had been chosen. GPs liked the thought of an integrated clinical, care and medication management system. They were thrilled at the fact that they would never have to rewrite a medication profile again and were pleased that the facility was willing to make a commitment to scanning and saving all resident documents, including laboratory results, in the document database to enable a single source for patient records. GPs were also pleased that they could access Medical Director from within the system to share data and had provided a timeline for implementation.”

David identifies the implementation of strict protocols as another key element of the organisations success in implementing the integrated system.

“All hard copy documents including resident files, lists and communication were removed from circulation, forcing staff to utilise the electronic systems” David says. “Staff were adequately supported during the implementation, so the adoption of new systems was quick and staff did not have the opportunity to fall back on legacy systems that would result in the failure of a fully integrated solution”. ■

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12/03/13 12:53 PM

Technology | 27

QPS Benchmarking Report: Funding, Workload and Clinical Outcomes

By Adam Holcroft

QPS Benchmarking has been providing benchmarking services since 2000 to residential aged care facilities, community care, day surgeries and all Hospices in New Zealand. QPS clients have the advantage of being able to use the statistical process control features built into the web based program since 2008, which measures and highlights the variation in performance for each key indicator. Adam is General Manager of QPS

T

he QPS Benchmarking Aged Care Program provides a framework of metrics in all critical core processes for Residential Aged Care Providers including clinical, financial, safety, human resource and researched leading indicators for resident, relative and employee satisfaction.

The following results provide an insight into how increased funding through ACFI has given residential aged care Providers the means to increase hours of staff providing direct care to residents as acuity and frailty increases. The clinical outcomes support the increasing care needs of residents as well as highlighting the challenges Providers are faced with based on the changes occurring in high and low care facilities.

Data was extracted from the QPS Benchmarking database covering the period from 1st July 2010 to December 2012. The following report is based on a sample of 370 residential aged care facilities participating in the QPS Benchmarking program.

Results Summary ACFI Funding and Care Domains Graph A

Graph B

28 | Technology Graph C

Graph D

ACFI funding (Graph a) and all care domain (Graphs b, c, d) results decreased during the July to September 2012 period due to ACFI changes made effective by DoHA on the 1st July 2012. These decreases are also influenced by the fact that ACFI submission rates dropped significantly after June 2012. It is recognised that while the numbers of existing residents being reassessed decreased, new residents represent the majority of assessments over this period. Since new residents primarily contributed to average ACFI changes across organisations, without the offset of increases from reassessed current residents – we see that a more significant drop across domain scores and funding was experienced. This “wait and see” approach was taken by providers due to the sudden nature of the change announced by DoHA and has allowed providers to analyse and understand how to manage the assessment and reassessment process post 1st July 2012. Funding appears to have resumed a similar pattern of growth from October to December 2012.

Care Staff Work Hours Graph E The increases seen in the ACFI funding results (Graph a) are being used to provide more direct care staff to meet the increase in care needs of residents. The increases in Care Staff Work Hours as demonstrated in Graph e are for both high and low care RACF’s.

The QPS Benchmarking results for funding, care hours and clinical outcomes demonstrate a significantly changing profile of Low Care facilities. The impact of Ageing in Place in Low Care is becoming increasingly evident as there has been an 11.57% increase in care hours compared to a 4.23% in High Care from September 2010 to December 2012.

Technology | 29 Resident Falls Graph F

Graph G

Graph H

Graph I

Falls continue to be one of the greatest challenges for both high and low care facilities. Providers are faced with the need to balance resident rights, choices and independence in a restraint free environment, while residents are becoming more frail with an increasing risk of falling.

The data is demonstrating some very interesting changes over time, with a higher proportion of residents falling and sustaining an injury in Low Care facilities, and trending upwards. High Care data demonstrates opposing trends, with declining falls with injury over the same period. Low Care facilities exhibit an upward trend of 13.43% in falls with injury as opposed to a downward trend of -1.61% in High Care.

Falls without injury in high care facilities is increasing by 6.21% while low care facilities are decreasing by 2.09% based on trend data.

30 | Technology Skin Tears Graph J

Graph K

Skin tears data reported for the same period supports the changing profile of residents in Low Care facilities with a much higher rate of increase compared to High Care. The data also supports the fact that skin tears in high care facilities are more frequently reported with no injury incident identified due to the residents’ age-related skin changes and disease processes. Previous research conducted by Dr Shaw (statistician) for QPS Benchmarking demonstrates the strong cause and effect relationship between falls and skin tears in both high and low care facilities. While falls are no doubt the most common cause of skin tears, strategies such as protective clothing, padding of equipment such as wheel chairs and the use of proper lifting and positioning techniques all assist in the prevention of skin tears. ■

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Technology | 31

Measure IT

By Amanda Seymour

Delivering better quality aged care services through enabling technology is not only about e-health and clinical care systems. There are other key areas such as Quality, Education and Performance Programs that make significant contributions to overall efficiencies and effectiveness.

P

rior evidence in these areas has tended to be anecdotal.

However our experience at McKenzie Aged Care Group (MACG) has enabled us to gather empirical evidence.

This provides factual, statistical proof that by implementing technology to assist with quality, education and performance programs we have gained significant measurable benefits.

Maintaining a Quality program across eight state-of-the-art aged care facilities is complex. There are many risks to navigate. Hence we determined that efficient use of technology is the path to success, and we used technology to implement: • Training and Development Programs • Incident Management Systems • Continuous Improvement Programs • Feedback Systems • Performance Systems What surprised us was the almost immediate measurable value we gained from using technology.

With 8 facilities, 850 employees and 850 Residents, information management presents difficult challenges: 1700 people requiring a complex web of data both stored and shared; 7 separate IT systems were not effectively sharing information. Our aim was to create efficiencies by only entering the data once and having it flow through to all areas of the business, pushing information in and out of our governance, risk, improvement and compliance system.

The key for us was meaningful trend reports and analyses of the entire business. The aim was to reduce the amount of time managers had to spend extracting data from diverse systems and compiling reports, thus freeing up more time, allowing them to focus on analysis vs. compilation, and enabling swifter identification of and response to emerging situations.

In addition to raw productivity benefits, which we can calculate from measuring the time savings, specific important business benefits were identified. A typical example of swift benefit returns to us is demonstrated in the following graph of overdue mandatory education: 16 0

14 0

12 0

10 0

Ma r201 2 8 0

J u ly 2 0 1 2 D e c 201 2

6 0 Total Overdue Education Comparison

4 0

2 0

0 A

B

C

D A g e d C a r e F a c ilit y

E

F

G

This graph clearly demonstrates the benefits of an enabling technology of alerts and reminders, which advise staff and managers of due or overdue mandatory education/training. Within a few months we were able to, across all our facilities, dramatically reduce the volume of outstanding mandatory education required, and consequently increase our compliance in these key skill and knowledge based areas. Clear follow-on benefits have been experienced, from increased confidence at audit times to favourable feedback from auditors on the visibility of this type of reporting.

Another example, this time in our Quality consumer feedback area, is that our managers are now able to instantly view trends such as those demonstrated in the graph below:

This shows us that complaints have decreased while compliments have dramatically increased over a 3 month period.

This is quantified evidence that our focus on quality is improving, and that alone, regardless of the measurable impacts, has had a valuable positive cultural impact on staff, residents and visitors.

In summary implementing and actively using technology has moved us from prior challenges of: • Duplication of information • Inaccuracies • Poor use of staff time • Labour Intensive To • Significant improvement in compliance over the last 6 months.

• One data entry point • Automated relevant and meaningful collated reports • Time saving and quantifiable cost saving benefits We have adopted a culture that embraces technology infrastructure to support our business as it continues to grow.

A culture that is realising and proving that technology does bring with it measurable benefits. ■

Some Of Australia’s Largest Aged Care Providers Have Good Reasons For Keeping A Great Companion.

32 | Technology

Here’s One.

That’s right. And that’s why these astute providers will always rely on AMH Aged Care Companion Online, not only to achieve health benefits for the residents, but also to invest in cost benefits for the facilities.

Indeed, an increasing number of major aged care providers are now making AMH Aged Care Companion Online available throughout their facilities, to help staff deliver better outcomes in medication management.

This electronic resource, produced by the same team that publishes Australian Medicines Handbook, is designed specifically for industry professionals to achieve QUM through providing quality care.

The content is carefully organised for speed and ease of reference. It contains information on more than 70 specific conditions common in older people, including: dementia and management of behavioural symptoms, cardiovascular diseases, fall prevention, osteoporosis, palliative care issues, COPD, insomnia, depression as well as some broader concepts. Drug choices are ranked as first line/other options or arranged by disease severity or symptoms, with dosing information specifically for the older person.

With more aged care facilities adopting this tool for sharpening their competitive edge, other health professionals, including those in general practice, have also integrated it as an essential part of the quality framework of their organisation.

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Technology | 33

eCase Medication

By Steven Strange | CEO | Health Metrics

P

harmacy and Aged Care expert Keryn Coghill (www.mederev.com.au) says Health Metrics (www.healthmetrics.com.au) is leading the charge in integrated medication management technology. The integration of Medication Management with its Single Client Record Architecture (SCRA) technology and the deep use of MIMS data (UBM Medica) combine to make the Health Metrics’ eCase solution second to none. eCase medication management solves the traditionally “hard to solve” issues. The problems are addressed without the usual difficulties associated with software deployments. This is in part due to the highly useable interface and the availability of tablet based applications on both iPad and Android devices.

With the Mederev integration, the medication management solution ticks all the boxes. Providers receive “intelligent” administration of medication from eCase, while Mederev provides the risk management and training for personnel. The risk management components of Mederev are invaluable to the total solution. It’s a perfect combination.

The Medication Management module, like all other eCase modules, is a deeply integrated set of functionality for Residential Aged Care, Independent Living Units and Community Care. Like the other modules in eCase, the Medication Management module challenges the traditional constructs of medication administration, both inside

and outside residential facilities. Further, it inherits all the functional properties of existing eCase modules. These include items such as Secure Community Engagement, Workflow and Alerts, SCRA (all records move with all resident/client types), and more. This means that users have a consistent and easy to use interface. There is no need to be flipping between different applications or different products or different devices in order to achieve the desired care outcomes.

