Lasa spring 13 issuu by Adbourne Publishing

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

LASA secures industry meeting with new Ageing and Disabilities Minister in first week of the job Marcus Riley (LASA Deputy Chair), General Peter Cosgrove (LASA Chair), Senator Mitch Fifield (Assistant Minister for Social Services â&#x20AC;&#x201C; dedicated Minister for Ageing and Disabilities) and Patrick Reid (LASA CEO).

Creativity in care:

Social Services for ageing:

Retirement living:

Ageing with dignity & resilience:

Simple humanity making a difference

challenges and possibilities

The service integrated housing model

A photo story

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

28 National Update 5 7 9 10 12 14 15

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

GENERAL

28 35 38 41

17 LASA National Congress 2013 Report 20 LASA 2013 Election Manifesto and Action Plan 24 Palliative Approach Toolkit 27 LASA to participate in a new advisory service for

46 49

palliative and end of life care for older Australians A passion for quality palliative care Sedative Medication in Residential Care Staffing Ratios in Aged Care Changes to home care and moving to CDC The Risk and Opportunity of Change Consumer Directed Care Capacity Building Service for Aged and Community Care Providers Retirement Living

EDITOR Justine Caines National Government Relations and Communications Manager PRODUCTION Jacqueline Murkins Projects Manager, LASA LASA Federal Patrick Reid CEO Unit 4, 21 Torrens Street Braddon ACT 2612 E: patrickr@lasa.asn.au

LASA Victoria John Begg CEO Level 7, 71 Queens Road Melbourne VIC 3004 E: johnb@vic.lasa.asn.au

LASA WA Beth Cameron CEO Suite 6, 11 Richardson Street, South Perth WA 6151 E: ceo@wa.lasa.asn.au

LASA NSW/ACT Charles Wurf CEO PO Box 7 Strawberry Hills NSW 2012 E: Charles.wurf@nswact.lasa.asn.au

LASA SA Paul Carberry CEO Unit 5, 259 Glen Osmond Road Frewville SA 5063 E: ceo@sa.lasa.asn.au

LASA QLD Barry Ashcroft CEO PO Box 995 Indooroopilly QLD 4068 E: barry.ashcroft@qld.lasa.asn.au

54 What makes a good care worker and why care providers must recruit and retain them? 57 What makes a Good Life? 58 Ageing with Resilience and Determination 62 Adam Price 64 Healthy workforce challenges for the Aged Care sector 71 How to earn the reputation you deserve 73 TAFE SWSi leads aged care boom 75 Book Review 76 Calendar of Events 76 Product news

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DISCLAIMER Fusion is the regular publication of Leading Age Services Australia (LASA). Unsolicited contributions are welcome but LASA reserves the right to edit, abridge, alter or reject

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 distributed amongst an organisationâ&#x20AC;&#x2122;s staff. No part of Fusion may be reproduced in any other form without written permission from the articleâ&#x20AC;&#x2122;s author.

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National Update | 5

Message from the Chair Creative Care – Simple Humanity Making a Difference General Peter Cosgrove AM MC (Ret’d), Chair LASA

aring for our fellow humans should be a most simple concept. What else matters than providing comfort and support to those we love? In most cases not a lot else matters but what comes with it are all the complications and contradictions that are human existence. I believe this is what we have seen with a number of recent media broadcast programmes highly critical of residential care providers. Within age services there is a lot of passion and good will and some leading names dedicated to raising awareness and developing age services. This is fantastic and I hope that in a small way I added to that effort to achieve to greater awareness of the pressing issues that will sooner or later affect us all, be it as a recipient of care, a carer or family member, or a young person who will bear responsibility for the ongoing funding of age services. As Chair of LASA I joined CEO, Patrick Reid and recently met with President of Alzheimer’s Australia, Ita Buttrose and CEO, Glenn Rees. We believed it was important to address the issues Alzheimer’s Australia had been raising regarding the use of sedative medication and the quality of residential care in Australia. The meeting was cordial and as the peak body for providers we agreed the need for the organisations to work together wherever possible with a mission of continuous quality improvement, rewarding outstanding providers and at all times acknowledging the team approach in age services. LASA has taken a zero tolerance policy on any improper behaviour. We have also acknowledged the difficulties providers face on a daily basis as they operate; namely that funding falls well short of the care provided and the ongoing battle to recruit and retain staff.

I had the distinct pleasure to recently witness age services at their very best. First I was introduced to the work of the Arts Health Institute (AHI). AHI run two creative programs. Play-Up is based on humour therapy, using trained performers and facility staff to engage and entertain residents. Play-Up techniques have been proven to assist dementia sufferers, particularly the symptoms of agitation. The other program is Sing Out Loud Together. This program joins local primary school students (Year 6) with residents and incorporates literacy education while promoting social engagement. It was amazing to see the interaction and the joy from both students and residents. This was a great living example of the intergenerational approach to ageing, something I want to see in every aged care facility. This work by AHI was greatly assisted by the vision and innovation of the Whiddon Group. I visited the Glenfield site which is a very large community that has 441 residents of whom 70 have dementia. There is an active ‘commentariat’ on most aspects of age services but The Whiddon Group just get on with it and they do it so very well. They are an example of world class care that incorporates the essential elements of human interaction. It was fantastic to see both the Play-Up and Sing Out Loud programs in operation. In conclusion I think we have much to celebrate and some highly dedicated and capable leaders providing care that surpasses any set standards. As we work with a new government I plan to help shape the face of age services and of aging in Australia to show the creativity and depth of human spirit that makes all the difference. ■

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National Update | 7

Report from the CEO The Winds of Change: Can Ageing within the Social Services Portfolio Achieve what Industry Needs? Patrick Reid Chief Executive Officer | LASA

ince my last report there has been a high level of activity. LASA’s Congress has taken place with 880 in attendance and excellent feedback. Thanks to all who attended and especially to our sponsors, exhibitors and foundation partners who enabled such a fantastic educational and social event. We also have a new government, led by Prime Minister, Tony Abbott. For age services we have also seen a change in portfolio with ageing contained within Social Services. Social Services will be the department with the largest area of expenditure and payments in the Budget. The new department will be responsible for settlement services, multicultural affairs and the administration of aged care. LASA has welcomed the new age services and disability Minister, Senator Mitch Fifield. Senator Fifield will have operational responsibility of age services, with Social Services Minister Kevin Andrews (a former aged care Minister) responsible for aged care funding. LASA has already approached both Ministers seeking an audience to discuss the LASA Action Plan for the first 100 days of government (see LASA Manifesto page 20). The move of ageing into the super portfolio of social services and alongside disability was certainly a surprise. With time for some reflection it may be a positive move. Movement away from the debilitating structure known as the Department of Health and Ageing brings with it many positives. The momentum of the National Disability Scheme could also assist ageing, particularly in relation to carers. Age services excluding residential aged care are much better placed within a social services portfolio. A focus on maintaining wellbeing and promoting older Australians to live at home as long as possible is certainly more likely to be achieved within the new portfolio; as is the intergenerational approach required to support and respond to growing demand. The challenges within residential care, particularly with residents approaching care in a more frail state is something that will require diligent advocacy. It has been flagged that there should be a seamless interfacing in ageing to enable

transition to and from services and facilities. This is certainly optimal but requires strong linkages between programs, now the linkage will need to be inter-departmental as well. LASA has welcomed the Coalition’s policy released during the election campaign. The policy was in line with LASA’s election manifesto and included; • Commitment to a 5 year industry agreement to be known as the Healthy Life Better Ageing. • Re-direction of the $1.2 billion allocated to the workforce supplement back into care funding • An independent accreditation and complaints system. • Promise to cut $1Billion worth of red tape per annum • Rewards for quality care providers (who have attained 3 year accreditation) Whilst new for age services, funding agreements have been used over a long period, particularly in community pharmacies. LASA believes a funding agreement will • Address structural underfunding of aged care services • Increase market attractiveness and rebuild investor confidence, essential to meet demand and replace obsolete stock • Encourage a basis of quality rather than compliance for the industry • Cut red tape in sector • Better address rising costs and risks to government than LLLB • Provide lower risk as industry transitions to the environment recommended by the Productivity Commission. LASA’s message to the new government is clear, we welcome working together and will provide a wealth of industry support and guidance to the new minister, but similarly to the words of Tony Abbot when he was sworn in as Prime Minister saying ‘’Today is not just a ceremonial day, it’s an action day,’’ Prime Minister, action is certainly required across age services, immediately. I look forward to reporting on LASA’s advocacy in the next edition of Fusion. ■

STOP PRESS On Monday 23 September LASA Chair Gen Peter Cosgrove, Deputy Chair Marcus Riley and myself met with incoming Minister responsible for Ageing, Senator Mitch Fifield. LASA hosted the Minister at the Braddon office which was a refreshing change from the normal flurry of Parliament House. LASA thanks Minister Fifield for meeting within a week of becoming Minister and for the productive briefing. LASA looks forward to a productive partnership in the coming years.

8 | National Update

National Update | 9

NEW SOUTH WALES-ACT Report Information and education are vital to respond to change Charles Wurf Chief Executive Officer | LASA NSW-ACT

he changes which have come to the industry through Living Longer, Living Better have led to strong Member demand in recent months for information and education. This demand was anticipated as the changes that have come, and are coming through Living Longer, Living Better, have the potential to affect the way many providers operate, and for some will impact on their viability. LASA NSW-ACT has now held a series of Member Seminars and Member Forums, both in our Surry Hills office and externally, on topics including the Dementia and Veterans’ Supplements, Home Care Packages, and Accommodation Pricing and Significant Refurbishment. Further Member Seminars and Member Forums can be expected before the end of 2013 to address demand and emerging issues. The topics which these Member Seminars and Member Forums have been held will potentially become workshops in our 2014 Education Program. As workshops these will have a refined focus and will cover their subject matter in more depth, to take into account the practical realities facing providers who are now working each day with many of the Living Longer, Living Better changes. One understanding which will remain with providers following Living Longer, Living Better is the speed through which policymakers can develop and impose change, and the paucity of information and feedback for providers from those same policymakers when implementation is required. All industries are being increasingly affected by the need to provide necessary information and education to short timeframes,

to enable their member organisations to better make informed decisions when delay has potentially significant financial consequences. At LASA NSW-ACT we are determined to increase the ‘dynamic’ through which we provide education for the age services industry. This ‘dynamic’ includes both in subject matter and mechanisms for delivery. A program for education simply cannot be developed and locked-in twelve months in advance. Even programs developed six months in advance struggle to keep up with external change. LASA NSW-ACT will continue to promote and deliver education into 2014 through our Quarterly Education Program and will add and promote Member Seminars and Member Forums as needed – on some occasions with as potentially as few as two weeks of notice – as has been necessary during the second half of 2013. Different mechanisms for delivery and also locations for delivery, are under active consideration. As are the opportunities for delivering education which come through being part of the LASA federation. By every measure Living Longer, Living Better has changed the requirements and pace for delivering information and education to the age services industry. The election of the Abbott Government also now holds the potential for further change or policy redirection. Our industry’s need for information and education is only increasing, and we as an Association look forward to meeting this challenge into 2014 and beyond. ■