Coinciding with the introduction of Medication Management is the launch of the iPad and Android applications (apps). These apps enhance the “deliverability” of software at the Point of Care. Tablet devices such as iPads and Androids are so user friendly that almost no training is required for care staff to login and start adding value to the resident and the provider. This is consistent with the Health Metrics usability mission, “…access anywhere, anytime, from any device…”

Imagine a provider being able to hand an iPad and a password to a new carer as part of their induction where little or no training is required.

The new carer logs in, and all the things they need to do are in front of their eyes. All the things that need to be done for a resident are a touch of a screen away. All the things that need to be done for a resident are never missed because the supervisors have a management console view of all activity. To calculate the value proposition of this scenario, one would need to combine the resource savings with the quality care outcomes for residents. eCase is an enterprise strength software suite for the aged care sector. It is delivering a new era of staff productivity opportunities that do not compromise the care outcomes for residents.

Health Metrics is a leader in functional innovation for the Aged Care sector, and remains ahead of the technology curve. ■

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34 | Technology

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Technology | 35

The Gamification of our World

By Brian Prince

Brian Prince is the Chief Technology Evangelist – Cloud, Microsoft, Columbus Ohio U.S.A. He gets super excited whenever he talks about technology, especially cloud computing, patterns, and practices. His job it to help customers strategically leverage MS technology, and help them bring their architecture to a super level. Brian will be presenting ‘Lessons from the Gaming Community’ at the upcoming ITAC Conference in Melbourne.

I

am a gamer. There, I said it. I can’t hide it. I have been a gamer for a very long time. At home I even have four Xboxes so that our family of four doesn’t compete for them. We play a lot of games, because it is a great way for our family to spend time together, and share. Along with gaming on the Xbox comes achievements. These are points that you collect outside the game for actions you take inside the game. All of the achievements you earn across all of the games you play pile up into one number that you can share with your friends. For example, I earned my 50,000th point by chopping virtual wood in Skyrim that had no bearing or usefulness in the game. Just for an achievement.

These achievements are used to drive player behaviour in games. For example, in a game called Borderlands, you can play one of four different characters. There was an achievement for playing each character to the 10th level (about two to four hours of play time) in the game. This was the game designer’s way of encouraging players to explore more of the game content.

Gamification is the concept of taking game design elements, and adapting them in the real world to help drive wanted behaviour. This isn’t a totally new concept, but computer gaming has refined it and made it popular again. There are roots going back to the Soviets and before of systems put in place to incent people to new behaviours.

There are many examples where this has been used to great effect. I went to a small private university for my undergraduate degree. The total student population was about 6,000 students.

The university was always working hard to motivate students to attend all of the available social activities. They wanted to get more students to the football games, the jazz ensemble recitals, and to the homecoming dances. In the past few years, they have started a point system. Each student, as they arrive at an event, scans their student ID. This grants them points that they save up. Over time, in as few as five activities, they can use the points how they want. For five points you can get a free burrito at the local Chipotle store, for more you can get a discount at the student store. They have seen a big increase in the student attendance at these campus social events.

A customer I worked with was building a Juvenile Diabetes education application. Part of helping a child to live with their disease is educating them about diabetes. While they had great

curriculum and information put together, the children were not finishing the application. After a few lessons they would stop coming back.

They decided to tie access to small reward games in the app to their leaning progress. As the child finishes more exercises in the app (recording their blood sugar, diet, and exercise) they would gain coins. The child could use these coins to unlock new minigames in the content. These mini games were very simple, based on already successful games, and leveraged information about diabetes. They saw an immediate improvement in the compliance rate of the children using the app.

There are a wide variety of ways of gamifying an activity. The most important step is to understand what desired behaviour you are trying to drive. The simpler this is, the better. For example, with Ribbon Hero from Microsoft, the Office team wanted to encourage users to explore and use features they weren’t used to and weren’t aware we even in the product.

The next step is to make sure there is some tracking going on. This could be points, check marks on a list of needed steps, badge collections, or any number of other options. Stack Overflow has become a very important online set of forums for software developers. Users gain badges as they build credibility and presence in the online forums, unlocking advanced features and voting not available to new members.

This third step is to reward. The behaviour, and tracking have to lead to a pay off or a reward. This can also take many shapes. This can be as simple as a username on a top score list that is shown on a website, or as significant as a promotion. In one case, a company had built a continuing education plan using gamification. To get a step increase in your performance review, you had to have earned a specified number of training ‘stripes’ though their system. This tied continuing education to continuing career growth at the company.

There is no one way to leverage gamification principles in your organisation. For each scenario, how you employ gamification will be a little different. But keep it simple, keep it trackable, and keep it rewarding. Start small, and grow from there. You will need to tweak and tune as you grow the process. *Bing* Achievement unlocked: You just read an article on gamification. ■

36 | Technology

AGED CARE INDUSTRY IT ROADMAP

By Rod Young

In 2012, the Aged Care Industry IT Council (ACIITC) was contracted by Doha to undertake a study of the Personally Controlled Electronic Health Record (PCeHR) and its potential benefit to aged care providers, to examine how the industry could integrate the electronic health record into future models of care. The Project was known as the PCeHR Pathfinder Project.

T

he ACIITC is a vehicle jointly owned by LASA and ACSA. ACIITC was started some six years ago for the purpose of providing a common industry position on the development of IT across the industry. It was accepted that IT had the benefit of providing an enhanced quality outcome for aged care consumers.

The Pathfinder Project involved three aged care providers and three aged care software vendors working with the National eHealth Transition Authority (NeHTA) to review work processes and determine how the new PCeHR could be used to improve aged care integration with primary and acute care.

As part of the Pathfinder Project ACIITC was to develop an Aged Care Industry Roadmap.

ACIITC determined that the Roadmap developed for the Pathfinder Project was a good start, but it could be developed further for the greater benefit of the broader industry. It was agreed that ACIITC needed to develop a more comprehensive Roadmap which could be used for the following purposes: • To have a comprehensive plan that can be supported broadly by aged care providers; • To drive future IT development in the industry; • To incorporate within the IT strategies within Providers’ respective Strategic Plans for the future;

• To be used to create an agreed plan that could be taken to the Government as a long-term plan for deploying IT in the future to achieve improved quality service outcomes, rather than relying on one-off project grants; • To put the industry Peaks in a position to put forward common positions to Government To support this objective, ACIITC convened a full-day meeting of industry leaders in February 2013. The IT Roadmap Workshop, supported by an independent facilitator, was tasked with developing a comprehensive plan for the future of industry IT development. The Workshop also worked on the development of a plan that would support the industry in the development of service improvements and workforce improvements that will achieve improved service outcomes.

ACIITC plans to release the Aged Care IT Roadmap at Itac2013, which will be held in Melbourne 1st and 2nd. May 2013.

The IT Roadmap will also be circulated to the industry generally for general information and use by aged care providers.

ACIITC is hopeful that the aged care industry will find the IT Roadmap useful and that it will provide a substantial benefit for the industry for the future. ■

Technology | 37

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Technology | 39

ACIVA Report

By Dr Caroline Lee – ACIVA President

O

n 24 February, 2013, the Aged Care Information Technology Vendor Association (ACIVA), the Aged Care Industry Information Technology Council (ACIITC) and Doll Martin & Associates consultants conducted a full day forum in Melbourne to prepare other vendors for their e-health journey. Rod Young (ACIITC Board member) welcomed all to the event, while Caroline Lee (Leecare and ACIVA President) introduced the Aged Care Vendor panel members and briefly described the Pathfinder project. Ken Oates (Doll Martin) acted as MC throughout the day. Key speakers discussed how to develop software: • to access the Personally Controlled e-health Record (PCEHR) site and download/upload documents describing a resident’s or client’s summary medical status or ‘events’ (Yoseph Phillips, Leecare), • that connects to the Health Identifier (HI) Service, which holds all professional, organisational and individual citizen health identifiers (David Loiterton, AutumnCare), • that can function using Secure Message Delivery (SMD), which will soon enable software products installed in various healthcare settings to send details directly to each other (Peter Young, Database Consultants Australia), • that passes conformance testing and software accreditation which approves a system to access any of the aforementioned services (Raf Cammarano, Silverchain), and • what needs to be setup at aged care sites (Jennifer Dunne, for icare).

Through a Q&A session, the Vendors present at the forum then discussed methods for implementing e-health into their clients’ aged and community care businesses.

The benefit to vendors embarking on this journey is related to the documentation now available for vendors. The aforementioned software companies who have been involved in implementing the functionality to access PCEHR documents and connect to the HI Service have provided the extensive feedback required to enable NEHTA to prepare resources, Welcome Packs, Testing resources, compliance information and test data that functions.

Vendors must enter into a development contract with the Department of Health & Ageing prior to their involvement, therefore, it is necessary to contact the e-health division to commence. Welcome packs, compliance and testing details are available from NEHTA. Accenture and Medicare will be key contacts throughout the process and, for various testing activities, a final CCA test is conducted by NEHTA. Suri Ramanathan (ACIITC President) was thanked for his involvement and the encouragement provided to the vendors during this process. Rod Young summarised industry concerns related to Potential and actual connectivity costs. The day ended

with a promise from ACIVA and the ACIITC to continue assisting software companies to embark on this journey.

This work means aged care providers can commence asking questions of their software companies, asking if they have or will soon have the capacity to connect to the e-health world.

Accessing such data will be possible through the aforementioned company’s software products, but each product had to undertake extensive Notice of Connection testing and Compliance, Conformance and Accreditation testing over the past few months to ensure this functionality. Other Vendors wishing to connect will also need to undertake the aforementioned testing. ACIVA is the entity which can assist vendors with this process and should be contacted prior to commencing. ■

40 | Technology

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Technology | 41

Providers must lead PCEHR to facilitate Consumer Centric Care

By Suri Ramanathan

C

ore finding of PCEHR Pathfinder Project There are 2.8 million Older Australians, who range from grey nomads to those needing complex care, who are a significant and growing segment of our nation.

Along with their families, we proudly serve them, so they can continue to lead a life of dignity. Human dignity in health requires one to be able to take ownership of ones health and control ones choices. The mantra is ‘To Age Well’.

Personally Controlled Electronic Health Record (PCEHR), introduced on 1 July 2012, is an ambitious program to make this hope a reality. It enables the consumer access their Medical Records from a secure web portal and allows them to give access to those Care Providers and other key stakeholders as they see fit.

While in its infancy, when the bells and whistles are not yet in place, the core care related data naturally comes from (Accredited) Care Providers. To commence the journey, one has to create a record and populate it with data. General Practitioners, Registered Nurses and some others are permitted by legislation to do this.

The fundamental benefit to a Provider is that it reduces the time taken to assemble clinical data, and verify its accuracy and currency. Additionally, once there is a transfer to and discharge from a hospital, timely receipt of clinical data is a major issue for the sector that the PCEHR can assist to overcome.

Then, there is the pursuit of an electronic advance care directive as well as an up to date record of medicines, amongst of other information.

This Electronic Medical Record is by no means comprehensive as clinical records kept by a Provider over time, but is a way of facilitating portability of information between segments of health (Primary, Acute and Aged), as part of an integrated health system.

All of us know the massive gaps in this area.

Department of Health and Ageing (DoHA) in early 2012 commissioned Aged Care Association Australia, and through it Aged Care Industry Information Technology Council (which is under the auspices of both Peak Provider Bodies in Australia) to investigate the adoption of PCEHR and present a strategy to go forward with for Aged Care. Under this leadership, three Providers and three Software Vendors participated in delivering this project.

The project was called PCEHR Pathfinder.

The Providers were RSL Life Care (NSW/ACT), Montefiore Nursing Homes and Silverchain – covering both Residential and Community Care. They explored the policy issues, simulated use of the PCEHR within their work setting, and advised on best approaches to adopt and the change management requirements to inculcate PCEHR in Aged Care.

Three leading Software Vendors were LeeCare, Autumncare and EOS Technologies. Their role was to receive guidance from the Providers to how best modify their software to make it work for the Providers, as pioneers to streamline the changes to software that can then be disseminated to other Software Vendors who were not part of the project.

Consumers have now been empowered to create this record with their nominated Care Provider (who is required to be registered with an HPI-O). With over million Australians under the direct care of Aged Service Providers, we are best placed to assist our clients. There are various regulatory and policy procedures that have to be incorporated to safeguard the Client as well the Provider to facilitate this process. Pathfinder addressed these issues from a Provider point of view, as it was charted to.

We also recognise that the best way for a new participant to enter Aged Care is for PCEHR to be an entry requirement.. The Aged Care Gateway Project, as part of the Living Longer, Living Better Reform package seeks to do so and should be operational in 2014.

While certain of its reach and the ability have a quick adoption of PCEHR by Aged Service Providers, the project also recognised that the Providers Aged need to be remunerated to attend to this historical change of those currently under its Care and ongoing updates of all Clients. The benefits are not only to the sector but also to the other parts of the health system. This is no different to GPs, who have been granted an ongoing fee to do so. That is, to create and maintain electronic records that can be accessed by those the Client nominates.

Council, on behalf of Providers, are keen to pursue this matter and impress upon policy makers to how best to optimise opportunity versus opportunity cost.

The report was submitted to DoHA in August 2012 and the sector waits to work out next steps. ■

42 | National Update

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Technology | 43

What’s in it for me?

By Ann Turnbull

In my experience, the one thing that will derail a proposed change is when those who will be affected by the change do not believe that they will be better off. The first question they will ask is ‘What’s in it for me?’ The second question is ‘Do I have to do more work?’ An effective change management strategy will keep those two questions in mind at all times.

M

ost aged care facilities who consider an electronic clinical system introduce the progress notes/care planning modules first. Once that is up and running, introducing an electronic medication management module can be considered. These two modules complement each other by sharing data and, together, save time, reduce transcription errors, reduce the time taken to admit a new resident and significantly reduce the time spent doing a medication round.

At Lynden, we introduced the medication management system first because it was clear to the nursing staff that this module would provide the most for them in terms of saving time and reducing their frustration. Prior to introducing this module, we spent time discussing the frustrations with the current manual medication system. There were many, and it was easy to see how this new IT could address the majority of the issues. We also spent time talking about the frustrations with manual recording of progress notes and care plans etc., and realized that this was not such a big issue because not all staff were feeling the frustration, which occurred occasionally, but not daily. It was clear that the biggest benefit from the clinical module would be when a new resident was admitted, however, the frustrations of the manual medication system occurred on every shift every day for every resident.

Because nurses could see that an electronic medication management system would significantly reduce their frustrations, they were keen to adopt this new technology.

Once you have the staff on board, you need to provide them with adequate training and support, so that when they come across a problem, there is someone around to help them fix it.

Some staff were computer savvy, but many were absolutely IT illiterate and had to be shown how to turn it on. Even if a change is widely applauded, if enough training and support is not available precisely when it is needed, the new system itself will become the frustration and the change will not be a happy one!

At Lynden, we provided every nurse with training and made sure that a “champion” was on duty every shift every day for the first few weeks until staff were confident using the system.

Because this project was such a success in terms of eliminating the frustrations of the manual system, further IT changes were welcomed. Of course the new electronic system produced some

frustrations of its own but these were nothing compared to the old frustrations!!

In summary, staff must want the change and must believe that it will be of benefit to them. They must also believe that the change will teach them to work smarter, not harder. The final essential element is to provide plenty of training and support while the change is new. ■

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44 | Technology

ITAC 2013 Information Technology in Aged Care Conference 1st & 2nd May 2013 The 6th Annual Information Technology in Aged Care Conference will be held on the 1st and 2nd of May 2013 at the Crown Conference Centre. The theme of the conference, Consumer Centric Service Delivery: driving the efficiency gain emphasises the importance of information technology in establishing a sustainable, quality-focused aged care environment. The conference will bring together local and international experts across the fields of community care, medication management, assistive technologies and offsite information systems delivery.

T

hese 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.

ITAC 2013 will provide key content and opportunities for individuals and organisations with an interest in the aged care sector. International and national experts will present on a range of topics related to the conference theme. Presentations will also focus on the broad business and strategic issues facing an industry dealing with multiple challenges in an environment of substantial reform.

Join ITAC 2013 for a stimulating exchange of ideas and business focused solutions • Have you thought about how Living Longer Living Better will impact your organization?

• Are you a community care provider? If so, have you thought about how to manage CDCs from July 2013 without an IT support system?

• Do you know that providers who use clinical care software and claim ACFI electronically generally get more accuracy in claims history and higher subsidy than claims done manually?

• Residential care providers will need to publish accommodation costs on the My Aged Care website from April 2014. Are you ready?

Can you manage the task without software support?

• Have you got an IT strategy? Does your business plan include an IT future direction?

• Clinical applications in residential care and community care are becoming core business for many organizations involved in delivering services to the aged. ITAC2013 should be in the diary of any Care Manager, Director of Nursing or interested clinician who is thinking about where their organization needs to head in the important area of IT deployment”

Go to www.itac2013.com.au for full program and to register online ITAC 2013 Awards Have you considered submitting your application for the ITAC 2013 Implementation and Innovation Awards?

The awards are open to Aged and Community Care Providers and their implementation partners (vendors or service providers) that have effectively used ICT to improve business outcomes in the Australian Aged and Community Care environment.

ITAC 2013 is brought to you by the Aged Care Industry Information Technology Council (ACIITC) ■

Technology | 45

1–2 May 2013 Crown Conference Centre Melbourne Online registration now open at: www.itac2013.com.au Exhibition & Sponsorship Opportunities selling fast – go online for more details

Consumer Centric Service Delivery DRIVING THE EFFICIENCY GAIN

ITAC 2013 is brought to you by the Aged Care Industry Information Technology Council (ACIITC) supported by Leading Age Services Australia and Aged and Community Services Australia

ITAC2013 will try to work through these and many other issues that will impact your organisations operations in coming years.

•

Have you thought about how Living Longer Living Better will impact your organization?

•

Are you a community care provider?

If so have you thought about how to manage CDCs from July 2013 without an IT support system?

•

Do you know that providers who use clinical care software and claim ACFI electronically generally get more accuracy in claims history and higher subsidy than claims done manually.

Join ITAC 2013 for a stimulating exchange of ideas and business focused solutions.

•

Residential care providers will need to publish accommodation costs on My Aged Care website from April 2014.

Are you ready? Can you manage the task without software support

For full program and to register online go to www.itac2013.com.au

•

Have you got an IT strategy?

Does your business plan include an IT future direction?

FURTHER INFORMATION: Jane Murray, ITAC 2013 Conference Manager Corporate Vision Events T: 08 8981 5119 E: itac2013@ cve1.com.au

General | 47

LASA National Roadshow

By Kay Richards

Since late February, LASA has staged a ‘Roadshow’, involving over 630 LASA members across the country and Julie McStay, of Hynes Lawyers. The Roadshows were designed to invoke discussion about the Bills tabled on the 13th of March 2013, and also to identify how the proposed Bills would affect LASA, Providers’ business, and clients and their families.

T

he Roadshows discussed the impact of the Bill on two areas: Home Care and Residential Care. With Home Care, the focus was on the four packages provided by the Consumer Directed Care Principles and income testing for clients. With Residential Care, discussions covered payment methods for residents and their families, including implications for income and asset testing, annual and lifetime caps, the removal of high and low care distinctions (and subsequent changes to the Specified Care and Services Schedule), accommodation pricing (and the three-tier system), plus the Refundable Accommodation Deposits (RAD) and the Guidelines and Complaints Process associated with the Choice of Payment Method Period. Also discussed was the removal of retentions and insurance on the RAD. Unsurprisingly, most Providers had very similar questions, as it seems the same issues in general are affecting them. Most Providers asked about the logistical issues of Home Care, such questioning who monitors annual and life limits, and who takes care of administration. They were also concerned that increased costs for the clients would require additional debt recovery processes for the Providers. Of course, it would not be desirable for LASA or Providers to become a Government debt collection agency. In terms of residential care, the concerns were mainly about increases in costs due to the review of the Schedule of Specified Care and Services. Although offering ‘additional amenities’ was also met with scepticism, it did spark discussion on Extra Service – specifically, asking why Providers would consider offering Extra Service places when there is very little change in the arrangements – the applications are still being run through ACAR with planning region limitations.

There is also still tension in the industry. The issue of providers being unable to continue to take retentions is being compounded by the lack of guidelines for setting, advertising and agreements of the Daily Accommodation Payment and Refundable Accommodation Deposits.

Also discussed was the process and timeline for the Bills, where Hynes Lawyers’ contribution was invaluable. Although

the timeline is quite tight, there are multiple windows of opportunity for lobbying and agitation.

LASA members are urged to be vocal through their State office about the legislation’s impact on Providers’ business, and on clients and their families, as during the lawmaking process, the practical implications of the decisions made should be kept forefront in the minds of the legislators. The Minister has confirmed that the Bill has been referred to the Senate Community Affairs committee. LASA will be putting forward an oral submission to remind the committee of those practical implications, and members are urged to put forward their own submissions. LASA will provide more information and support on this as it becomes available.