10 | National Update

Queensland Report Sustainability – how will age services answer the questions? Barry Ashcroft Chief Executive Officer | LASA Queensland

t the time of writing, Australia finds itself with a (very) new federal government and with it…the reality of new and/or modified policy, legislative and funding frameworks (again!). For the age services sector, this framework currently comprises the Healthy Life Better Ageing Policy; an 8 page plan broadly outlining the government’s reform priorities, but with very little in the way of detail and/or costings. And whilst this framework will be central to the provision of age services moving forward, I think it is how we recognise and respond to the broader drivers of change that will ultimately determine the ongoing viability and sustainability of our sector. In its inaugural report: Sustainable Australia 2013, the National Sustainability Council identified a number of megatrends and drivers that would likely impact on Australian households and businesses, significantly reshaping opportunities and risks. Under the megatrend ‘Growing Pains’, the report suggests that the road ahead sees ‘ageing populations, rising health costs and shifting values forge large new ‘wellness’ markets, but also risk generational tensions’ and that ‘planning for an ageing population’ will be one of the key issues and challenges facing our nation. In meeting these challenges, the council identified a number of interventions would be required, one of which was ‘reducing the scale of intergenerational financial transfers required to support older Australians by increasing the ability of Australians of working age to accumulate resources and assets to support themselves in old age (such as through superannuation). Recently, I’ve had the privilege of participating in a number of LASA Q ‘conversations’, with a broad cross-section of our membership, on a range of topics around the challenges and opportunities facing the sector. Unsurprisingly, the findings of

the National Sustainability Council were echoed in this discourse, particularly around the themes of user pays and self-managed care. Already evident in the Consumer Directed Care and Accommodation Pricing contexts, this significant shift away from a largely government underwritten system to that of a ‘safety net’ and/or user pays approach, is set to provide the industry with some of its most challenging and exciting times. Impressively, LASA Q members are not only leading the thinking around this paradigm shift, but are pre-emptively adapting and applying techniques and strategies to meet these challenges and harness the opportunities. Members cited (amongst other things), the better use of ‘lazy assets’, partnerships and collaborations around ‘back of house services’, a recognition of the divergence of clinical care and customer service (and how this is reflected in business models), and the move away from government funding reliance, as ways of ensuring longevity and performance over time. And it is only time that will tell if government(s) are willing, or able, to take advantage of the insights found in reports such as Sustainable Australia 2013, or from within industries (including our own), to affect policy interventions that will meet the challenges of adapting to the nation’s changing circumstances, be they environmental, societal or technological. It is an understatement perhaps to say that the future of the age services sector is not without significant challenges. However, I think Robert Lippiatt (Executive Director, Southern Pacific Consulting Group) summed it up in a recent conversation with LASA Q members when he said ‘you may have more questions than answers…but it is in the way you and your organisations choose to answer these questions that will differentiate you from your counterparts (in the future)’. ■

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12 | National Update

victoria Report Supporting workforce growth and skills through simulation training John Begg Chief Executive Officer | Victoria

ealth Workforce Australia (HWA) has predicted Australia will face a shortage of 109,000 Nurses (both Registered and Enrolled) across the healthcare system by 20251. This concerning statistic demonstrates the vital importance of investing in, and ensuring the growth of, Australia’s healthcare workforce over the coming decades. The expected population growth of older people who are already living longer with increased complexity of care needs will also impact on the skills required by the current and future workforce. The increasing availability of fully qualified and experienced nurses is of particular and critical importance to the age services sector both now and into the future. The LASA Victoria vision is to provide the clinical knowledge and expertise required by nurses who provide ongoing care for older people living in an aged care facility. Of upmost importance to the training of Registered Nurses is access to clinical placement experience in providing support for older people have multiple comorbidities and disabilities. Within age services this includes placements in residential and/or community aged care facilities. As well as delivering the innovative Aged Care Graduate Nurse Program (ACGNP) from 2012 to 2013 (run in a partnership with Monash University through funding from the Commonwealth), LASA Victoria has coordinated placements for 150 students across 910 day of clinical experience within residential aged care from 2011-13 through funding from HWA. Both programs will continue into 2014. LASA Victoria saw the availability of additional HWA funding for Capital and Goods and Services as an exceptional opportunity to provide a Simulation Training Venue to assist the clinical practice of Registered Nurses. Such simulation training enables students to enhance their placement experience by reinforcing education already provided through accredited or University training.

A simulation training van for LASA Victoria Rather than develop a fixed simulation training room, LASA Victoria saw an opportunity to provide simulation training in age services facilities by way of a modified mobile van. Consequently, a van was purchased in early 2013 and is currently in the process of being specially fitted out for simulation training Using a mannequin on an ambulance stretcher that can be wheeled into a facility, LASA Victoria clinical simulation experts will have the capacity to conduct training in both basic and complex technical procedures such as female catheterisation, tracheostomy care, PEG care, wound management and syringe drivers without impacting on the privacy of a resident living in a residential care facility. Students – and facility staff – will be able to refresh their clinical skills with a great degree of fun and interest in the first aged care simulation training Van in Victoria. It is anticipated that, in the future, the simulation van may be used by aged care facilities in metropolitan, regional and rural areas. Through the use of the van, LASA Victoria will be directly contributing to the critical need for clinical experience with the long term view of building the capacity and capability of the age services workforce. This great initiative is a true demonstration of LASA Victoria’s dedication to assisting our industry to provide quality care. The LASA Victoria simulation training van will be ready within the next few months, and will be used throughout Victoria. For more information, please contact Pamela Johnson on (03) 9805 9400. ■

References 1. Health Workforce Australia 2025, http://www.hwa.gov.au/sites/uploads/healthworkforce-2025-volume-1.pdf

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14 | National Update

South Australia Report Dinner and Awards Paul Carberry Chief Executive Officer | LASA South Australia

n 23rd September LASA SA’s members, staff and sponsors gathered at the National Wine Centre in Adelaide for our Annual Dinner and Awards Evening. This event has been a fixture in our calendar since 2006 and continues to attract strong support, with just over 200 people in attendance this time around. The dance floor was full whenever the band was playing, and the food and service was at its usual high standard. The night is about many things – celebration of the great work done in our industry, recognition and reward for staff, an opportunity to catch up with colleagues from other facilities, including those you may have worked with who are now with other organisations. It’s also an opportunity to give special recognition to staff who have been judged to have given exceptional service, who have gone above and beyond the call of duty, and made a real difference to the lives of residents and their families. The awards are available to staff at any level in their organisation, it’s not about seniority, and it’s about their contribution. Suggestions for nominations can be made by their management, their peers or by residents or relatives, although management needs to approve of the nomination. The nominations are reviewed by a panel of three judges, who are all experienced aged care managers or consultants,

but who are not currently involved in running an aged care home. To ensure even unconscious partiality, the names of the nominees and their organisations are removed from the forms reviewed by the judges. The judges work to a set of criteria and scoring system which we provide them and are asked to determine four finalists on the basis of allocated points. The nominee with the highest score is the winner. All finalists receive a prize and certificate recognising their achievement and the winner receives a further prize, valued at $1,000 and winner’s certificate. The excitement and pride on the faces of the finalists says it all; recognition from their peers, their management and their clients, is not the reason they do what they do, but it’s wonderful when it comes along unexpectedly. This year our finalists were Kelly Anne Baylis from Padman Health Care, Lesley Bubner from Minda Nursing Home, Leanne Newton from Serene Residential Care, and Cheryl Scott from Ananda Aged Care. As always, these awards and events would not be possible were it not for the organisations who sponsor them. Our thanks to the major sponsors, Guild Insurance, HESTA Super Fund, Leecare Solutions, and physiotherapy provider WorkXtra. ■

National Update | 15

WESTERN Australia Report Action packed times ahead! Beth Cameron Chief Executive Officer | LASA Western Australia

ssuming no-one has been axed between writing this article and printing, we currently have the sportiest PM in history, Prime Minister Tony Abbott. Boxing, cycling, rugby, netball, there’s nothing Abbott won’t try. So what a brilliant time to be launching our inaugural LASAWA conference for June 2014 where, following in our Victorian friends footsteps, we will bring all that is new in aged care to Perth – with a sports flavour. Why sport? Because Aged Care in WA is full of champions. We will talk about overcoming challenges, team work, leadership AND it will be a great theme to dress up for at the dinner. There is so much we can learn from sport. To give you an example, Chartered Secretaries Australia recently ran a session in Perth on Governance in Sport. I suspect I was the only one who showed up for the governance, sad I know. But whether you are into footy or financial frameworks, you would have loved the session. A panel of leaders from a range of sporting organisations shared their experience of the governance challenges they faced. Challenges that you will be familiar with: drug use; racial vilification; rigged horse races. Each of the speakers spoke about the failure of governance and accountability structures with each challenge and regret that it occurred. They spoke of the damage to the reputation of their organisation or the sport and the resulting impact on revenue. One guy in racing mentioned that the hit to gambling revenue following one controversy (not even Tom Waterhouse sized) was in the millions. Lots of interesting stories, such as cycling taking great efforts to get rid of drugs, and from lifesaving – where no one has drowned between the red and yellow flags for 100 years but three people have died in competition.

The panel were all for transparency. They suggest that if you do commission an inquiry into your organisation, make it public. If you don’t people will just speculate about what it is you are hiding. Lessons for aged care boards and executive: governance structures matter! They are directly linked to your reputation and your reputation is what brings in your customers, supporters and revenue. If you have a team that aren’t inspired by governance policies and procedures, point them to the shining examples of Eddie Maguire, Essendon, and Lance Armstrong. The spectacular fall from grace, reduced credibility, subsequent financial hits. Sport makes governance much more fun! Don’t you feel smarter already? Imagine how much fun and learning will be had over two days in Perth. Lock it in Eddie. ■

General | 17

LASA National Congress 2013 Report The 2nd Annual LASA National Congress was a resounding success with 808 registered attendees. On behalf of the LASA Board and CEO, Patrick Reid, we would like to thank the sponsors and exhibitors along with all of the delegates who attended in Sydney in August

he Congress theme of New Frontier: New Focus was highly relevant to issues currently faced by the industry. Across the two and a half days, speakers covered all areas of age services with particular reference to where we are and the future that we need to embrace. This position enabled us to address areas of serious concern but keep a forward thinking and optimistic focus to see possibilities and understand that our industry can take an active role in the development of future services. Key topics presented included legal issues, consumer behaviour, managing risk, reform implementation, technology and governance. We also heard from inspirational keynote speakers. Mark Bouris who is known and respected for bringing quality financial advice from the boardroom to the family living room; Social Entrepreneur Jon Dee revealed how he implemented social change and helped a generation to think and act differently; Todd Coates shared his story of developing iconic brands, covering both the challenges and triumphs. These trailblazers demonstrated how it is possible to succeed against considerable odds; and how one can change cultural thinking and modify businesses, even in times of adversity, in fact especially in these times! LASA as the leading voice for industry demonstrated the initial results of the NBN Telehealth project, a project funded by the DOHA and administered by LASA on behalf of the Aged Care Industry IT Council. A live demonstration with a home care patient needing assessment of an injury was well received by the audience. Our program provided practical information about relevant and timely industry issues, but also inspired, challenged and extended the audience thinking. This year delegates had access to a first class social program that included the opportunity to network with colleagues at a Cocktail Reception with the magnificent Sydney Harbour as a backdrop; with the added treat of a ferry transfer from Darling Harbour to the Opera House. In true tradition, delegates

“All was perfect!!! “ “Great conference and one of the best. “ “Was impressed by the range of speakers from other industries & the relevance of their stories to our businesses.” “Thank you had a great time and was good to network and meet new people. The cocktail party and ferry ride was excellent and nice to have some fun in all the seriousness.” “It was overall the best Congress I have attended having been to more than 20 (ANHECA and ACAA) National Congresses. Congratulations to all who contributed to organising this very successful event.” enthusiastically participated in the congress dinner with a myriad of Cowboys and space creatures as part of the ‘Final Frontier’ theme. Already there has been overwhelmingly positive feedback regarding this year’s Congress. Planning is already underway for Congress 2014 in Adelaide from October 20-22. A special thanks to LASA’s organising committee, Charles Wurf – CEO, LASA NSW-ACT, Cynthia Payne – CEO, SummitCare, Robert Orie – CEO, Sir Moses Montefiore Jewish Home, Deborah Key – Director of Nursing, St Luke’s Care, Steve Gordon – Director, Gordon Group, Jacqueline Murkins – Projects Manager, LASA, Justine Caines – Government Relations & Communications Manager, LASA, Kay Richards – National Policy Manager, LASA and Stuart Bicknell – Manager Member Services, LASA NSWACT and all our fantastic sponsors, exhibitors and delegates for making Congress 2013 such a wonderful event. ■

20 | General

LASA 2013 Election Manifesto and Action Plan

Silence on age services won’t change growing need.

Bob M Waikiki WA

Industry wants commitment in the first 100 days of the new Government.

he needs of age service consumers have been largely ignored in the 2013 Federal Election, with few announcements or policies being directed to this pivotal industry. LASA, as the peak body for age service providers, cautions the incoming Government of the significant consequences of ignoring the needs of ageing Australians and the industry that provides care and services post 7 September. “While age services may be currently seen as a ‘sleeping giant’ and not worthy of attention, age services is a clear and present challenge for all Governments. Age services is an intergenerational issue, some need it for themselves, others for family and another group again will be called on to fund it” said Patrick Reid, Chief Executive Officer of LASA. “LASA is committed to working with the Abbot Government to help maintain and grow a viable and sustainable age services industry, and to assist with planning ahead.” “LASA is looking at key issues to provide stability for our industry in the first 100 days of a new Government. As we work through age services reform LASA has identified a Top 4 list to ensure that providers and consumers are supported, while minimising uncertainty during this period of change.”