As this is an election year, lobbying Federal members will be particularly effective, and this is a perfect time to get real, practical legislative results for our industry.

Roadshow events were concluded with a presentation by the LASA National office, describing the upcoming campaign and how members can become involved. The National Office concluded that members should support the Campaign Strategy put forward

by LASA. Members will receive further information following the LASA Board and State CEO meetings in Canberra.

LASA members will be able to view the LASA National Roadshow workshops online by accessing state and territory websites. ■

48 | General

Response to the Workforce Compact

By David Amesbury – Manager IR/HR LASA Victoria

Background

O

n 20 April 2012, the Prime Minister and the Minister for Mental Health and Ageing released a comprehensive 10 year package to reshape aged care – Living Longer. Living Better The reform package included an announcement that up to $1.2 billion would be made available through the Addressing Workforce Pressures initiative to better support the people who work in aged care. This initiative was to be delivered in two parts – through the Aged Care Workforce Compact and Supplement, and the Aged Care Workforce Development Plan developed during 2013.

As part of the initiative an Aged Care Workforce Compact (the Compact) was developed with the intent to consult unions, employers and peak bodies to get consensus around increase wages and improve conditions to aged care workers. Whilst peak bodies and employers were fully supportive of this initiative both groups, including LASA, strongly opposed from the outset any aspect where costs were to be borne by employers. After months of negotiations what the Minister has effectively delivered is a bargaining framework for industrial relations that redirects our existing ACFI funding into future wage increases.

The outcome of the Compact is a fundamental policy failure for aged care workers, providers and the older Australians in our care.

What is the Compact?

The Compact is a National Industry Framework Agreement.

A decision by individual approved aged care providers will be required to fulfil the principles articulated in the Industry Framework Agreement (Workforce Compact) and this would in turn authorise the Aged Care Workforce Supplement (the Supplement) to be made to a compliant aged care provider.

The Industry Framework Agreement (Workforce Compact) encapsulate principles for the negotiation of workforce conditions at the enterprise level using existing local industrial processes,

against which approved providers will be required to demonstrate industrial or contractual compliance with the conditions on which the Supplement is agreed to operate.

For residential aged care providers and home care providers, the Supplement will be a separate, additional, primary supplement under the Aged Care Act 1997, taking effect from 1 July 2013.

It does not replace or impact on the current Conditional Adjustment Payment for residential aged care providers.

However, for providers funded outside the Aged Care Act 1997, the Supplement will be an increase to amounts paid under funding agreements (I note these providers are not eligible to receive the current Conditional Adjustment Payment). This includes providers of the Commonwealth Home and Community Care program, the National Respite for Carers program, the Day Therapy Centre program and providers of the Veterans’ Home Care program and the Community Nursing programs.

What are the requirements to receive the Aged Care Workforce Supplement?

The Aged Care Workforce Supplement (the Supplement) will be available from 1 July 2013 to eligible aged care providers who meet the terms and conditions of the Compact as outlined in this document.

Aged care providers whose employees are paid under State and Territory Government awards or public sector enterprise agreements will not be eligible for the Aged Care Workforce Supplement. This means Public Sector Residential Aged Care Services (PSRACS) in Victoria will not be eligible, however: • Providers who put in place arrangements to meet the terms and conditions of the Compact prior to 1 July 2013 are eligible for increased funding from 1 July 2013.

• Providers meeting the terms and conditions of the Compact between 1 July 2013 and 31 December 2013 will be eligible for increased funding from the date pay rises to their staff take effect (so long as all other requirements have been met).

Table 1: Percentage margin over the relevant Award rates that must be maintained 2013/14

2014/15

2015/16

2016/17

Personal and community care workers and other aged care staff

1.50%

3.00%

3.00%

3.00%

Enrolled nurses

2.50%

5.50%

8.50%

8.50%

Registered nurses

4.00%

8.00%

12.60%

12.60%

General | 49 On-costs are to be borne by the employer and unfunded Table 2: True cost of employment on-costs Superannuation

9.0%

This will increase to 12% over the life of the agreement

Work cover premiums

3.0%

(varies but industry average)

Annual Leave

9.6%

(5/52 = 9.6%)

Annual Leave loading

1.35%

(4 x 0.175/52 = 1.35%)

Sick leave

2.9%

(75% of 2 weeks/52 = 2.9%)

Long Service Leave

1.65%

(0.8667 weeks for 10 years of service)

Public Holidays

4.0%

This can vary from State to State

TOTAL

31.5%

• Providers who meet the terms and conditions of the Compact after 31 December 2013 will be eligible for increased funding from the date the application is received by the Department of Health and Ageing.

Aged care providers with an enterprise agreement in place In order to access the Supplement, aged care providers must ensure that their enterprise agreement is consistent with the terms and conditions of the Compact, outlined below.

Wage increases – minimum requirement In order to access the Supplement, aged care providers must: • Ensure that annual increases in wages are a minimum of 2.75 per cent per annum, or the Fair Work Commission annual minimum wage increase, whichever is higher; and • maintain a margin over the relevant Award rates for all employees of at least those shown in Table 1.

The Supplement must then be passed in full to each provider’s aged care employees as wage increases.

The Supplement will be required to deliver a minimum additional one per cent wage increase for all employees each year in 2013/14 to 2015/16, and an additional 0.5 per cent increase in 2016/17.

Enhancing training and education opportunities Providers will be required to ensure aged care employees are to be given access to appropriate and targeted education, training and development opportunities that are necessary and relevant to their roles and responsibilities.

Such training should be provided to employees during normal rostered hours of work.

Professional development Employers will be required to commit to the professional development of employees, and that this commitment can be supported in a variety of ways at the enterprise level.

Table 3 – Summary of minimum commitments to attract and retain employees Area

Clauses in Agreement

Enhancing training and education opportunities

Access to training and education Professional development Representation leave

Improved career structures Improved career development and workforce planning

Review of part-time hours Conversion of casual employees to permanent employees Workload management Workplace health and safety Disciplinary matters

Commentary The absorption of employment on-costs is a considerable cost to employers and a real deterrent from aged care providers entering into the Compact.

The productivity gains from decreasing staff turnover and retention of staff is doubtful and cannot be substantiated.

Improving capacity to attract and retain employees – minimum commitments In addition to the wages requirements, there are other minimum commitments for aged care providers to meet in order to access the Supplement, which are intended to improve the capacity of the aged care sector to attract and retain employees.

It is open to providers to improve upon these provisions, based on agreed operating requirements at the enterprise level, and in line with the objectives of enterprise agreements or employment arrangements.

Note: These matters will need to be negotiated into your enterprise agreements

Representation leave • Employers will be required to recognise the importance of training for those who play a representative role in the workplace through consultative committees and dispute resolution.

• Employers to be required to make a commitment to taking action in areas identified as contributing to supporting improved retention rates for aged care employees.

Review of part-time hours – work-life balance and flexible working arrangements • Providers will need to make a commitment to cover processes and arrangements for managing and systematically reviewing the working hours of part-time employees.

50 | General

• Where an employee is regularly working more than their guaranteed minimum number of hours the employee may request to have their hours reviewed annually.

Conversion of casual employees to permanent employees Employers will be required to an agreed mechanism for converting casual employees who work regular and systematic hours, covering the following: • A casual employee who has been rostered on a regular and systematic basis over a period of: • 26 weeks has the right to request conversion to permanent employment. An employee, who does not make a request within four weeks of the right to request falling due, is deemed not to have elected to convert.

• Providers may set this provision, at the enterprise level, in the context that the hours must be capable of fitting within the existing shift and rostering arrangements.

Workload management Providers will be required to demonstrate workload management arrangements.

Workplace health and safety Providers will be required to set up consultative structures to support positive change in the area of workplace health and safety, supported by a program of training for participants and managers, and staff more broadly.

Disciplinary matters Providers will be required to ensure that there are disciplinary procedures and provision is made to cover representation and procedural fairness.

Aged care providers who do not have an enterprise agreement in place: • In order to access the Supplement, residential aged care providers with 50 or more operational places must put in place an enterprise agreement consistent with the terms and conditions of the Compact.

• Residential aged care providers with fewer than 50 operational places and home care providers will need to certify that they meet the terms and conditions of the Compact, including that

they have written to all employees advising that they have applied for the Supplement.

• Providers of the Commonwealth Home and Community Care program, the National Respite for Carers program, and the Day Therapy Centre program will need to certify that they meet the terms and conditions of the Compact, including that they have written to all employees advising that they have applied for the Supplement.

• Providers of the Veterans Home Care and Community Nursing programs will need to satisfy the Department of Veterans’ Affairs that they meet the terms and conditions of the Compact.

Aged Care Workforce Census and Survey In order to access the Supplement, aged care providers must take part in the Department of Health and Ageing’s regular Aged Care Workforce Census and Survey.

Summary The Workforce Compact has a number of elements that require compliance including wage increases, agreement to workforce commitment clauses and meeting minimum wage thresholds and therefore it is anticipated that interest from providers will be low to participate in the compact.

There is also considerable concern about how these increases are funded into the future beyond the 2016/17 financial year and the matter of absorbing increases in superannuation costs over the life of this agreement.

Before entering into the Compact, it is vital that employers carefully consider the costs to their business by doing some detailed financial modelling and getting expert industrial relations advice.

LASA Victoria cautions members to carefully analyse the elements of the workforce compact before agreeing and making commitments to incorporating the workforce compact into your enterprise agreements or industrial instruments. ■

More information For further advice or information please contact: David Amesbury Manager – IR/HR LASA Victoria P: 03 9805 9400 E: davida@vic.lasa.asn.au

General | 51

Telehealth GPs improving the delivery of patient care

A general practitioner (GP), or a practice nurse on their behalf, can provide clinical support to a patient in residential aged care facilities (RACFs) during a video consultation with a specialist so that the patient can remain in the comfort of their residence.

GPs and specialists using telehealth video consultations can improve the quality of life for some RACF patients who experience mobility issues in getting to a specialist appointment.

Telehealth video consultations provide convenient access to healthcare services enabling more timely diagnosis and treatment.

Video consultations facilitate the provision of collaborative care by specialists and GPs, and provide opportunities to clarify any confusion or misunderstanding about a patient’s care early and effectively.