General | 21

‘LASA‘s Top 4’ with a timetable for action

DAY 1

Scrap the Means Testing of Residential Accommodation Deposits (RAD) Consumers who elect to fund their Residential Accommodation Deposit (RAD) through the sale of their home will now have the RAD amount included in their means test, an important fiscal item that has not been included in the past. Consequently, someone of modest means will be impacted adversely; further driving a loss of value for the consumer and putting further pressure on an already stressed care sector. The flow-on effects are clear: fewer facilities to provide services to a rapidly growing ageing population. The incoming Government must fix this as a matter of urgency. LASA calls on the incoming Minister for Ageing and also the incoming Minister for Finance to free the RAD from the means test as a pragmatic and demonstrable commitment to improving the sustainable provision of age services.

DAY 15

Announce a cost-of-care study to ensure funding matches the true cost of quality care Current age services funding does not match the true cost of care delivered to older Australians. The Productivity Commission Report, Caring For Older Australians, clearly advocated for clear funding increases and innovative policy initiatives for funding to match the demonstrated care provided. We call on the incoming Government to be brave and not fear looking at a cost-of-care study. However, any incoming Minister will need to understand what the industry knows intuitively; the gap between what is paid for services and their true cost is widening at an increasing rate – far beyond indexation or consumer copayment. If this gap continues to grow unchecked, the results for the new and also subsequent Governments will be catastrophic, as will the results for those requiring such services.

DAY 30

Equalise the annual cap calculation for home care and residential care Currently older Australians receiving home care have their care costs averaged throughout the year (for the purposes of the funding cap). However, a consumer in a residential aged care facility must pay all of their costs up front until they reach the annual cap. This highlights a stark inequity between the treatment of the funding cap in home and residential care; significantly driving up the consumer co-payment and adding unnecessary complexity to the process. The Government must swiftly move to rectify this inequality which places artificial constraints on providing services while also adding unnecessary red tape to an already overly complicated and complex process.

DAY 100

Commit to improve the Aged Care Approvals Round (ACAR) process The Government needs to guarantee an Older Australian’s right to age services, rather than arbitrarily limiting places. This can make access to age services in the home a game of chance, and one where the odds are weighted against the consumer. The latest Aged Care Approvals Round (ACAR) saw 106,000 applications for only 5,835 places. This means some Older Australians miss out. The Government needs to enable a consumer’s right to access age services, rather than rationing places so that no Older Australian misses out on care.

22 | General

Gladys Tamworth NSW

Get real over pricing

Putting funds where theyâ&#x20AC;&#x2122;re needed

The Government must ensure the viability of the industry by retaining the existing accommodation pricing arrangements where providers can set their own accommodation pricing structure in line with market forces, consumer mix and the prevailing competitive environment. The Productivity Commission Report, Caring For Older Australians, supported the maintenance of a deregulated and market-driven pricing approach in combination with the publication of accommodation payment amounts to maintain transparency and to facilitate competition amongst providers. This reflects that there is quite simply no evidence the existing deregulated approach to accommodation pricing has disadvantaged older Australians. The residential aged care industry and the retirement village industry have operated successfully with deregulated accommodation pricing arrangements for decades. By retaining the existing arrangements the Government will avoid an additional level of bureaucratic intervention and â&#x20AC;&#x2DC;red tapeâ&#x20AC;&#x2122; which a Pricing Commissioner and the necessary associated infrastructure would require. Acting now will also remove significant business constraints that would affect the viability of the industry such as the proposed 60-day approval timeframe and the four-year limit applicable to accommodation payment amounts above the Ministerial determined maximum amount.

The Government must repeal the Workforce Supplement and divert allocated funding back into care as an interim step towards a properly constructed indexation of age services. The Workforce Supplement is ineffective in supporting better wage outcomes for age services staff. It is complex and cumbersome and does not recognise the current level of remuneration being paid to staff by individual providers. Therefore, it is cost-prohibitive for many providers and the take-up of the Workforce Supplement will be limited and not achieve its stated outcomes. The result? The industry will lose critical care funding and age services consumers will suffer.

General | 23

“All Australians need to hear from elected representatives as to how adequate funding will be provided to ensure high quality services and equity of access to allow older Australians to live well” – Patrick Reid, Chief Executive Officer, LASA

Unnecessary burden The Government must end certification requirements which are an unnecessary burden for the industry. The vast majority of residential aged care facilities are certified and the intent of certification, namely to encourage an improvement in existing building stock and the provision of minimum standards relating to space and privacy, has been achieved. The standards relating to the design and construction of new and substantially renovated aged care buildings are already appropriately governed and the certification process is an unnecessary and costly impediment to the timely commissioning of an aged care facility.

Keep the cap The Government must maintain a daily cap on the maximum co-contribution applicable to residential aged care. Under proposed means-testing and co-contribution arrangements older Australians seeking residential aged care may be liable to pay for their entire care costs up front. The DoHA provided example shows as much as $118 per day or more – until they reach their annual or lifetime cap, while those accessing home care will have their daily co-contribution capped at a maximum of $27.50 per day. This is inequitable and poses a significant disincentive for an older person to seek admission to residential aged care even if this is the best outcome to meet their care needs.

Choice The Government must allow older Australians to choose how they pay for their accommodation, including the use of retentions. The current proposal to prohibit the charging of retentions will push up the cost of accommodation as providers look to recoup lost income, while also removing an older Australian’s right to structure their accommodation payments to best meet their needs. Page 49 of The Productivity Commission report, Caring For Older Australians, considered the benefits associated with allowing retentions and concluded that providing any retention amounts are linked to the published charge and bond amounts, and care recipients are fully informed about payment options, the Commission considers that such flexibility in payment options could be allowed. ■

LASA stands ready to work with the Government to both develop and implement solutions to the significant issues which face the age services industry. Should these issues not be addressed with urgency, there will be undue hardship and pain for this vulnerable section of the Australian community.

24 | General

Palliative Approach Toolkit: New Resources and Training Opportunities

he Australian Government Department of Health and Ageing has provided funding for a national rollout of the Palliative Approach Toolkit (PA Toolkit) for Residential Aged Care Facilities (RACFs) under the Encouraging Better Practice in Aged Care (EBPAC) Initiative. The PA Toolkit is designed to assist RACFs to provide high quality palliative care for their residents and to ensure the delivery of that care is sustainable into the future. The rollout is being led by the Brisbane South Palliative Care Collaborative. Important outcomes for this exciting new project include nationwide PA Toolkit workshops and the development of six new resources. Workshops. There will be a series of one-day workshops for RACF managers, clinical leaders and staff trainers focusing on how the PA Toolkit resources can be used to implement a ‘whole of organisation’ approach to the provision of high quality palliative care that is sustainable. No registration fee will be charged to attend these workshops and RACFs participating in the rollout will receive a free copy of the PA Toolkit. The rollout will commence in late October 2015. Further details including the dates of upcoming workshops are available on the project website at www.caresearch.com.au/PAToolkit. Resources. Six new clinical, educational and management resources are being developed to support the use of existing materials in the PA Toolkit. These new resources focus on strengthening the internal capacity of RACFs to translate best available palliative care evidence into effective day-to-day clinical and operational practices. The existing PA Toolkit resources are available now to download from the project website and the new resources will be available from late October 2015. The new resources are: Workplace Implementation Guide. This resource sets out ten key steps for implementing a palliative approach in the RACF and provides detailed guidance on how to plan and undertake each step. Training Support Guide. This guide provides detailed information and tools to guide the design, delivery and evaluation

of staff education, training and development activities related to implementing a palliative approach in residential aged care. DVD on How to Use the Residential Aged Care End of Life Care Pathway (RAC EoLCP). This short video uses a case study to demonstrate how to use the RAC EoLCP and how it can improve the care of dying residents. Guide to Establishing a Medication Imprest System in Residential Aged Care Facilities to Manage End of Life (Terminal) Symptoms in Residents. This guide focuses on the pharmacological management of symptoms commonly experienced by residents in the terminal phase of life. It recommends eight drugs for inclusion in an imprest to support the end of life (terminal) care of residents and provides flowcharts to guide symptom management in dying residents. Educational Flipchart. This resource can be used by staff educators to train care workers. It explains various aspects of a palliative approach and issues relevant to the delivery of high quality palliative care in residential aged care. Bereavement Support Booklet for Residential Aged Care Staff. This booklet aims to assist staff to better understand the personal impacts of caring for terminally ill residents on a daily basis and provides some self-care strategies.. ■ For further information please contact Gillian Davies, Project Manager, National Rollout of the PA Toolkit, Brisbane South Palliative Care Collaborative on: Gillian_Davies@health.qld.gov.au

General | 25

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26 | General

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General | 27

LASA to participate in a new advisory service for palliative and end of life care for older Australians Palliative Care Australia has recently announced a new, innovative Advisory Service which will support those working in aged and primary care to improve the delivery of palliative care and advance care planning for older Australians receiving aged care services.

What does the project involve?

he Advisory Service [still to be named!] is an initiative of the Living Longer, Living Better aged care reform package and will cost $14.8 million over three years. It will consist of a national phone number that aged care workers and GPs can call to access advice on advance care planning and palliative care, when and where they need it. In addition, a website will provide a one-stop information hub for resources, including those to support minority populations such as Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse communities, those who are Gay, Lesbian, Bisexual, Transsexual and Intersex, and people with dementia. The project also has a strong focus on upskilling GPs and aged care providers through improving their palliative care skills and advance care planning expertise, and increasing linkages between aged care and specialist palliative care services. To ensure high quality advice, standard clinical practice guidance will be developed and technologies, such as telehealth, will be employed to ensure equity of access and to overcome geographic isolation and difficulty in accessing advice and support.

Why is this important? Approximately 60,000 people die each year in the care of residential and community aged care services. There is a strong need to improve the end of life care provision for older Australians receiving aged care services. The National Palliative Care Strategy (2010) notes the importance of access to information and services to the provision of high quality palliative care, and the Living Longer Living Better aged care reform package (2012) includes funding initiatives to improve palliative care in community and residential aged care.

Who will deliver the project? The project is delivered by a number of organisations in a consortium arrangement. Each organisation has expert knowledge and experience in palliative care and aged care, they are: Respecting Patient Choices, Palliative Care Australia, CareSearch, University of Queensland, Queensland University of Technology, Australian and New Zealand Society of Palliative Medicine, Leading Age Services Australia, and Aged and Community Services Australia.

How can I be involved, where can I find more information? The project aims to build on, not duplicate local existing efforts of palliative care services around the country. The Consortium will be completing an environmental scan to find out what services are available and linking them to the project. They will also be recruiting expert reference groups to be involved in the project so keep an eye out for future updates in this newsletter. A project website and newsletter will be developed to provide updates, until then please direct all queries to pcainc@palliativecare.org.au â&#x2013;

28 | General

A passion for quality palliative care If you want to teach end of life care, you have to start at the beginning. For Linda Marlow, Director of Nursing at Hall & Prior’s Rockingham Aged Care Home, this idea has shaped the unique palliative care program that transformed the home’s approach to end of life care and won a Better Practice Award from the Aged Care Standards and Accreditation Agency in July this year.

Palliative Care Link Team (from left to right: Clinical Nurse Manager Sharron Magennis, registered nurse Peter Handley, carers Cindy Vegar and Lynlee Burr, and Director of Nursing Linda Marlow).

“

When I came into aged care eight years ago, I wanted to make palliative care approachable for staff, residents and their families,” Linda explains. “I wanted to make sure that we looked at end of life as a part of our everyday care, and I also wanted to address the fear that some staff have when caring for someone at the end of their life.” Palliative care is a difficult and sensitive area of aged care, and one that Linda and her Clinical Nurse Manager, Sharron Magennis, are incredibly passionate about. Over the past two years, the home has partnered with the Cancer Council, the Western Australian Health Department and Curtin University to educate their staff and foster a culture of support, understanding and open communication with exceptional results: the home has not transferred a resident to the local hospital for palliative care since the program began in May 2011. The success of the project can be attributed to its holistic approach that balances proactive clinical and dementia care with

compassionate personal support – not only for the residents, but for their families and the staff that care for them as well.

Palliative care: a personal approach Cindy Vegar has been a carer at Rockingham for eight years, and has been a member of the home’s Palliative Care Link Team since it was formed two years ago. For Cindy, being able to support residents and their families at the end of their life is the most rewarding part of her job. “Palliative care starts when a resident walks through the door for the first time,” Cindy explains. “The best thing we can do to make a resident’s end of life easier is to learn everything we can about them. As their health deteriorates, you can talk about things that have made them happy throughout their lives. You have to start that relationship right from day one.” “It’s really hard at times, but I try to step out of myself and focus on the families. It’s always going to be sad, but you want

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30 | General

Staff involved in the winning projects at Leighton and Windsor Park Aged Care Homes

to make sure that when the family think back they have positive memories of how their loved one was cared for and supported. They’ve got to live with that for a long time.” Cindy and the staff at Rockingham recently received a visit from the wife of a resident who had passed away a number of years ago. “She still remembered me after all those years,” she says, explaining that paying attention to the little things – the ambience of the room and the care shown to themselves and their loved one – can make the biggest difference.

Department in 2011. These staff formed the home’s Palliative Care Link Team, helping to educate staff and implement the Brisbane South Palliative Care Collaborative’s concept of End of Life Pathways* (also known as Palliative Approach Trajectories) that were introduced during the session. There is a member of the Link Team working on every shift, which provides residents, family members and other staff with access to a support network during the day or night. Palliative care is now a part of everyday care at Rockingham. It is discussed at the handover meeting each morning, and the Making end of life part of everyday care trajectory for each resident is displayed in the staff room with any Although the staff at Rockingham had shared a passion for changes communicated to all staff within 24 hours. These changes palliative care for a long time, the project began in earnest when can prompt the management team to arrange a care conference five staff from the home attended an education session, Talking with the family where the care strategy can be discussed in a about end of life, run by the Cancer Council and the WA Health supportive environment, along with any concerns. Since the project began, staff are more proactive in delivering end of life care. They have formed a close relationship with the home’s visiting general practitioners, and medications are now ordered in advance. As a result, the home has not made any late night calls to a GP or the Residential Care Line in over 18 months. “Staff confidence has improved because everything is out in the open,” says Linda Marlow. “The families • Specialist aged care executive recruitment • Workforce Engagement Planning and Advice understand what’s happening and are • Candidate Sourcing and Selection • Interview Coaching a part of end of life care. It is so simple Advice/Consultation (for organisations and candidates) to ask them how they are feeling, and • Recruitment Framework Development • Career Counselling/Resume Finessing what is troubling them. Most of the • Interview Design and Consulting • Remuneration Advice time it’s not wanting their loved one to • Position Description Design and Consulting die alone and not wanting them to die in pain, and they’re things that I can PJ Maynard Consulting Pty Ltd Ph: (02) 8084 2681 talk through with them. It means a lot

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General | 31

Windsor Park – Workplace Harmonisation

to them, and it’s made such a difference to the way we approach palliative care.”

Better Practice for quality resident care This year, the Aged Care Accreditation Agency announced 28 Better Practice Awards for projects from 31 aged care providers. The awards recognise innovations that contribute to the ultimate

goal in the ever-evolving field of aged care: improving the quality of care for residents. Rockingham Aged Care Home is one of three Hall & Prior homes to receive awards in 2013, and one of five received by the organisation over the past three years. This year, Leighton Aged Care Home and Windsor Park Aged Care Home both received awards in the Staff Development and Retention category for their

32 | General

General | 33 initiatives that have created a supportive environment for staff from culturally and linguistically diverse backgrounds. Sharyn McDavitt, Executive Manager of Windsor Park, explains the importance of supporting her staff to the level of care provided to her residents. “Some of my staff have already suffered enough in their lives before coming to work at Windsor Park,” she explains. “I try my hardest to make my staff feel cared for and happy, as it’s them who care for our residents and make them happy.” The home’s winning Workplace Harmonisation Project was developed to support and empower a culturally diverse staff and resident population comprising 109 staff come from 22 countries and care for 114 residents of 12 nationalities. The commitment of the home’s management team to implementing initiatives suggested by their staff has created an enabling environment where all staff are supported and encouraged to create change: not just at work, but in their community as well. Leighton Aged Care Home’s initiative to transform fire safety education into a practical learning activity won the organisation their third Better Practice Award. The project addressed a need to make fire safety training accessible and relevant for staff who speak English as a second language, with the added benefit of enabling all staff to gain practical experience in evacuation procedures without creating a manual handling risk. Staff from the home designed a life-sized mannequin – affectionately known as Evac Eddie – to make fire evacuation

drills visual and practical, rather than written and academic. “The Evac Eddie project is just a small part of the incredible work done at Leighton,” says the home’s Director of Nursing, Margaret Tranquille. “The highlight of the project was seeing an idea come to fruition with the help of our great staff.” These three projects are in various stages of implementation across all 13 of Hall & Prior’s Western Australian homes, together with strategies developed to improve behaviour management for residents with dementia that won Hall & Prior’s Kensington Park Aged Care Home a Better Practice Award in 2012. The Windsor Parks Indigenous Art Project (part of their Workplace Harmonisation Project) and Kensington Park’s Behaviour Management Project will be presented at the upcoming Better Practice Conference in Perth on 17-18 October. For more information, visit www.accreditation.org.au/education/perth-2013/ *The Brisbane South Palliative Care Collaborative developed End of Life Care Pathways that are specifically for use in residential aged care facilities. There are three End of Life Pathways or Palliative Approach Trajectories that a resident can follow: • Trajectory A: an expected prognosis of greater than six months • Trajectory B: an expected prognosis of six months or less • Trajectory C: an expected prognosis of less than one week. ■

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General | 35

Sedative Medication in Residential Care Leading advocates and national media have in recent months criticised residential care providers over issues of safety and quality, including inferences to the overuse of sedative medications in residential care. Much of the commentary suggests that providers are responsible for the overuse of medication and any associated negative side effects. LASA believes it is important that when discussing such a sensitive and complex issue that we consider all the issues and understand the roles of each stakeholder in the equation.

very important fact that has been overlooked in much of the media coverage is that doctors both diagnose and prescribe any medication to an elderly person living in residential care. The key relationship is between a doctor and the older person, and the family or carer. In some instances the provider will also give information regarding daily activities and capacity. LASA believes there is a place for sedative medications in the treatment of dementia sufferers, but also contends that providers are not central decision makers in this process. There is however a greater role for bodies such as the national Prescribing Service and Medicare in reducing the unnecessary use of sedative medications. LASA supports the quality use of medicines in conjunction with nonpharmacological approaches. LASA has taken an active role in this regard and has a position on the advisory committee for the RedUse program, developed by Dr Juanita Westbury of the University of Tasmania. This program is in its second phase. The initial project through a multi-strategic, interdisciplinary approach has been shown within a controlled study to successfully promote the quality use of sedative medications in residential aged care.1 The strategies employed include audit, benchmarking and feedback, a customised education program for nursing staff and interdisciplinary review. Research2 has shown that antipsychotic and benzodiazepine medications are often used in residential aged care, and may be associated increased risk of falls, stroke and death and therefore limiting the unnecessary use of these medications will

produce multiple benefits for older people, including increased mobility, alertness, and decreased fall and mortality rates. In the AIHW’s ‘Residential Aged Care in Australia – 2010/2011’ report, there were nearly 185,500 residential aged care places, with more than 85,200 permanent residents (52%) having a recorded diagnosis of dementia.3 In a recent Australian study conducted in 45 Central Sydney Residential Aged Care Facilities (RACFs) during 2009, 28% of all residents were taking antipsychotics.4 Although prevalence rates of antipsychotic medication vary from region to region, if a prevalence estimate of 25% is adopted, approximately 46,000 residents in Australian ACFs are taking antipsychotics. Some advocates believe that the potential risks of antipsychotic medications are likely to outweigh potential clinical benefits for as many as 80% of the people with

36 | General dementia in Australia receiving antipsychotic medications.5 Therefore, the proposed project offers the opportunity to review and reduce the antipsychotic use in over 37,000 Australian residents of RACFs. Benzodiazepines are also used in RACFs for their sedative effects. Like antipsychotics, the use of these medications is associated with significant risk and limited benefit, especially in the long term. Apart from detrimental effects on balance, memory and cognition,6 benzodiazepine use has recently been linked to the development of dementia and pneumonia.7,8 The prevalence of benzodiazepine use in two Australian ACF studies conducted in 2009 (NSW) and 2007 (TAS) ranged from 15% to 25%, respectively.4,9 Therefore, it is likely that at least 30,000 residents of Australian ACFs are taking benzodiazepines. Many residents will be taking both agents concurrently. In the 2007 Tasmanian study almost half of the residents taking antipsychotics were taking a benzodiazepine at the same time.9 Adopting a conservative approach, the RedUSe project estimates that over 50,000 residents of Australian RACFs will have their antipsychotic and benzodiazepine medications reviewed, and a significant proportion will have their use of these agents reduced as a result of wide dissemination of the RedUSe project. The RedUSe project will also provide education on the quality use of sedative medication for a large number of nurses and GPs. The recent AIHW publication: Nursing and midwifery workforce 2011, reported that over 45,000 registered and enrolled nurses worked in RACFs during 2011.10 LASA believes that continuous quality improvement is best dealt with through an open and positive approach. This requires all stakeholders to commit to open dialogue and joint statements wherever possible. For some residents the use of sedative medication will be the appropriate course of action and the benefits will outweigh the risk. In these circumstances LASA does not believe the term ‘chemical restraint’ is warranted or appropriate. As with many sensitive and controversial issues the narrower our focus the greater chance of entrenching positions and creating division. LASA believes that the wider we cast our net the greater our success will be. Firstly we must acknowledge residential aged care is the most regulated industry in the country, and unlike other settings a robust accreditation system has been enmeshed in daily practice and is considered core business. We must also openly discuss the duty of care providers have to keeping their staff and other residents safe in their workplace. Caring is a challenge we should all understand better, particularly when 2.8 million Australians provide a caring role to another Australian. The Aged Care Workforce Final Report 2012 reveals that 46% of Australia’s residential aged care facilities have a Personal Care Assistant on worker’s compensation. It also reveals that 53% of injuries are from pulling, pushing, lifting or bending, followed by 27% being hit or cut. When you consider that over a quarter of the industries

workers have been victims of assaults the complexity of the issue heightens considerably. We all understand the dangers of working in the mining and construction industry and appreciate the high wages these workers get paid, acknowledging the inherent risk of their work. This is not the case in age services and it needs to change. This was one of the reasons LASA developed the industry awareness campaign 3 Million Reasons (www.3millionreasons.com.au). As we continue to cast the net we can also appreciate the innovative work of the Arts Health Institute. Sydney Multisite Intervention of LaughterBosses and ElderClowns, known as the (SMILE)11 study was a randomised controlled trial addressing the benefits of laughter therapy for dementia sufferers in residential care. The study saw Seventeen nursing homes (189 residents) receive the intervention and 18 homes (209 residents) received usual care. Key findings were; humour therapy was not shown to impact on depression (main outcome), behavioural disturbances but it did have an impact on reducing agitation. The conclusion was humour therapy should be considered as a psychosocial intervention to reduce agitation, before starting medication. As the industry leader LASA is willing to play a proactive role in the assessment of sedative medication in residential care. At all times we will be mindful of each of the stakeholders and the legitimate role they play. This is a complex issue but with good will from all interest groups and open communication we believe that we can maintain high quality and safe care even when faced with the difficult symptoms that can be present in dementia sufferers. ■ For further information about the RedUSe project please email redUSe.project@utas.edu.au

References 1. W estbury J, Jackson S, Gee P, Peterson G. An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes International Psychogeriatrics 2010;22:26-36. 2. Schneider L, Dagerman K, Insel P. Risk of death with atypical drug treatment for dementia: meta-analysis of randomised placebo-controlled trials. JAMA 2005; 294; 1934-43 3. Australian Institute of Health and Welfare. Residential aged care in Australia 2011–12: A statistical overview 2012 Aged Care Statistics Series Number 28 Australian Institute of Health and Welfare Canberra Cat no AGE 68 4. Snowdon J, Galanos D. A 2009 survey of psychotropic medication use in Sydney nursing homes. Medical Journal of Australia 2011;194:270-1. 5. Alzheimer’s Australia. Antipsychotic medications and dementia: Alzheimer’s Australia position statement. Released 16 August 2012. 2012. 6. Madhusoodanan S, Bogunovic O. Safety of benzodiazepines in the geriatric population. Expert Opinion Patient Safety 2004;3:485-93. 7. Billioti de Gage S, Bégaud B, Bazin F, et al. Benzodiazepine use and risk of dementia: prospective population based study. British Medical Journal 2012;345:e6231. 8. Obiora E, Hubbard R, Sanders R, Myles P. The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: A nested case-control and survival analysis in a population-based cohort. Thorax 2012;0:1-8. 9. Westbury J, Beld K, Jackson S, Peterson G. Review of psychotropic medication in Tasmanian residential aged care facilities. Australasian Journal of Ageing 2010;29:72-9. 10. Australian Institute of Health and Welfare. Nursing and midwifery workforce 2011.Available at:http://wwwaihwgovau/publicationdetail/?id=10737422167&tab=2 11. Lee-Fay, Low et al . The Sydney Multisite Intervention of Laughter Bosses and Elder Clowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes British Medical Journal. 2013