GPs, specialists and RACFs can all take advantage of a range of generous incentives on offer which include a one–off on-board payment, as well as service incentive payments per patient for GPs and hosting incentives for RACFs. These all reduce after June 2013 so now is the time to get started!

Call 1800 257 053 or email telehealth@racgp.org.au or visit www.racgp.org.au/telehealth Scan the QR code to go straight to the RACGP telehealth page

To find out more about telehealth, the incentives and how to start, call the Telehealth Support Service at The Royal Australian College of General Practitioners on 1800 257 053 or visit www.racgp.org.au/telehealth to access a range of online resources to help you get started including factsheets, implementation guidelines, advice on technical options and information on using Skype.

This project is funded by the Australian Government Department of Health and Ageing

52 | General

Aged Care Reforms, more detail please

By Rachel Lane

With the aged reforms to be put into legislation in the coming months there is a surprising lack of detail about what the potential consequences are going to be on aged care operators and residents alike. This is creating uncertainty for aged care facilities and worry for potential residents.

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question I have posed for some time now is a fairly simple “Dorothy Dixer” scenario. Dorothy has $190,000 in aged care assessable assets and is a full pensioner, what amount of accommodation bond or daily charge can she be asked to pay post reform?

Under the current rules Dorothy would need to be left with $41,500, so the maximum accommodation bond would be $148,500. The accommodation charge that Dorothy could be asked to pay would be $32.76 as her assessable assets exceed $109,640.80.

There seems to be a couple of schools of thought about the aged care reforms. One school of thought is that the reforms will make aged care a “user pays” system for anyone who is not a supported resident. The asset threshold for supported residents post reform is expected to be $144,500, so Dorothy could have access to a tier 1, 2 or 3 facility provided she makes the relevant accommodation payment.

The Government have set out the following payment tiers for aged care facilities: • Tier 1 will be capped at the government set maximum for accommodation supplements, approx. $52.84 per day or a lump sum of $238,845.

• Tier 2 will be for payments above Tier 1 but not greater than $85 per day or a lump sum of $406,037.

• Tier 3 will be accommodation payments above the Tier 2 threshold. Prices will require government approval and will be established based on set criteria.

As Dorothy doesn’t have the capacity to pay the entire amount by lump sum (even in a tier 1 facility) she will most likely need to pay by way of a combination of lump sum and daily charge – or all by daily charge. For example, if the facility she would like to move to is a tier 2 facility and they have a bond price of $300,000 and a daily charge equivalent of $60, she may choose to pay a lump sum of $150,000 and $30 by daily charge.

The other school of thought is that there will be little change to the current system; a resident’s capacity to pay will be limited to their assessable assets minus the minimum assets amount they must be left with. An accommodation supplement of up to $52.84 would be paid for supported residents.

In the case of Dorothy if she moved to a Tier 1 facility this would mean that the maximum accommodation bond she could be asked to pay would be $148,500 – the maximum daily charge would be $52.84.

Obviously this doesn’t add up and given the choice the resident is most likely to choose the lump sum payment option.

This would leave the aged care operator in a situation where they would not be receiving the necessary payment, from either the resident or the government, to cover the cost of providing the accommodation and the inability to cross subsidise Dorothy with a resident who pays above the set price.

The daily charge and lump sum equivalent are based on the Government set interest rate for aged care facilities, known as the Maximum Permissible Interest Rate (MPIR). A potential consequence of this is that if interest rates go up the lump sum amount will go down and vice versa. For example, when setting the price tiers the MPIR was 7.62% which meant that $85 daily charge equated to a lump sum amount of $406,037. The current MPIR is 7.24% which means that the lump sum equivalent of $85 would be $428,522. If we assumed that interest rates dropped and the MPIR was 6.24% the equivalent lump sum would increase to $497,195. Conversely if interest rates increased and the MPIR used was 10.24%, and the daily charge was $85, the lump sum amount would reduce to $302,978. When we look at the history of the MPIR, we can see that prior to the GFC the rate was 11.31%.

There are a number of factors that will influence a resident’s decision to pay their accommodation payment by way of a lump sum, daily charge or a combination, including; the level of assets outside the home, the ability to keep and rent the former home, other forms of private income, the impact on pension entitlement, the amount of the accommodation bond compared with the value of the home and of course the calculation of the care contribution.

A reduction in a resident’s capacity to pay money into the accommodation bond, due to an increase in interest rates, is likely to lead to a reluctance to sell the former home to meet a lump sum payment as the assets “left over” may impact on their pension entitlement and the amount they need to pay in care co-contribution. From the aged care operator’s point of view an

General | 53

increase in interest rates may make capital payments more, not less, valuable.

A detailed analysis of what the reforms mean to a resident’s ability to access and afford the care they need and an aged care operators ability to provide quality care and be sustainable needs to be undertaken… but first we need more detail. ■

Rachel is the Principal of Aged Care Gurus and co-author of the book “Aged Care, Who Cares?” with Noel Whittaker.

She regularly facilitates educational workshops on aged care finances for advisers, legal professionals and aged care operators. Rachel has been working in financial services for 14 years and specialising in aged care for the past 8. Rachel holds a Masters in Financial Planning which included a research report on aged care in Australia titled “Aged Care; The struggle to provide Quality, Equity, Efficiency, Sustainability and Choice”.

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54 | General

OECD – 1ST Expert Consultation on Integrated Services and Housing

By Bryan Lipmann AM | CEO Wintringham

In November last year, the OECD invited 50 people from around world to participate in the 1st Expert Consultation on Integrated Services and Housing. I was fortunate enough to be included in this group, and then to be one of the people asked to make a presentation.

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s the meeting discussed issues covering a wide range of service problems, most of which have direct relevance to our experience in Australia and of wider significance than elderly homelessness, it has been suggested that LASA readers would be interested in hearing something of the meeting.

By way of background, the Organisation for Economic Co-operation and Development (OECD) originated in Europe following the end of the Second World War to assist with the redevelopment of their devastated economies. The OECD is primarily a policy and economic development organisation for advanced economies that is committed to sharing best practice models and information on a range of economic, environmental and social issues. Initially a European organisation, membership of the OECD has now been widened to 34 countries including the USA, Australia and Japan.

The impetus for the meeting was a decision taken in 2011 by the OECD to make the study of integrated services for vulnerable populations a priority. For readers unfamiliar with the work of Wintringham, it has been this attempt at the integration of housing

with mainstream aged cares services for the elderly homeless which has characterised all of our work. We were therefore thrilled to have an opportunity to share our experiences with colleagues from around the world. Visiting Paris wasn’t all bad either!

The term ‘Integrated services’ refers to examples of social services that join across various program areas to benefit either service users or providers. What is of particular interest to Wintringham is the notion of horizontal integration, which involves accessing services from program areas that were previously unlinked to homelessness.

Of interest to participants at the OECD forum was the way that Wintringham was able to horizontally integrate the mainstream aged care program to homelessness by redefining elderly homeless people as being primarily aged and therefore eligible for aged care funding. As a result, over the last 20 years, hundreds of millions of dollars have moved from aged care to those few organisations working on behalf of a group of people who should have been entitled to care but were not able to access it. Horizontal Integration is therefore simply a set of words: another way of expressing that homelessness is a community problem

General | 55

and all levels of government bear some responsibility to address this scourge. It shouldn’t just be left to the small and underfunded National and State homelessness programs.

In the absence of a truly integrated service sector, which is probably only ever going to exist as a proposition in an academic paper, organisations serving vulnerable groups need to target not just the special, individual needs of each client but importantly, we need to target resources. Wintringham has attempted to do this by using an eligibility argument that is embedded in a social justice framework.

For people working with marginalised groups, it is often futile arguing for access to mainstream services. What can be more useful is to put the case that our clients are entitled to mainstream funding. By developing a specialist service within a mainstream funding program, we can create a form of horizontal integration for a vulnerable population group that is resourced by a previously unlinked program source. The net effect is increased resources for the vulnerable population you are serving.

A topic that may resonate with some readers was a discussion that Wintringham initiated on the power of words and how language and meaning can be used to influence both policy

56 | General development and community perception. There is in all societies a Dominant Ideology which has its own language and reference points that most of us use or relate to in everyday speech.

Unconsciously at times, we repeat phrases or words that while appearing to be innocuous, reinforce entrenched beliefs or dogmas.

An example is the pejorative way the word ‘institution’ is used. It’s interesting how that word immediately conjures up in someone’s mind the very last place you would want to place your mum, or live yourself, yet someone else at the same time, could call the same building or group of houses, a ‘community’ which of course has a very different meaning. What is also interesting is the

way that opponents of a concept use language to arouse fear or loathing. At a housing development Wintringham undertook in East Bentleigh, aggrieved neighbours scribbled “Home for Deros” on the building sign, yet the residents were to be simply pensioners.

All representatives at the OECD appeared concerned about the way organised opposition groups worked to prevent marginalised groups accessing any additional or integrated services. Some countries in Europe face significant economic problems that are probably exacerbated by the freedom to move between borders without visas, together with the large legal and illegal migration of people from non-European countries searching for a better life. With only limited opportunities for work and great

General | 57 difficulty in accessing welfare support, these virtually stateless people become the target of xenophobic nationalist groups and face increased risk of homelessness and the consequent problems relating to health and physical security. It is not an easy time to be arguing for wider access to services for marginalised groups.

A presentation I suspect would be of great interest to mainstream non-homeless providers was from Dominique Verte, the Flemish Minister for Innovation and Pubic Investment in the Belgium Government, who revealed the results of research which showed that the majority of elderly people said that when they became older and frailer, they did not want to live with their children or in supported housing and would prefer to continue living in their own home. In order to do this they freely acknowledged that their houses would need to be adapted if they were to live at home, yet very few people actually did these renovations. As a result of this inaction, decision-making in late life is likely to result in higher support needs and, in turn, higher service costs.

The consultation concluded with an agreement that further work should target both empirical research and information sharing, but importantly, much emphasis was placed on the

development of conceptual ideas that would assist with the development of various forms of integration.

At times, the meeting seemed a million miles away from the everyday issues of assisting with the running of a homeless organisation, but perhaps for that reason, it was a wonderfully stimulating few days. ■

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General | 59

What about men?