General | 37

38 | General

Staffing Ratios in Aged Care – What’s so bad about that? Ratios have been offered as a solution to providing quality residential care. LASA’s position is that providing quality care is more complex than that. As with many issues confronting age services quality care crosses a number of key elements.

e asked James Saunders, General Manager of Cook Care his views on ratios Q: All facilities have budget constraints and would use some form of rostering framework. How is this different to working within a staffing ratio? The issue of mandating staffing ratios was considered by the US Senate a few years ago. After conducting two separate studies including a multivariate analysis and a time and motion study. Both concluded that ratios were only one factor when assessing “appropriate staffing levels”. Other factors included; staff training and experience, staff morale, physical layout of the facility, amount

of time saving equipment (assistive technology). It is essential that we factor all of these variables into an assessment of staff needs. Q: As ACFI is based on resident assessed need is it reasonable to expect that it will cover staff wages? Yes, ACFI should cover staff costs but again there are variables. Wage costs vary in every state and territory based on the cost of living and supply and demand issues associated with recruiting and retaining staff. A case in point is Western Australia where the mining economy makes it exceptionally difficult to recruit and retain staff. The above award wages paid in Western Australia for example would not translate to a small rural town where employment was scarce.

General | 39

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Q: Are all staff included in this, incorporating management, administrative support, housekeeping and catering? It is the expectation of industry that ACFI will cover all “facility based staffing”. This includes care, hospitality and administration. It is accepted that this would normally exclude corporate or head office personnel. Q: How do we know when staffing levels are adequate for good quality care and positive outcomes for residents? I think the current approach by the Agency is appropriate. In the way that they look at quality indicators such as call bell response time, satisfaction, accident/incident rates, pressure ulcers and wound management. Q: How much impact does facility design have on staffing levels? With the move away from multi-share rooms to single rooms with ensuites we are seeing a considerable impact on staffing levels. There has been a dramatic increase in the building’s foot print which means staff need to walk much further; also, with multi share rooms less staff were required for supervision purposes. Q: How much impact does staffing skill mix have on staffing levels? Research conducted in the US identified the importance of having both licensed and unlicensed staff. Q: Is there such a thing as too many staff – does quantity equate to increased quality? The US research identified that providing licensed staff up to 1.3 hrs per day per resident and care staff up to 3.2 hrs per day per resident was beneficial but after this point there was no improvement in care delivery. Q: Where does accreditation and complaints management come into this discussion? The US Senate ultimately decided against mandating ratios because of the cost of increasing staffing which is government funded. If ratios were introduced in Australia, we would need an additional 20% increase in funding. The current accreditation system is based on “outcomes”. Ratios are an arbitrary process measure which conflicts with an outcomes based accreditation system. Resident surveys and complaints measurement can demonstrate consumer satisfaction (or dissatisfaction) with staffing levels. ■

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40 | General

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General | 41

Changes to home care and moving to CDC – our compliance top 10 By Julie McStay, Director and Head of Aged Care and Retirement Living, Hynes Legal

he change from the former CACP, EACH and EACHD packages to new Home Care Packages took effect when the Aged Care (Living Longer Living Better) Act 2013 and the relevant subordinate legislation commenced on 1 August 2013. On that date, all existing community care packages transitioned to home care packages as follows: • CACP package – Home Care Level 2. • EACH package – Home Care Level 4. • EACHD package – Home Care Level 4. New level 1 (basic care and services) and level 3 packages (intermediate care and services) were also introduced. We have identified the top ten items we suggest home care providers focus on when considering how they will comply with changes to home care requirements and moving to CDC.

1 – Review DOHA’s home care guidelines The guidelines released in July 2013 are an excellent starting point for providers who have existing home care packages or are considering applying for packages in future approval rounds. The guidelines are not intended as a substitute for legal advice but they do provide a good source of information about the manner in which the Department of Health and Ageing (DOHA) can be expected to apply the new provisions.

2 – Come to grips with the new assessment process Under the new home care arrangements care recipients will undergo an Aged Care Assessment Team (ACAT) assessment to determine whether they need home care at a level equivalent to low care residential care (a level 1 or 2 package) or high care residential care (a level 3 or 4 package). The ACAT does not

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42 | General need to determine a person’s care needs at a particular level within each band. This process is called “broad banding” and is expected to continue until at least July 2015. If a care recipient has been assessed as eligible for a particular level of package, but none is available, they can be offered a lower level package, as an interim measure, until a higher level package is available. However, if the care needs of a person who has an ACAT assessment for a 1 or 2 package increase, a new ACAT assessment is necessary before the provider can offer a level 3 or 4 package.

additional requirements for agreements to deliver care on a CDC basis. The User Rights Principles 1997 (Cth) set out the matters that must be included in a home care agreement regardless of how the care is delivered i.e. CDC or non CDC. Simply Legal (documents by Hynes Legal) has a range of compliant home care agreements (CDC and non-CDC). Visit http://simplylegal.com.au/aged-care-retirement-living-legaltemplates/home-care-documents

3 – Review entitlements to ensure access all available subsidies and supplements

Providers should review their services in light of the new common list of care and services that apply across all four package levels that are set out in the Quality of Care Principles. There is also a single list of excluded items that applies across all four package levels. The main difference between the home care levels is the amount of care and services that can be provided to the consumer, rather than the type of care at each package level. If required, a care recipient can now access nursing and clinical services across any of the 4 packages Care and services must be provided by the home care provider in a way that meets the Home Care Common Standards – the old Community Care Standards under a new name.

Importantly: • An ACAT approval to receive a home care package takes effect from the day the approval is given, but a subsidy is not payable until the consumer has been offered and accepted a package by the provider and a home care agreement is entered into. Processes should be implemented to ensure care agreements are entered into before commencement of the delivery of care. • A Dementia and Cognition Supplement is available to all home care providers that provide care to consumers who meet the eligibility criteria across any of the four levels of packages. There is also a Veterans’ Supplement for veterans with an accepted mental health condition. • The onus is on eligible providers to make application for subsidies and supplements.

4 – Proactively manage the transition to CDC All packages allocated in the 2012-2013 ACAR must be delivered on a CDC basis and all existing home care packages must be delivered on a CDC basis from 1 July 2015. Providers can transition their packages to CDC earlier but they must notify DOHA of the intended date of transition and after transition they must comply with the CDC requirements. Providers should decide when they wish to transition their existing home care packages to CDC and review the following to ensure they are compliant with CDC requirements with respect to: • care planning; • financial planning; and • their care agreements.

5 – Review your brokerage arrangements The provider to whom places have been allocated retains principal responsibility for ensuring care is delivered in a way that complies with the legislation. Providers should review brokerage agreements to ensure they comply with the new home care requirements (and the CDC requirements if you are offering care on a CDC basis or are transitioning your packages to CDC prior to 1 July 2015) and to manage your organisation’s risk.

6 – Review your home care agreements DOHA has indicated that it does not require home care providers to transition existing care recipients to new agreements. However as existing care recipients are replaced by new care recipients, providers will need to ensure their care agreements comply with the new home care arrangements. There are

7 – Home care services

8 – Police checks and other requirements Provider should ensure they are compliant with the new requirements with respect to: • key personnel; and • staff, volunteers and contractors.

9 – Financial reporting to DOHA The current Financial Accountability Report and Statement of Compliance process will continue to apply for the 2012-13 financial year and possibly for 2013-14. The Financial Report for the 2013 financial year must be provided to DOHA by 31 October 2013. The Aged Care Financing Authority has been asked to provide advice to the Minister on whether there should be changes to the reporting process. If there are any changes they are likely to apply from 1 July 2014.

10 – The Coalition The recommendations made in this article are made on the basis of the changes as implemented on 1 August 2013. The Coalition’s Policy on Ageing released as at the date of preparation of this article has no specific proposals that indicate any plans to unravel the changes made under Living Longer Living Better reforms with respect to home care. If you need assistance with any of the matters raised in this article please contact Julie McStay, director and head of Aged Care and Retirement Living, Hynes Legal. Julie.mcstay@hyneslegal.com.au ■

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46 | General

The Risk and Opportunity of Change By Rachel Lane, Principal of Aged Care Gurus

The reform of any system represents both risk and opportunity, as Charles Darwin is so famously misquoted as saying “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”

he means testing of community care packages will create a demand for advice in a bid for care recipients to minimise their liability and evaluate the cost of care. This will enable people to be better informed about a range of different legal and financial arrangements that are often entered into prior to permanent residential aged care. Such arrangements include: granny flat rights/life interests, over 55 communities and retirement villages. While some people enter into these arrangements with a view to combatting social isolation and the delivery of care comes as they “age in place”, in other cases people are entering these arrangements as an “aged care alternative”. The means testing of community care packages will be an income assessment, based on Centrelink’s rules, with income in excess of a threshold creating a liability to contribute. Full means tested pensioners will not have a liability to pay and will simply continue to pay the basic fee of 17.5% of the pension. Part pensioners and those with the equivalent level of assessable income (up to $43,186p.a) will pay the basic fee plus a care contribution up to $13.74p.d/$5,000p.a. While self-funded retirees and people with equivalent levels of assessable income (above $43,186p.a) will pay the basic fee plus a care contribution up to $27.47p.d/$10,000p.a. While a means test based on a percentage of income appears to be a fair and affordable way to levy those with the capacity to contribute, in reality it will favour those with high levels of assets and low levels of assessable income. Let’s look at an example. Frank is a part pensioner, he has a house worth $800,000, $200,000 worth of investments and a car and personal effects worth $25,000. His next door neighbour Alan, has house worth $850,000, a holiday home worth $500,000, a boat worth $50,000, a car worth $50,000, investments totalling $300,000 and $350,000 in superannuation that provides him with an income stream of $25,000 (of which only $10,000 is assessed for Centrelink). Post Reform Frank’s Care Contribution towards his community care package will be $6.15 per day in addition to his basic fee of $9.17 per day, giving him a total cost of $15.32p.d/$5,576.48p.a. Frank’s next door neighbour Alan’s liability to contribute towards the cost of his care will be $0p.d, his total cost will be the basic care fee of $9.17p.d/$3,337.88p.a.