‘‘ ’’

By Frances Russell | BApSc MPH Ann Cantor BA Visual Communication, Ad Dip Transpersonal Art Therapy, QMACA Tracey McDonald AM FACN PhD

W

hile the social and aged care facilities. At Bill coloured his heart to match his moodcultural elements RSL LifeCare ANZAC creating stripes of colour representing of aged care Village, our veteran care strength and happiness, members of the residences and connection means we have family and a black base representing the assisted living areas are created to a higher proportion of men, end of the road. Art provided a vehicle to welcome everyone, the influence accounting for 34% of the express his feelings about love and loss. of a majority group can exert an residents in the homes where influence on what occurs there. the Art Therapy project was The Australian Institute of Health introduced in August 2010, and Welfare reports that men make up 29% of residents (AIHW, specifically for male residents in assisted living.

2011) and that Australia-wide, men are a minority within residential

60 | General

‘‘ ’’

Men have particular issues and emotions, leading them to needs as they age. Most grew up in internalise feelings of grief Jim often struggles to find the words to an era of strong gender roles, where and loneliness. (Schmutte, express himself and finds it difficult to stay men were the breadwinners and 1998) connected with the topic. When offered a women the domestic carers. Often In a study by Jilek paint brush he is able to focus, make clear ,they will not seek help or accept (2006) comprising in-depth and concise decisions about colour and charity and believe that they must interviews with men entering content and often communicates quickly be self-sufficient. Asking for help residential care at 10 facilities and effectively through his art. can make them feel old, incapable in Sydney, four key themes and emasculated (Men’s Health were identified for men in Information and Resource Centre, 2009). Male communication residential care: styles are also important, as they are different to the way women • The struggle for control often communicate. Men tend to talk side by side rather than • Institutionalisation and the fight for privacy and dignity facing each other, and may be more comfortable socialising in • Social isolation and the need for mateship groups organised around an activity. Men also react differently • “I am still alive” – the need for meaning to grief. It is less socially acceptable for them to express their Art therapy was introduced to address issues such as individuals experiencing life changes, trauma, illness or disability

General | 61 which often prompt people to move into assisted living. The aim was to provide a safe and supportive environment where, through the use of a variety of art and creative medium, participants can reflect on their lives and consider issues currently confronting them. The focus of this person-centred activity is on process rather than creating artistic masterpieces and self-esteem is promoted from creating something worthwhile and having others respond positively to their works.

Art therapy is widely believed to be of particular benefit for people with dementia-related communication difficulties. It stimulates creativity and imagination; helps develop coping skills; provides a safe and nurturing environment; develops motor skills and co-ordination; enables the identification and expression of feelings; and allows for refection. It could even be said that it provides a way ‘out of the head’ and ‘into the heart’.

Art therapy sessions are conducted by a qualified art therapist who understands the health and social environment of the facility.

Continuity is achieved by the same art therapist being involved in all sessions, allowing for relationship building and continuous evaluation of participants’ progress against therapy aims and individual goals. The therapist assesses progress made by each participant and enters a summary in their care records as well as consulting with the registered nurse following each session.

The first group, ‘The Hero’s Journey’ began in August 2010 with eleven men nominated by their registered nurse because they were having trouble settling into the care environment and/or not participating in activities. A second men’s group and a women’s group was later added due to popular demand.

All groups experienced marked improvements in social interaction. The men’s groups in particular displayed little interaction at first, however, over time, a gradual and spontaneous increase occurred in their interaction, and camaraderie improved within the group as they encouraged each other’s efforts in making art. A strong sense of trust within a supportive environment allows participants to share personal stories, including those of grief and loss.

Confidence also grew over time. Initially hesitant to create an artwork and quite critical of the result, participants developed as a group of art makers and became more willing to experiment with art materials and be less judgmental of results.

Continuity of therapy seems to be the key to success. We know this because of a marked decline following a recent period in which residents were unable to participate in their usual social interaction and stimulation as a result of infection control procedures. However, after therapy resumed, normal functioning and energy levels returned within several sessions.

The process of creating art is especially empowering if participants are encouraged to make choices and experiment. Art therapy in residential settings enables participants to make many decisions for themselves, safe in the knowledge that there are no wrong answers or choices.

By observing art therapy participants during this period, we believe it has a positive impact for residents in assisted living and has helped residents deal with life changes associated with ageing and illness.

The making of art is empowering and life enhancing, as evidenced by the sense of pride with which participants share their art in group exhibitions and with families, who were both surprised and delighted. Art therapy is one of the few opportunities we have to do something that surprises both ourselves and others and is a powerful tool in helping us cope with life challenges. ■

REFERENCES AIHW (2011). Tracking the growing path to ageing and aged care. Access Online Magazine, 29. http://www.aihw.gov.au/access/201103/feature/ageing-and-agedcare.cfm Men’s Health Information and Resource Centre. UWS. 2009. Older men and Home and Community Care Services: Barriers to access and effective models of care. Paper No 1. http://issuu.com/mhirc/docs/mhirc_1.hacc/1 Schmutte, T. (1998). Elderly Men: Special Problems and Professional Challenges.

Journal of Applied Gerontology 17(1): 97-99.

Jilek, R. (2006). The lived experience of men entering residential aged care. Geriaction 24(2): 5-13

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General | 63

From institution to inspiration . . . from daily despair to hope for tomorrow . . . imagine the freedom!

By Charmaine Waugh | CEO Australian Aged Care Group

D

uring a study tour of aged care overseas last year, the CEO of the Australian Aged Care Group, Charmaine Waugh heard about Ekuphumleni Old Age Home in Gugulethu, South Africa. It was a care facility in crisis, and was placed under full administration of the Department of Social Development and an organisation (Geratec) in 2011 primarily due to ineffectual management, neglect of residents, lack of qualified staff and complete lack of maintenance to buildings and equipment.

64 | General Ekuphumleni faces a number of challenges. Their primary goals are to transform the home into a haven of care for vulnerable older people and to realise their vision of excellence in personcentred care. In order to achieve these goals, they must tackle a number of areas such as development of menus and special diets, quality control, waste eradication, energy saving controls and creative energy alternatives, strict financial control, hygiene and occupational health and safety, training and development of staff in all areas, and the implementation of proper governance and accountability.

Imagine the freedom when this is achieved!

Involvement of stakeholders has been the uppermost consideration in being able to overcome the challenges. The Seniors Club in the local community have provided much needed support by turning much neglected land spaces into a vegetable garden that benefits the senior club members as well as the Ekuphumleni residents. Barren, dusty and empty courtyards have been transformed into garden oasis when the residents took ownership with the assistance of the local Health Care Forum.

Staff have also embraced the vision moving from ‘just hanging around and chatting’ to being involved with residents’ activities.

Donations from the community were dumped in storerooms in the past. Today, they have been sorted, hung on rails for ‘easy shopping’ – they’ve become an Eku Boutique.

General | 65 The Australian Aged Care Group has a commitment to making a positive contribution to communities. On her return from the study tour, Charmaine presented this project to the leadership group at Kew Gardens Aged Care. The group has enthusiastically embraced the opportunity to assist an aged care facility in South Africa.

Following consultation with the home in Gugulethu, Kew Gardens’ goal is to raise sufficient funds to purchase medication packaging equipment to the value of $10,000 by June 2013. A number of other, more basic opportunities have been identified that will be investigated following the completion of our fundraising project.

Kew Gardens’ leadership team has divided themselves into four groups and developed action plans. Some of our activities include a trivia night, massages (from qualified staff), trash ‘n treasure markets, raffles, lucky chance boards, auction of a chef and wait staff for a dinner, etc. Kew Gardens Aged Care service providers have also been approached, seeking a moderate $100 donation; to date we have received positive results.

All of the Kew Gardens staff are in support for those less fortunate than ourselves in the same field of work.

Our aim with this project, in addition to raising these vital funds, is to enhance the leadership group’s skills and creativity AND to have fun, fun and more fun! ■

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66 | General

How Epilepsy Action Australia’s Online Academy helps

By Craig Hutchinson

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pilepsy can begin at any age. However, you are more likely to develop epilepsy when you are young or in later life. Although many people are diagnosed before age 20, epilepsy is the third most common neurological disorder, after dementia and stroke, in those aged over 65.

What causes epilepsy at this age?

Epilepsy is a condition with many possible causes or no known cause. When epilepsy begins later in life, a reason can usually be identified. Anything that causes brain damage or scarring – such as illness, trauma, or lack of blood or oxygen – can lead to seizures. In this age group: • Stroke is the most frequent cause of seizures, which affect up to 15% of stroke survivors1. The larger the stroke, the higher the risk. Sometimes seizures are the first sign of a stroke.

• Some medications such as antidepressants and major tranquillisers can reduce the brain’s seizure threshold (the point at which increased electrical activity in the brain will result in a seizure). Herbal medicines may also provoke seizures.

• Seizures can be triggered by blocked arteries, heart disease and any other disorders that limit supply of blood or oxygen to the brain, or trauma causing head injuries or brain haemorrhage.

• Up to 16% of people with Alzheimer’s disease can have seizures.2 • Other seizure causes include diabetes, kidney or liver failure, serious infections, brain tumours and chronic alcohol abuse.

Epilepsy and the health care system There is a shortage of quality epilepsy training for health professionals and carers in Australia.

Epilepsy and convulsion disorders are the ninth most common cause of preventable hospitalisations in Australia. Health professionals have a role to play in reducing this burden, by

increasing their own knowledge of epilepsy, and providing patient care.

Other conditions such as asthma have warranted nationallyaccredited courses to standardise health care, but to date, not epilepsy.

That has now changed, with the launch of Epilepsy Action Australia’s Online Academy.

What is Epilepsy Action Australia’s Online Academy?

After more than two years’ development, Epilepsy Action Australia’s Online Academy is now up and running (www.epilepsy. org.au/online-academy). It’s a major online learning initiative where people with epilepsy, their carers and aged-care workers can learn more about the condition.

The Epilepsy Action Online Academy cuts across barriers by delivering tailored epilepsy education cost-effectively via the internet, and it caters to people across the spectrum of knowledge needs.

“A comprehensive range of courses is available, and the response so far has been really positive,” Epilepsy Action Australia CEO Carol Ireland said.

“In an Australian first, we offer nationally-accredited courses for aged-care workers, nurses and personal carers to learn more about epilepsy, which is the world’s most common serious brain disorder,” she said.

“Around 225,000 Australians have epilepsy, and yet unfortunately it is a very misunderstood condition, and this was one of the main reasons for launching the Online Academy.”

Courses currently available include: Seizure Smart An accredited course for people working in health, aged care and community services sectors, helping to improve understanding

General | 67

of epilepsy and consequently improve care and outcomes for clients. The course is self-paced and takes only about three hours to complete.