When it comes evaluating the cost of residential aged care, the means testing of the care contribution and the pricing of accommodation payments anomalies make it far more complex. Many people have seen the setting of a market price structure for accommodation payments as a “win” for consumers. In my experience most facilities are currently setting their “market price” or “base bond” at or below the Tier 2 price cap of $455,000. In the cases of larger bonds that I have seen residents are choosing to negotiate with the facility to pay a bond amount that enables them to exchange an exempt asset (their home) for an exempt asset (their bond) to maintain pension entitlement or in some cases people are negotiating the bond to increase their pension and/ or reduce their liability to pay an income tested fee. Post reform, the ability to exchange exempt assets will be lost as the amount of bond (RAD) a resident can pay will be capped. People who don’t have the capacity to pay the market price, but whose assets are above the $144,500 (or equivalent level of income) will simply need to pay beyond their means. A Resident whose house is worth more than the RAD will need to consider what the impact of the house being sold will be on their pension entitlement, as the proceeds outside the RAD will be assessed for determining pension entitlement under an asset and an income test. They will also need to give consideration to the fact that the RAD value itself will be included in the means testing of care contribution, whereas if the home is retained only the first $144,500 is assessed. Let’s have a look at a pretty simple scenario Shirley is a Full Age Pensioner, her assets are: House $550,000 Bank Accounts $48,000 Personal Effects $2,000 Shirley’s cost of a community care package is $9.17 per day/$3,337.88p.a and $0 Care Contribution Pay by RAD (sell house)

Cost of Care

RAD

$300,000

Basic Daily Care Fee

$44.54

Care Contribution

$27.47

Total (Daily)

$72.01

Total (Annual)

$26,211.64

+ Out of Pockets ($50p.w)

$28,811.64

General | 47

Pay by DAP (keep house)

Cost of Care

Basic Daily Care Fee

$44.54

DAP

$56.21

Care Contribution

$1.37

Total (Daily)

$102.12

Total (Annual)

$37,171.68

+ Out of Pockets ($50p.w)

$39,771.68

While on face value the RAD option may appear to be the most affordable, we need to consider more than the two totals. In the RAD scenario: Shirley’s pension entitlement would reduce by $137.80pfn/$3,582.80p.a and her Care Contribution is $26.10p.d/$9,500.40p.a higher than if she paid by DAP. There is an opportunity cost on the RAD, if we assume growth on the house at 2.5%p.a the cost is $7,500p.a, in addition the value of the RAD will be reduced by inflation over time. Shirley’s investment income (assume 4%) and her pension will provide her with sufficient cash flow to meet her costs and she will have $298,000 of liquid funds available to her. In the DAP scenario: Shirley would continue to receive the full pension and she could keep and rent her home to assist in meeting her cash flow. Her home and any rent would be exempt from the calculation of her pension and the care contribution. Shirley would need to declare the rent for tax and there may be capital gains tax on the property if retained for more than 6 years and there is the risk that the house may realise a capital gain or loss when sold in the future. There would be ongoing expenses associated with keeping the house. Her pension and investment income (assume 4%) would be around $17,000p.a short of meeting her cost of living, so if the house can be rented for at least $330p.w net of expenses and tax she will be able to meet her cash flow.

If she chooses to rent the house to child for $1p.w she will exhaust her bank accounts in around 2.5 years. Prospective residents of aged care facilities are going to need to think twice about the long held notion that they should sell their house to pay a bond (RAD). They are going to need to consider a complex set of intertwined assessments that can impact on their pension entitlement, tax, estate planning wishes and of course the cost of care itself. People who transition through other arrangements, such as granny flats, over 55’s communities or a retirement village on their way to residential aged care will need to factor in the future consequences of such arrangements also. Those currently considering the move to residential care should consider the risks and opportunities of moving prior to or after 1 July 2014. ■

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General | 49

Consumer Directed Care Capacity Building Service for Aged and Community Care Providers Information for Providers

lder people want to have greater control over their lives, including making choice about the aged care services they receive. The previous Government’s Living Longer Living Better reform package recognised this with the fundamental system shift to consumer directed care service delivery. Aged care providers are at different stages of readiness for this shift. COTA Australia has been funded for a project to provide a capacity building service to equip organisations to deliver quality consumer directed aged care services. This project is being conducted in partnership with the provider peak bodies, ACSA and LASA. Ensuring the sector is able to implement consumer directed care will improve the quality of care provided overall as well as for individual older people. The objectives of the project are to: • Ensure aged care providers understand consumer needs and what is required to deliver CDC services; • Research the challenges providers face in delivering consumer directed care; • Develop approaches, strategies and tools to overcome the challenges enabling design and delivery of consumer directed care services; • Provide information, advice and hands on training to equip services operate and deliver quality consumer directed services and care; and • Ensure that the consumer benefits fully from the Government’s aged care reform agenda. The needs of different groups will be considered, such as boards, executive staff, case managers, care workers and corporate services staff. Pat Sparrow from COTA will manage the service and Ronda Held has been engaged as a consultant to assist with the planning and design process. A Steering Committee with representatives from COTA, ACSA and LASA will oversee the service, and a Project Consultation Group will provide advice on planning and delivery of the service.

A parallel project Making the Most of CDC will be managed by COTA in conjunction with a range of consumer groups to equip consumers to make the most of the benefits and opportunities that CDC can provide. This will be done through information, peer support/ education and other measures that may be identified. The kinds of issues regarding CDC implementation that have been raised to date by providers include: • Changes required in approach to service facilitation/coordination and skills required by staff • Implications for direct care services and contracted service providers • Legal Issues – duty of care, decision making, security of tenure • Compliance issues – including documentation, care plan template and meeting the Home Care common standards • Workforce – flexibility, capability building • Finance systems and individual budgets • IT Systems – including system specifications • Governance and Management requirements, cultural change • Communications and marketing • Consumer participation/co-production in program design • Guiding policies and procedures • Approaches to CDC for people with special needs including those with dementia, from a CALD background, aboriginal peoples & Torres Strait Islanders and homeless people. The Project may be able to assist with training materials, DVD or You Tube clips, information for boards, sample policies and procedures, and advice/support for providers. Please feel free to contact us for assistance or conversations regarding the implementation of CDC. Regular updates will be provided through your peak body newsletters. ■

PROJECT CONTACT: Email: cdc@cota.org.au Phone: 03 9909 7910 Pat Sparrow: 0410 492 235 Ronda Held: 0450 785 437

50 | General

General | 51

RETIREMENT LIVING: the Service Integrated Housing model By Geri Taylor, Manager Policy & Retirement Living, LASA Q

OVERVIEW

SERVICE INTEGRATED HOUSING

ne of Leading Age Services Australia’s (LASA) priorities is that it “will provide effective services and a voice advocating for retirement living and emerging approaches in housing for older Australians” on the basis that the “greatest growth in the age services sector is in community care and accommodation tailored to the needs of older Australians.” Besides LASA’s interest, there is an increased focus by others such as consumer organisations and policy makers in the accommodation and services policy and service provision for older Australians. This is because of the increasing numbers of older Australians starting to present as a higher percentage of the Australian population – although the likely impact will be relatively moderate compared with many other advanced economies. Indeed, The Economist1 writing about the ‘shock of the old’ shows that between 2010 and 2050 the impact for Australia, relative to 28 other advanced and the BRIC countries, will not have the doomsday impact being touted and with the greatest expenditure on health care, rather than pensions and long term care outlays. Additionally, the impact can be tempered if the economy remains strong and an active immigration policy leading up to 2050 is undertaken. It has also emerged because of the wash up from the Productivity Commission’s Caring for Older Australians Report 20112 and the now previous Government’s response to the report with the Living Longer Living Better Reform legislative changes. It appears many individuals and organisations have a policy position and perspective on what has to be done ‘for’ older Australians, with many critical of the role retirement villages play in responding to both the accommodation and service needs likely to be demanded by older Australians in them, without appreciating the role played by this sector. In part, the future will lie with an increasing understanding that working ‘with’ (rather than ‘done for’) older, more exacting and sophisticated consumers in developing product choices for accommodation and services will entail an expansion of congregate housing options (including higher quality retirement villages offering much more than just independent living units). As Australians live longer and are more healthy than in previous generations, the service integrated housing concept will come into its’ own over the next three decades; although remaining in the family home to age in place will continue to dominate given the older Australian’s cultural and economic ties to it.

The term service integrated housing (SIH) was developed to describe the various forms of purpose built housing for older people where the housing provider also delivers, or arranges for the delivery of, support and care services. It is identified as a third component of aged care in Australia. Retirement villages are emerging as the SIH sites for low care services and this description will hide a wide variety of more intensive service models developed to meet future likely markets. According to the Australian Housing and Urban Research Institute researchers3 who developed the term in 2007, and refined it in 2010, retirement villages are the main form of service integrated housing in Australia. The Productivity Commission referred to this concept in their 2011 report and included the below diagram which was developed by one of the authors of the AHURI paper, Dr Anna Howe.

DIAGRAM 1: SERVICED INTEGRATED HOUSING WITHIN AN AGEING IN PLACE MODEL 4

52 | General According to empirical research from retirement village providers, residents moving to villages are increasingly attracted to the promise of secure accommodation where access to support and care is facilitated and/or provided by operators. Also of benefit are those co-located with a residential aged care facility.

RESIDENT PROFILES Each state and territory has had their retirement village industry develop based around local markets, housing options and legislative arrangements. However, all jurisdictions report that the entry age is up from the early 70s a decade ago to late 70s to mid 80s with researchers calculating the length of tenure around ten to twelve years; although this tenure is likely to be much shorter for those moving into assisted living/dedicated service apartments where new residents are usually older and more frail. The following diagram adapted from Leading Age USA5 reveals that the residents moving into and existing residents in retirement villages (seniors living communities) are: • Older, with higher levels of health issues (albeit still able to live independently) • Are attracted to those villages which offer more than just amenity: support and care are deciding factors • Expect higher quality and efficient operations: affordability and value for money are essential • They, and their families, want secure and safe communities

DIAGRAM 2

These criteria are applicable to the Australian scene. Because of this future, the retirement village industry will need to evolve skilfully and within a sound evidence based policy framework if it is to be successful in reassuring the potential market, policy makers and the general community that it is able to play an essential component working in partnership with older Australians to age well.

SOME IMMEDIATE KEY ISSUES FOR THE INDUSTRY TO PROMOTE THE SIH MODEL In brief, these revolve around: • Growing an ethical and transparent industry to support a better understanding of the retirement living products, what it can deliver and what it cannot do because it is basically a user pays system which requires a sound financial return for operator survival in both the for profit and not for profit sectors • Promoting partnerships with those in the residential age care, home care services and health sectors to enhance seamless services where it is feasible to do so • Developing the industry to accept that it is not in the medium density housing industry, rather it is in a service industry with consumers who want to live independently in their retirement village home and age well in place • Strengthening strategic alliances with other professional organisations/institutions and consumer bodies, some of whom are distrustful of the industry, as in unity of understanding, shared values and vision there is strength

General | 53 • I mproving the policy and research base to underpin the industry. The Australian Association of Gerontology released a policy position on housing and older Australians last year6 including the need to consider affordability, factors for those living in rural and remote areas, age friendly housing, seniors public housing matters. All these topics are critical for the industry • The need to embrace a Code of Best Practice for operating a retirement village such as the one developed by Consumer Affairs Victoria • The limited take up of a formal and independent Accreditation system with the result that there is not any objective assessment that a minimal standard of consumer protection and corporate governance exists in a village. IRCAS is LASA’s preferred Accreditation model • Finally, working collaboratively to minimise inferior business operations and promote excellence throughout the industry.

IMPACT OF THE RECENT CHANGE IN THE FEDERAL GOVERNMENT The jurisdictional responsibility for housing is with state and territory governments, and is likely to remain so as these jurisdictions have carriage of other housing models that are attractive to older Australians through choice or necessity. These include pensioner rental models, manufactured home estates,

public housing, recreational parks and Body Corporate and Community Management models. Nevertheless, as retirement villages become more and more a site for support and consumer directed care, it could be envisaged that the Commonwealth Government may become more interested in quality considerations. This is one reason why action on key issues is required. Another reason is to reassure politicians and their public servants that the industry is on a sound footing and wedded to strong corporate governance standards. ■

References 1. Franklin D & Andrews J Editors, Megachange. The World in 2050 The Economist Profile Books London 2012, Chapter 10, p140 2. P roductivity Commission, 2011 Caring for Older Australians, Report 53, Final Inquiry Report, Canberra 3. P rofessor Andrew Jones, Dr Anna Howe, Professor Robert Stimson, Associate Professor Cheryl Tilse, Professor Helen Bartlett Housing Support and Care for Older Australians: The role of Service Integrated Housing AHURI Queensland Research Centre, 2010 4. P roductivity Commission, 2011 Caring for Older Australians, Report 53, Final Inquiry Report, Canberra, Vol 1: page xxiv 5. www.leadingage.org 6. A ustralian Association of Gerontology Position Statement – Research Priorities for Older Australians. Australasian Journal of Ageing, Vol 31 2, June 2012 pp130-135

CHANGES TO ACFI FUNDING FLAG A NEED FOR TRAINING UPDATE Since changes to the ACFI were introduced in February it has become clear to Lyn Turner, Director, National Care Solutions that not all facilities were well prepared for these changes and may be at risk of not capturing the funding they are entitled to through submission of their ACFI appraisals. Lyn has been working in the aged and community care sector for over 12 years and has been with National Care Solutions, a specialist aged care consultancy provider, for the past 6 years. Prior to this Lyn was Education and Training manager with ACQ (now LASA) for 7 years. Lyn was a national trainer in the rollout of the ACFI in 2007 and 2008 and has continued to work with nursing homes to ensure they are fully aware, through her training, of the “world of ACFI.” Lyn has worked with many homes where over a period of maybe 12 months they have seen their ACFI daily average claim rate climb from around the $100/day per resident to over $140.00/day per resident. For an 80 bed facility this can mean an increase of $3,200 per day or $1,168,000 per annum. Lyn says the improvements are simply recognition of the assessed care needs of the residents being accurately recorded in all clinical documentation by well trained staff who recognise what documentation is required to make a claim. The congruence of the progress notes, assessments and care plans is essential to this success.

Lyn is also an external assessor with the Aged Care Standards and Accreditation Agency so is mindful of accreditation requirements as well when training/consulting. Lyn works with your staff in an action learning environment to ensure all stakeholders are working towards the same goal of recognising the assessed needs of their residents and documenting appropriately to ensure ethical claims that are upheld at validation. With the changes to ACFI in February there is a need for further education for most ACFI Appraisers to ensure they have the correct documentation as required at validation. Lyn is happy to come to your site to work with your staff to ensure you are claiming for any funding you are entitled to in relation to the ACFI.

National Care Solutions provides high quality aged care training and consultancy in the following areas ✓ ACFI Training, Preparation & Review. ✓ Preparation and submission of tenders/ ACAR/general applications ✓ Training & Development Services ✓ General Management Consultancy Services (including management mentoring) ✓ Human Resource Assistance ✓ Internal auditing, Preaccreditation gap analysis audits ✓ Preparation and submission of accreditation applications To have us come on site and work with you to help you reach your goals please contact: Lyn Turner 0418733786 lyn@nationalcaresolutions.com.au

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Don’t Agonise

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54 | General

What makes a good care worker and why care providers must recruit and retain them? By Angela Gifford, CEO, Able Community Care/Angela Gifford International www.uk-care.com, www.angelaegifford.com

good care worker can be defined as one with skills and experience appropriates to the person he/she is providing care to. This comes with caveats however that care workers like the person they care for and the cared for are happy with the care worker. This is a simple but true, human definition.” For any care provider, care workers are the day to day face of the organisation. Your care workers can lose or retain existing clients and gain or lose you new ones. It is the client who pays the wages of every staff member and ensures a profitable or non-profitable annual result. Clients are customers buying your services. Happy customers recommend your organisation and customers want reliable, regular care workers fulfilling their needs. Customers want care workers happy with the organisation they work for. Consumer Directed Care which gives power to people to choose their care provider is a major wake up call to all care providers announcing the ‘status quo’ of many years standing is disappearing. In countries, such as the UK where CDC has been absorbed into the culture, customers have buying power and choice. If one care provider cannot fulfill their needs, another provider will and many decisions to change care providers are based on what care recipients see as unsatisfactory care worker situations. The older population is on the increase and more people will require care. How is that care to be provided and how can a care provider tackle the problems of care worker recruitment and then retain those care workers? Many people are of the opinion that an increase in pay rates would go a long way to help solve the recruitment problem. Reality is, in the short term this is unlikely to happen. It is also a simple fact that rates of pay are known when a person seeks to become a care worker and accepted. Just as in all professions, care worker recruitment begins with HR Departments which have the responsibility from first base. I would suggest that if HR staff have no care experience or have not visited customers of the organisation they are recruiting for they are not in a position to successfully process care worker vacancies. Potential care workers who are unable to speak, read or write English, except for specific circumstances, should not be deemed as suitable for care work: health and safety grounds, unable to understand or communicate with the person who needs their

care, record keep, etc. (In the future care providers may need to provide training in basic English communication skills to service their market). Selection processes for applicants without professional care experience should be based on a care provider’s ability to offer responsible training either in house or externally. Care providers should induct new care workers into what their organisation represents, how they are expected to be part of the mission statement and how optimum outcomes are to be achieved for each customer. There is no magic solution available. Each care provider needs to work on their recruitment strategies. Re-visit their selection processes with the paying customer in mind. Audit current methods, can they be done better? Knowing customers want regular care workers, retention processes for care staff have to be an inherent part of any care organisation. Apart from giving customer satisfaction, the process of staff rostering becomes much easier and financially efficient when regular rosters operate. What can be done to increase retention and by definition, increase the number of applicants who come to your organisation? Care workers who have confidence in their ability to carry out the work they are given are more likely to remain with their employer. This means knowing exactly what the skills of any care worker are and to offer opportunities to enhance those skills by further training. The recipients of care require a wide range of care skills and experience but this is not the only factor that needs to be taken into consideration when placing a care worker. Empathy from a carer to client and client to a carer is fundamental. Staff will not be retained if they are working with a person with whom they cannot empathise, do not like and with a person from whom they derive no job satisfaction. Care workers who are not happy with their employer will demonstrate this. They will seek an alternative employer and may take their client with them. Loyalty is a dynamic part of care worker retention. If care staff are loyal to their employer they will give extra. Employers have to earn that loyalty. Not only with reference to job selection but in giving support to each and every worker. Support can be given in many areas: y giving full details of a client who requires care to the care 1. B worker before they cross over the person’s threshold.

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2. B y Care Managers having regular verbal communication with the care workers with reference to their client’s care package. The care worker is the front line; ask for their views and suggestions on their client’s care. Treat their role with the respect it deserves. 3. Know your care worker, acknowledge training achievements, personal milestones, five years, ten years, a wedding, 25th anniversary, becoming a grandparent, a personal sadness, a card if they are in hospital and a thank you card or flowers whenever they go the extra mile. 4. A llow and encourage Care Managers to build up relationships with care workers. Give individual direct telephone lines/email addresses. Build up inter-dependent professional relationships, it pays dividends. 5. M any organisations have a format for asking staff when they leave, why? This is too late. Ask your workers on a regular basis why they like working for your organisation, what suggestions they have for better services. Take responses seriously. 6. P ay wages on time.

7. Operate your own ‘in house’ on call system. Out of hours support should be given by a person who knows both the care worker and the customer, not an unrelated call centre response system. 8. Staff appraisals gives guidance as to how individuals would like to see their career pattern progress. If it is to gain skills to care for different client groups then facilitate this. If it is a request for refresher training, or to add skills to assist their current clients, facilitate this. 9. Have a weekly email communication about current care news, new work that has come in, news re clients who have sadly passed on, successes/news of the organisation, achievements and individual milestones of care workers, etc. This is all part of ‘belonging’, a powerful retention tool. Happy workers will recommend the organisation they work for and will encourage others to request application forms. Happy care workers are an important advertising tool, an effective recruitment resource and the key to all other provider activity. ■

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What makes a Good Life? By Anne-Marie Gillard, General Manager Health and Community Services, ACH Group agillard@ach.org.au

hat are the possibilities for people as they enter their 70s, 80s and 90s? What is the role that we can play to support older people in their aspirations? How do we challenge unhelpful perceptions on health and ageing and lead the way in helping people define optimistic futures with evolving, new and meaningful roles through critical life transitions? What could the role of work, both paid and volunteering, for people in their 70s, 80s and 90s look like? As Australian’s collectively age, these questions lead to the need to understand “what constitutes a good life as we grow older”? The proportional growth of over 55’s has accelerated, becoming the fastest rate of population ageing ever seen in Australia. Underlying the long term ageing trend is the ongoing improvement in life expectancy. Baby Boomers are in the midst of transitioning out of the workforce and into another stage of their life. The Boomer generation represents a step change in terms of behaviour and expectations. Many will remain mobile, active and healthy until their late 70s and will continue to work long past traditional working age. They are also more likely to have substantive aspirations for their post paid work years; the “third age” (Laslett 1996). According to Graeme Hugo (2003) the significance is that this period of lifestyle and identity reinvention has not been experienced by previous generations. Baby Boomers could spend up to 1/3 of their life in the third age. In this context, understanding positive ageing and healthy ageing, and what constitutes a “Good Life”, is critical for aged care service providers moving forward. Acknowledging, embracing and honouring the uniqueness that exists in each of us is foundational for a good life. At ACH Group we believe that in all we say and do we should challenge the stereotypes of older age and invent new possibilities for life in the 70s, 80s and 90s. ACH Group’s core promise is that we will be single minded in supporting, enabling and promoting Good Lives for older people. What over 1000 ACH Group customers have told us makes a Good Life is strongly supported by the literature. Having a sense of optimism, a sense of future and hope about tomorrow implies confidence in one’s own continuing ability to set and fulfil goals and to remain engaged in life. A positive attitude involves a sense of purpose, acceptance

of ageing and enjoyment of ageing. An optimistic outlook extends to health and researchers describe health optimism which involves positive beliefs about ones capacity, and is associated with a sense of control over ones health and greater engagement in healthy behaviours (Ruthig et al 2011). Levy tells us that older people with more positive selfperceptions of ageing have better functional health over time than those with more negative self-perceptions of ageing (Levy et al 2002). A Good Life involves contribution and engagement with others, enjoying the fullness of life with interests and passions. It involves a sense of belonging where people have a variety of relationships with other people, enjoying every day roles and rhythms. Healthy ageing is inextricably linked with having meaningful relationships and social engagement across the life course, and with healthy behaviours and attitudes (The Longevity project – Friedman and Martin 2011). Thriving, wellbeing and good health are linked to active ageing and productive ageing (Lund and Engelsrud 2008). Remaining in good health is one of the most important indicators for older people that they are ageing well and living well (Barnett 2004). Being physically and mentally healthy is of critical importance to being able to fulfil expectations regarding a Good Life. However, it is not enough to focus on our bodies, it is equally important to focus on families, work, and social connectedness. Social settings and social ties are crucial components of health across the decades. Social relations deeply affect one’s habits, daily activities, long term plans and reaction to challenges. At its essence; Friedmann maintains that individual health depends on social health (Friedmann and Martin 2011). Creating opportunity and choice for people to achieve healthy and positive ageing and ageing well is about “Good Lives” rather than “End of life”. We can facilitate a good life for people by actively challenging societal stereotypes on health and ageing, promoting good health including social connectedness, and creating a positive and intentional attitude to create and seize opportunities for personal growth and fulfilment. To quote ACH Group customer, Margaret McKay, If I’d known growing older was going to be this good, I would have done it years ago! ■

58 | General

Ageing with Resilience and Determination: A Photo Story of Shirley Fernon Interview with Heather Fernon

When did you start to document your mother ageing? I began to photograph my mother about 2 or 3 years ago. I had asked her many years before, but I discovered she was much more interested, once she could review the images on the screen at the back of my digital camera.

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Was there a particular moment or issue that prompted you to do this? My mother was hospitalised after a mild heart event in 2009. During her convalescence, we were advised of changes that would need to be made to her residence, so she could safely return home. She had been determined not to make any alterations up until this point, and so I began photographing her home which was largely unchanged since 1956, to keep for our own memories. When my mother returned home, I started to make regular notes on her progress, but found this did not adequately describe the situation, and so asked her to participate in the photographs. At first she was reluctant, but eventually became interested in the immediacy of digital technology – and was happy to “critique” my efforts. What have you found as you document your mother’s ageing process? The ageing process for my mother has been very gradual, but her determined personality has not changed a great deal under the circumstances, despite fading hearing, eyesight and memory. It is her own “risk analysis” of her mobility on any given day, which enabled her to continue to live in her own home, supported by dedicated nursing staff and carers, on whom she became increasingly dependent. As she has moved into her 90’s I began to focus on the details, such as her hands and face in order to visually describe her strength and forthright determination. As a society how do you think we ‘deal’ with ageing? I am continually surprised by the number of people who have responded to the photograph of Shirley in the National Photographic Portrait Prize, because they have or have had, elderly relatives living at home; however, the needs of a rapidly