Emergency Medications for Seizures Interactive accredited course for personal carers and aged care workers, designed to provide participants with skills and knowledge to effectively administer emergency medications for seizures. The course is self-paced and takes approximately five hours to complete.

The Epilepsy Knowledge Program This course is designed to increase Registered Nurses’ knowledge of key clinical and social aspects of epilepsy and seizures for application into their service delivery and practice.

This online program has been accredited by Royal College of Nursing and attendance attracts 20 RCNA Continuing Nurse Education(CNE) points. Endorsed by APNA, completion of the program entitles eligible participants to claim 20 CPD hours.

The Online Academy uses interactive tools, including videos, and offers a range of ever expanding resources including: Fact Sheets, Memory games and ‘My Epilepsy Diary’; an online seizure monitoring tool.

What is Epilepsy Action Australia?

The non-profit association Epilepsy Action Australia was founded 60 years ago, and is the largest national provider of epilepsy services. It is the only Australian epilepsy organisation to receive Federal Government funding.

Why is it important?

Older adults are the fastest growing population to be affected by epilepsy. By completing the online courses offered by Epilepsy Action Australia, nurses and aged-care workers can be much better equipped to treat someone properly when they’re having a seizure, and help them better manage the condition.

www.epilepsy.org.au ■ References 1. Bassel W. Abou-Khalil, MD. Epilepsy Currents, Vol. 10, No. 2 (March/April) 2010 pp. 36–37. Wiley Periodicals, Inc. American Epilepsy Society 2. Seizure Smart – Seniors – Epilepsy Action Australia retrieved from http://www.epilepsy.org.au/resources/fact-sheets

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www.aqualogic.com.au NSW: U H/ 2 Hudson Ave Castle Hill NSW 2154 T: (02) 8850 1300 | F: (02) 8850 2255 QLD: 2/123 Muriel Ave Moorooka QLD 4105 T: (07) 3392 9299 | F: (07) 3392 9211 sales@aqualogic.com.au

68 | General

NDIS could be a game of luck

By Tom Johnson

Most seniors love a good game of chance like Ludo, Bingo or Two-Up. When it comes to the National Disability Insurance Scheme (NDIS), however, you would be hard pushed to find any seniors wanting to take a chance in that game.

U

nder draft NDIS laws, those who become disabled after they turn 65 will be ineligible for the scheme.

Instead, they will enter the aged care system where they will generally need to pay their own way. This means that if someone becomes disabled when they are aged 64, they will receive lifetime coverage under the NDIS, yet if they obtain that same disability a year later, they will miss out.

National Seniors Australia chief executive Michael O’Neill has described the situation as a ‘cruel lottery’. Severely injure yourself at the wrong time, he says, and you will be shunted into an aged care system that is “ill-equipped, understaffed and now, at the early stages of reform, in a greater state of flux than ever before”.

After a lifetime of paying taxes and building Australia to where it is today, the laws are obviously a hard sell. The Productivity Commission’s justification is that the age cap prevents the NDIS from duplicating services provided in the aged care system.

Australian Greens Senator Rachel Siewert refutes the merits of this. The WA Senator argues that the aged care system may not have the capacity to support Australians over 65 who become disabled.

The 65 year old age limit itself is under debate. According to the Australian Bureau of Statistics, 20 per cent of Australians retire after the age of 65. Furthermore, the Department of Health and Ageing says that the average age of people entering residential care 82. Hence the cap of 65 years hardly represents the moment when people switch to aged care.

“Today’s 65-year-olds are in good health and, increasingly, in full-time employment,” says O’Neill. “They’re still paying taxes,

raising and supporting families, volunteering and adding to the rich fabric of their local communities”.

The NDIS was created in response to the Disability Care and Support inquiry by the Productivity Commission in August 2011.

All governments recognised that disability requires lifelong care, so the NDIS will replace traditional budget allocations for disability with a funding pool for longer term investment. For instance, if someone in a wheelchair needs to install a ramp to get to their front door and to modify their house, then that person is more likely to receive the funds through the NDIS because of the investment it would have on a person’s quality of life and independence. The expensive upfront costs would be less of an issue.

The scheme has support from both major parties. The Gillard Government got the ball rolling for the NDIS while Opposition Leader Tony Abbott says that he is ‘Dr Yes’ when it comes to the scheme.

The Senate Community Affairs committee recently released a report with 29 recommendations to the scheme, with one being that the states and territories work with government to make sure that people over 65 could access adequate support if they become disabled due to the ageing process.

The NDIS is still teething, and the opportunity to amend the legislation is still there. However, the first stage of the NDIS will start from July 2013. It will initially cover South Australia, Tasmania, the ACT and parts of New South Wales and Victoria. Feedback from the roll-out will then be used to ensure the process runs smoothly when it covers the rest of Australia. ■

General | 69

RACF and assisted registration

By Rod Young

Eastern Sydney Connect and St Vincent’s Hospital share their success in signing up patients at local Aged Care Facilities (ACFs).

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t Vincent’s GP and Provider Engagement Coordinators have been working with local Aged Care Facilities to sign up residents who represent more than 50% of presentations to hospitals EDs. These patients usually have very complicated medical & prescribing histories, many of them have multiple healthcare providers involved in their care & at times feel overwhelmed with the amount of information they are expected to remember.

They have had a 100% success rate at Elizabeth Lodge; a local Low Care Facility in Darlinghurst; working with the management to target the facility on two days when most of the patients would be involved in planned group activities. The team members from St Vincent’s spent the day walking around and chatting to patients, explaining the PCEHR and filling out the forms with them. All 80 patients were signed up over the course of these 2 days. Although they have encountered Power of Attorney issues for a few of the patients, the process was straightforward and the residents were keen to sign up. The St Vincent’s team feel that support from local eHealth GPs working in aged care has been essential to their success. The Benefits of having the Aged Care Facility, St Vincent’s and the local GPs connected is of great value to everyone involved in the residents’ care. However, there are still benefits to be found even if the resident’s GP is not connected to the system; through the provider portal or aged care software, the ACF can now instantly access documents such as discharge summaries, which previously would have been delayed in reaching them. Elizabeth Lodge will soon be able to view the PCEHR using iCare, the software used by all ACFs in the Anglican Retirement Village (ARV) group. The majority of ACFs use a clinical care software package with the vendors of these systems working towards PCeHR compliance. Independent Living Facilities (also in ARV group) are potential quick wins for assisted registration because the patients in those facilities are highly functioning, often have laptops and are responsible for managing their own healthcare and their PCEHR. The St Vincent’s team continue

to work with numerous Aged Care Facilities & organisations across Sydney to assist with signing up residents& connecting the facility to the PCEHR. Those residents with a PCEHR that attend St Vincent’s hospital will benefit from a better connected health system where their GPs, aged care facilities, specialist & pharmacies can all share & view information, assisting with more informed decision making when it matters most. Eastern Sydney Connect; Simply Better Connected.

Contact: Jennifer Dunn: P: 8382 9076 M: 0412 925 151 Kim Gilbert: P: 8382 9075 M: 0429 006 912 Eastern Sydney Connect is a collaborative project between St Vincents & Mater Health Sydney Limited, St Vincent’s Hospital, St Vincent’s Private Hospital, St Vincent’s Clinic, DoHA, NEHTA, Eastern Sydney Medicare Local and Murrumbidgee Medicare Local St Vincent’s Health Network covers St Vincent’s Campus and Sacred Heart Darlinghurst and St Joseph’s Auburn. ■

Eastern Sydney Medicare Local

70 | General

Years of thought go into aged care

By Tom Johnson

Aged care as we know it today has changed vividly over the years. In the early 1800’s, purposebuilt aged care facilities did not exist. Instead, those who had no family or finances to support themselves were relegated to an almshouse alongside alcoholics, the homeless and the insane; hardly the way that someone would want to spend their elderly years.

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ince the 1950s, government has started to play a much greater role in looking after older Australians. When the Menzies government came into power, aged care was essentially a small pension fund and hospital services funded by the 1951 Pensioner Medical Service1. Church homes, which offered support for older people were the first to demonstrate the advantages of proper aged care accommodation to government and the public.

Although the Aged Persons Home Act in 1954 introduced a funding stream to voluntary aged care organisations, the advancement of the industry was hindered by the government’s unwillingness to interfere with the management of aged care facilities. This was to be left to church and volunteer groups. The Menzies government made gradual increases to the pension and broadened the eligibility criterion. Later, the Whitlam government’s short tenure increased funding into nursing homes, which helped to subsidise the accommodation of those with less money.

It was not until the Hawke-Keating Labor government came to power in 1983 that aged care received the attention it deserved.

Strong lobbying from pensioner organisations and women’s groups, who believed that neglected family carers needed more support, got the ball rolling for a proper aged care agenda. Rising nursing home charges, numerous Commonwealth enquiries and evidence of patient mistreatment also set the scene for reform.

Their major piece of reform was the 1985 Home and Community Care (HACC) Program which stopped unsuitable placements in nursing homes, such as younger disabled people, and improved the quality of life for older Australians and their carers.

The Aged Care Act 1997 was introduced by the Howard Government in order to implement the Structural Reform Package.

One of the reforms was to merge the hostel and nursing home sectors. Previously, a resident staying in a hostel (low care service) would have needed to move into a nursing home (high care service) when their required levels of care increased. The reforms meant that residents and relatives could stay in one place and not need to find new accommodation and begin their relationship with staff and other residents all over again2. This also helped the residents of hostels who, prior to reforms, were ineligible to receive higher subsidies for their care even if their dependency increased3.

The reforms also introduced new ways for residents to pay for their accommodation, changed how aged care was funded and made

providers care for a minimum number of residents who were unable to afford their accommodation. Providers would receive subsidies to cover this so that all residents would have the same quality of care4.

The reforms had a positive impact for elderly Australians. By 30 June 2001, the number of people receiving a community aged care package had increased by 450 per cent since 1995-965. All nursing homes had also been accredited as part of the reforms, which resulted in the physical standard of the buildings increasing, particularly for around 300 homes which were not up to scratch6.

A range of improvements for aged care were announced in the 2001-02 budget. $2.6 million of funding was given to Psychogeriatric Care Units to assist sufferers of dementia and their carers7. The Carer Respite Centre network around Australia was broadened and the Extended Aged Care at Home program received a boost in funding so that those needing very high levels of care could still remain at home. Overall, government spending on aged care had lifted by 52 per cent since the 1995-96 budget8.

The Aged Care Act 1997 is again set for reform as the incumbent Gillard Government has introduced amendments for Parliament to consider. These reforms are necessary for the $3.7 billion Living Longer Living Better aged care package9.

Although aged care today is not perfect, it helps to be reminded of the huge investment and energy that has gone into the industry over one’s lifetime. ■

References 1. Kendig, H & Duckett, S 2001, ‘Australian directions in aged care’, http://www. menzieshealthpolicy.edu.au/other_tops/pdfs_pubs/kendigduckett2001.pdf, p. 5.

2. Australian Institute of Health and Welfare 2002, Ageing in Place: Before and after the 1997 aged care reforms, issue 1, June, p.1.

3. Ibid, p. 2.

4. http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/Content/ What+if+I+cant+afford+to+pay 5. http://www.health.gov.au/internet/main/publishing.nsf/content/44AC5B9CB357 7BD0CA256F19001013FE/$File/rep2001.pdf, p. iii.

6. Ibid, p. 3.

7. Ibid, p. 7.

8. Ibid, p. 33.

9. http://agedcarereform.govspace.gov.au/proposed-amendments-to-the-aged-careact-1997-released-for-public-comment/

General | 71

Book Review

By Eiren Black

Managing Your Ageing Parent’s Care: How to get help, choose the right housing and stop worrying by Kate Sumner. This book was first published in 2010 and revised in 2012.

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ate Sumner is an author, writer, editor and researcher with a background in both English literature and health care. Over the past 20 years, she has worked in a range of professional environments, including universities, multimedia units and publishing houses. Kate also worked for a period of time in primary health care, as a naturopath.

Like every other country in the world, Australia’s population is ageing, and older people represent a growing number and percentage of the society. Senior Australians are likely to make up almost thirty percent of the population by the year 2050 and at some stage, most of us will assist a loved one to make important choices about their end-of-life care.

A division of Device Technologies

Kate Sumner has written a user’s guide for older Australian’s and/or their carers. This book is filled with practical information to prepare for the inevitable – growing old. She explains the intricacies of the age care system, guiding the reader to better understand it and achieve the best possible outcomes for themselves and their loved one.

The book is includes straightforward information such as how to assess and to plan ahead; how to deal with the dynamics of family relationships; how to find quality care and housing; how to manage finances, including wills and legal decisions; how to prevent falls and accidents – even strategies for long term wellness. ■

Gt50

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The GT50 aids the continuation of cleaning programs long after cleaners and disinfectants have evaporated.

Despite its small size, the area of coverage for this model is 5m2, which makes it possible to use this device not only in the toilet, but also in the kitchen, hallway, patient rooms, sluice rooms as well as in waiting rooms and general areas.

Ideally suitable for Aged Care. Simply insert the device into the outlet and turn the control knob to determine the level of purification.

 1800 26 05 03 info@saniwaste.com.au www.saniwaste.com.au

72 | General

STAFFING HEADACHES? Simplify your education needs with Adept Training

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n the changing world of aged care we understand the importance of skilled, efficient and dependable staff.

You are focused on the care of your residents. You require a strong, cohesive and highly skilled team to continually adapt to these needs..

We at Adept Training provide highly qualified, industry experienced trainers to up skill and empower your staff with knowledge and practical skills to enhance their productivity and abilities.

For as little as $150* we can provide customised in house training. Supporting and providing your staff with training will

ensure an attractive and engaging place of work encouraging confidence and satisfaction. Training can be customised to suit the needs of your facility. We provide training for your workplace to create a harmonious and productive facility that is not only a great place to work for your staff but also for your residents to live.

A member of our team at Adept Training can visit your facility to assist you with assessing your training needs and create dynamic, rewarding and educative training.

Take a leap forward and contact us today on 1300 366 044 for further information or for a free consultation regarding your training needs. ■

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General | 73

2013 Calendar of Events 14-26 April 2013

1 & 2 May

14-17 May

SAGE Study Tour – Asia

ITAC 2013

China & Singapore E: jmartin@agedcare.org.au W: www.sagetours.com.au

Crown Conference Centre Melbourne Contact: Jane Murray T: 08-8981 5119 E: itac2013@jayscorpevents.com.au W: www.itac2013.com.au

Alzheimer’s Australia 15th National Conference

30 & 31 May

18-23 May

20 & 21 June

25th Annual LASA NSW-ACT Congress

ICN 25th Quadrennial Congress

LASA Victoria State Congress 2013

China & Singapore E: jmartin@agedcare.org.au W: www.sagetours.com.au

The Westin, Sydney E: laura.barnes@nswact.lasa.asn.au W: www.nswact.lasa.asn.au/events/ congress

Melbourne Convention and Exhibition Centre E: icn.reghot@mci-group.com W: www.acn.edu.au/ICN-25th-Quadrennial-Congress/www.icn2013.ch

4 & 5 July

5-7 August

3-6 September

NIMAC Conference

LASA National Congress 2013

Jupiters Hotel, Gold Coast T: 07-3725 5555 E: events@qld.lasa.asn.au W: www.qld.lasa.asn.au/events

Sydney Convention & Exhibition Centre Consec – Conference Management T: 02-6251 0675 E: lasa@consec.com.au W: www.lasacongress.asn.au

12th Australian Palliative Care Conference

Flemington – The Event Centre, Melbourne T: 03-9805 9400 E: events@vic.lasa.asn.au W: www.vic.lasa.asn.au/event/statecongress/

National Convention Centre Canberra T: 02-9954 4400 E: apcc2013@dcconferences.com.au W: www.dcconferences.com.au/ apcc2013/

74 | Product News

IS TECHNOLOGY PART OF YOUR ORGANISATION’S DNA? If you were in the banking industry you would of course be thinking “Yes, technology is part of our DNA,”…because banks cannot live without IT. In Aged and Community Care, the case is evidently very different. When you talk to managers across our industry, the vast majority see technology as something to help them do what they do now. They do not see it as a potential game changer.

For technology to be part of your organisation’s DNA, it needs to be entrenched and in use every day and yet almost go unnoticed. In the same way a stethoscope or blood pressure monitor are just there – picked up and used as and when required – and there is little or no thought given to their use. In contrast, IT systems are often seen as an impediment to care, something that has to be used, data to be entered, all for someone else. This is when technology that is not part of your DNA.

organisation as well as a logistics organisation. They travel over 20 million kilometres a year and need to put the right care provider into the right home at the right time 5,000 times a day. This is no small task.

EOS technologies’ flagship system is ComCare and is very much part of Silver Chain Group’s DNA. Today it is fully integrated across all levels and supports multifaceted business needs including optimised scheduling and rostering, risk management, mobility, wound care, training, packaged care including Consumer Directed Care, care plans, service delivery and business intelligence.

Not only does the technology help Silver Chain Group deliver good quality care; they can deliver better (and more) services and care because of this technology.

For more information about ComCare, contact Emma Pate today on 0419 286 572 or emma.pate@eostech.com.au

Within the aged and community care sector, Silver Chain Group is known for its innovative use of technology. They are, after all, a care

Nursing Lectures On-the-go Melbourne, Victoria – 13 March, 2013.

Ausmed Education today has announced its latest innovation in online CPD education for nurses. Through Ausmed’s Online Resource Library nurses are now able to stream over 300 different nursing lectures straight to their computer or mobile device. Streaming allows users to listen to the lectures directly through Ausmed’s website without having to download or install additional software.

The nursing lectures have been recorded at Ausmed’s highly regarded conferences and seminars and cover more than 37 different topics.

Ausmed aims to assist nurses in providing high-quality care by giving them reliable access to evidence based nursing lectures on-the-go.

About Ausmed Education Ausmed Education has been holding educational conferences and seminars for nurses across Australia since 1987. In 2009 Ausmed started providing online education to complement the learning provided by its face-to-face conferences and seminars. http://www.ausmed.com.au/listen

Press Contacts: Josh Wayman

Will Egan

Ausmed Education

Ausmed Education

josh@ausmed.com.au

will@ausmed.com.au

(03) 9826 8101

(03) 9826 8101

Craig Porte becomes CEO of Icon Global After 17 years of involvement with Icon Global, founder Scott Popovic has decided to step down as director, sell his shareholding and will cease full-time employment with Icon at the end of March 2013. Scott will continue on a consulting basis as he pursues his other interests outside of Icon Global.

Director and co-owner Craig Porte is purchasing the company becoming the majority shareholder and will take over as Chief Executive Officer and Managing Director of Icon Global. Craig is excited about taking the business forward to realise its ambitious plans for the market leading product carelink+.

Craig has been instrumental in the success of Icon Global and both he and Scott have worked hard to employ talented managers whose capabilities will ensure Icon Global and its customers continue to enjoy success and growth with market leading products and unwavering customer service throughout this major internal change.

In making the announcement Scott acknowledged the successful business he had helped build and the exciting future in store: “The business is now strong, the product is fresh and relevant and my contribution has brought a lot of satisfaction. Starting the business, recruiting good people who have grown with the business, and being involved in every step as the business has flourished gives me great pride. Craig understands our customers and has been driving the strategy in Healthcare of late. He has been at the helm in

rough seas and always been able to get Icon Global to safe waters. I look forward to seeing the exciting plans unfold as Icon Global enters its next phase”.

Craig has worked with Scott for 12 years and said: “Scott is an entrepreneur and problem solver that has been able to take an issue and deliver a business solution rather than a technical solution. Scott has steered the product from infancy and given the company a market leading solution. The plans for the business are bold and exciting with entry into new segments of the market on the drawing board and new technology to be rolled out in the next 12 months which is set to quantum leap carelink+ in the market” Icon Global is the owner of carelink+, the market leading product in the Community Care Industry and has offices in Geelong, Melbourne and Sydney. Our clients range in size from five to 500+ users, and with over 130 customers around Australia, Icon Global is well positioned to address the current and future challenges of the Community Care sector by providing innovative and consumer focussed products and solutions. The company has doubled in size over the past three years and looks forward to an exciting future with Craig Porte as CEO.

Contact: Ann Skorjanec – HR & Admin Manager, Icon Global Ann.Skorjanec@iconglobal.com.au

2010 winners, left to right: 2012 winners, left to right: Chris McGowan Jan Wright and Raeline George representing Silver Chain, Rhonda Sawtell, Abby Dunnicliff and Shirley Nelson.

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