60 | General

ageing population and older people living alone, appears not to be one which is discussed at great depth in the public arena. Each individual ages differently under different circumstances. As a society it is difficult to cater for a culturally diverse population who will require access to a wide range of support networks. At present, the dialogue to support family carers, through easy access to a range of web based information and support services could be more fully developed. Adaptability to technology is greatly facilitated by devices which are supported by software which is clearly laid out and easy to understand. In my mother’s case, she was very fortunate to be able to continue to live in her own home, supported by dedicated nursing staff and carers, on whom she became increasingly dependent. The demand on financial and human resources needed to support these choices in the years to come, however, will be considerable and it does not appear to have been fully recognised or planned for yet as a society. At 92 your mother still lives at home alone (her home of 56 years). You described determined and resilient, can you give us some examples? As a child I was shown an article on her great-grandmother Sarah Patterson. Sarah lived at her home in Forbes until she was 96. It was always my mother’s wish and expectation that she would do the same. She is happiest when she can maintain her independence, even if only to do small tasks herself. Having trained as a pharmacist in the late 1930’s, Shirley, despite short term memory loss, is very aware of medications and the responsibility of those offering them to her, checking at length, that they were as prescribed by the doctor. Equally

she was very determined to remain as independent as possible, despite her “bendy back”. She was cheerfully determined to walk to her letterbox daily, attend a weekly church group, “raid” her refrigerator or argue with “Holly” her 11 year old tabby cat. I note that your Mum has now moved into a residential aged care facility. What impact has this had on her? Despite a great deal of initial resistance to the new environment, she has settled into aged care well. She feels comfortable, and in a safe environment, with staff who are very pleasant and helpful. Under careful supervision the medication has been further tailored to improve her overall well being. How would you describe your Mum today? Shirley has made a successful transition to aged care, but still “knows her own mind”, and so it still remains a challenge for anyone to persuade her to change it! Now 93 years old, she is benefitting from having different groups of people around her as her mobility is becoming increasingly difficult. Ageing is an issue that affects all generations, yet it is something we don’t talk about as openly as we should. What can we take from your work to help prompt an intergenerational discussion? I hope that people will understand the implications of an ageing population, and the need for extensive individual planning, possibly decades ahead, required in order to be able to make choices which are best suited for their needs. It is really important that these individual wishes are articulated and discussed, with friends and family, to minimise the difficulties when challenges which arise as a result of the ageing process..■

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62 | General

Adam Price: Rousing Memories and Singing up a Storm

I DRUGS IN AGED CARE HAS JUST GOT A LOT MORE COMPLICATED » Reduced hospital beds » People living longer » New drugs treatments » Reduced Health Care Professionals

Cytotoxics who’s at risk ? The new Anti Thrombotics just when you thought Rat Sack had gone! Palliative medication And more to come! Complementary Medicine Often not very complementary

Are these managed in YOUR facilities? » Policy and Procedure Development and Training for all relevant staff » Closing the loop with doctors pharmacists & ACF’s » Drugs in ACF’s – Taking charge of the new rules

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n 2010 country singer, Adam Price faced a pivotal moment when he was diagnosed with leukaemia and given three weeks to live. An incredible fighting spirit finds him today in remission and bringing joy and wonderful memories back to older Australians through music. As a country music performer, Adam had been working 16 to 18-hour days while running an internet marketing consultancy when he fell ill with what he thought was a cold. “At that stage music was more of a hobby for me. I wanted to put more time into but I never got the chance” he said. Adam’s cold remained and was eventually diagnosed as “AML” (Acute Myeloid Leukaemia). He was admitted to hospital and was administered aggressive chemotherapy two days later. This is when he was given the shocking news that predicted he only had three weeks to live. “I am the eternal optimist, I thought, ‘I’m going to beat this thing’ even though the news shook me up, my faith in God remained”. Adam’s fight saw him suffer considerably. During treatment, he lost 40 kilograms, as well as 80 per cent of his eyesight for three months. Adam not only lost his hair but also the skin on his hands and feet and his finger and toenails. “I was told most people only get one or two side effects, I seemed to get them all,” he said. “This resulted in me contracting several viral infections on top of one another and the doctors didn’t know what they were.” Despite all of this Adam’s fighting spirit remained with him saying. “I decided from the moment I got through the treatment, I only wanted to do something that would bring both myself and others joy.” Adam concentrated on music and started doing some little shows for seniors, in residential care facilities in his home town of Newcastle. At first Adam was doing a few short shows a month as a volunteer, as he was still very weak. Early on many of the nursing homes decided to help Adam where they could in covering some of his expenses. In order to perform full time he initiated a sponsorship program, called ‘AdoptA-Singer’. As he explains this gives the community an easy way to support older residents and gives them an inspirational show where Adam shares his story and his music with them. “There is a real focus on entertainment for young people but it seems seniors aren’t getting as much attention. Now, with the support of a major sponsor Scooters & Mobility Newcastle, I’m

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in a position to focus my efforts on this “full time” and bring our wonderful senior citizens faith, hope and love.” “As well as country music, I love the old crooning songs by evergreens like Frank Sinatra and Engelbert Humperdinck. I really enjoy going to the nursing homes and singing those old songs that bring back some memories for them.” Evidence from current research suggests that indeed music can bring back memories and assist not only those suffering dementia but also give carers some respite in what is often a very tough job. Front man for Australian band Hunters and Collectors, Mark Seymour who is also an Ambassador for Alzheimer’s Australia has seen this first hand with his mother who sufferers from dementia. In recent media Mark said “Music has a profound effect on people.” At 30 to 40 shows a month, Price is nearing his personal capacity. As the program grows I will introduce other performers and give them the opportunity. “Wherever there are performers and nursing homes we can provide a valuable service.” ■ For more information on Adopt-A-Singer go to www.adoptasinger.com.au

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Healthy workforce challenges for the Aged Care sector By Mark Cassidy, GM of Risk and Innovation at 2CRisk

Introduction

ged care is on the cusp of change (DoHA, 2013). As a consequence, “assuming that staff to client ratios are maintained at their 2007-2008 levels, projections suggest that the current workforce will need to more than quadruple in size by 2050, with nearly 80 per cent of the projected growth required to support the delivery of residential care services” (Productivity Commission, 2011). The combination of a larger and ageing workforce presents the Aged Care sector with some significant health risk challenges. If these health risks are left unmanaged they will result in increasing absenteeism and workers compensation claims. In this article we explore these challenges and discuss some potential actions to reduce the likelihood of this happening. While not a new phenomenon, population ageing is expected to accelerate over the next few decades, particularly from 2020 onwards. In 2007, those aged 65 years or more comprised around

one in seven Australians. The number of people aged 65 and over is expected to increase from 2.8 million (13.4 per cent of the total population) in June 2007 to 7.2 million (25.3 per cent) by 2047. (Productivity Commission, 2011) Further, as different ethnic groups begin to move into older age cohorts in substantial numbers at different times, reflecting postwar immigration patterns, there will be greater diversity among the largest ethnic groups that makeup Australia’s elderly overseasborn population (Rowland 2007). As the Ethnic Communities’ Council of Victoria (2008, p. 3) argues, these developments ‘will require culturally and linguistically responsive, flexible and consumer oriented age care services’ (Productivity Commission, 2011). The two main service delivery streams for aged care in Australia consist of: • Home Care • Residential Care

General | 65 According to the Australian Institute of Health and Welfare, “community aged care programs are designed to provide alternatives to residential aged care with a mixture of individuallytailored care options to accommodate the diversity of needs and requirements of older Australians. Community aged care has strong connections to residential aged care, with many community care programs specifically designed to enable older people to live in the community for as long as possible.” Many of the health related challenges the aged care sector faces are common across many industries, however engaging an ageing workforce that ultimately become the end user (carer becomes the cared for) is unique to the aged care sector. Some of the key workforce health issues facing the aged care industry include (but are not limited to): • Understanding the occupational exposure to health risk in both the residential and home care environments • Understanding and being able to properly manage the health risk exposure of the workforce where, aside from the normal occupational exposures, other aged related health risks can and will impact on the ability of individuals to continue to be able to fulfil their occupational requirements. Failure to manage these issues presents an organisation with increased likelihood of: • Absenteeism, • Workers compensation claims, • Health issues leading to earlier than anticipated retirement from active work, and • Reduced time between the worker being a carer and needing to be cared for.

Exposure to risk In Aged Care Services, 87% of employees provide direct community based home care services as their main activity, of whom 86% were female (ABS, 2009). This simple statistic presents its own set of challenges. It needs to be recognised

that home care work occurs within a specific context that has implications for workers. • Firstly, care is provided in private homes that are not easily subjected to regulation in the same way as residential facilities. Training and work health and safety guidelines need to reflect these differences. • Secondly, there are hidden costs of providing home care (such as petrol and other car-related costs) that are borne by employees. • Thirdly, the individual nature of home care raises safety issues for employees. This is likely to become exacerbated as the range of social, health and behavioural disorders of client’s increases. • Female workers in this environment are more susceptible to manual handling issues, particularly in the home, given that there are potentially uncontrolled and poorly identified physical tasks that can change over time without due consideration being addressed in the form of a risk assessment.

Workforce Outlook The Health Care and Social Assistance industry is now the largest industry in Australia, employing 1,343,400 workers in Nov 2011 (ABS, 2011). Health Care and Social Assistance is expected to contribute almost one in four new jobs over the next five years (4.5 per cent per annum equating to 323,300 jobs). This industry has consistently been the primary provider of new jobs over the short, medium and long term with Australia’s ageing population, and associated demands on health care services and facilities, and strong population growth underpinning this expected increase, (DEEWR, Industry Employment Projections, 2011). We know that a higher proportion of older workers (45+) in aged care residential services have lower levels of educational attainment compared with all industries and significantly lower levels compared with the total Health Care and Social Assistance industry (ABS, 2006). This factor alone

66 | General is enough to increase exposure to OHS risk and a part of this can be explained by factors such as workers with lower levels of education and English as a second language, cannot necessarily migrate to less physically demanding roles as their skill levels do not support redeployment. The statistics below support cause for concern: • More than 240,000 workers are employed in direct care roles in the aged care sector. Of these, 147,000 work in residential facilities and 93,350 in community outlets. • The median age for residential direct care workers is 48 while for community direct care workers it is 50. • Most direct care workers are employed on a permanent part-time basis (72% of those in residential facilities and 62% in community outlets). About half of the direct care workforce in each sector work between 16–34 hours per week.

What are the health challenges? It is the authors opinion, that the health and wellness challenges present in the aged care industry include (but are not limited to): • Ageing Workforce (interesting phenomenon where the workforce actually becomes the end user) • Ageing, female workforce. • Manual Handling (uncontrolled in home visit/environments) • Absenteeism • Casual and ESL (English Second Language) workforce • Casual and International (casual student workforce with capped hours per week) • Lower educational attainment levels • Behavioural issues (e.g. dementia patients) causing injury • Workers compensation claims • Need more people in the industry as demand increases and roles within organisations change and community expectations increase • Next generation will see a greater transition towards “user pay” and self-funded aged care and away from fully government funded and support programs.

How do they present? From a health management perspective, the health risks present to the employer organisation include (but are not limited to): • Workers Compensation Claims • Less than optimal ability to perform tasks • Health related conditions requiring temporary or permanent cessation of normal work.

Discussion of ABS research and inherent increased risk exposure for Aged Care Industry In the residential aged care environment, one indicator of the seriousness of work-related injuries and illnesses is the extent to which employees are on WorkCover. ABS (2011) indicates that 54 per cent of facilities had one or more employees on WorkCover during the designated fortnight. This is an increase from 33 per cent in 2007. For each of these facilities involved in the research project, there was an average of 2.2 employees on WorkCover. Although 46 per cent of

facilities had PCAs (Personal Care Assistant’s) on WorkCover, the proportion of facilities with workers in any of the other occupational groups was much smaller, between 4 and 9 per cent. In home care environments, the type of work performed and the conditions in which it is undertaken is quite different to what occurs in residential aged care. Workers often work alone rather than in teams; they work in the private homes of service users rather than in a managed facility; and they can only influence the health and well-being of service users for short periods of time rather than being able to have them under constant surveillance. As discussed above, home care workers are exposed to risks in their work that could impact on their health and safety. The ABS data (2011) indicates that the most commonly reported injuries were: • Sprains and strains, • Superficial injuries, • Chronic joint or muscle conditions, and • Stress or other mental conditions For outlets that had any incident in the last 3 months, the four main causes are: • lifting, • pushing, pulling and bending; • a fall; • hitting or being hit or cut by a person, object or vehicle; and • repetitive movement. These were similar to the causes identified by workers: lifting, pushing, pulling and bending; a fall, repetitive movement; vehicle accident; and exposure to mental stress. Both outlets and workers indicated that a substantial minority of work-related injuries and illnesses were due to ‘other’ causes. With 14 per cent of outlets reporting an incident and 20 per cent of workers reporting an incident selecting ‘other’, it is possible that the standard measures of workplace safety by Safe Work Australia may not be adequate to identify the problems associated with working in community aged care. Further investigation into the causes and the types of workrelated injuries and illnesses in community aged care may be warranted.

So, where to from here? The 2012 Absence Management Survey reveals that on average, employees in Australia were absent from work for non-work related issues for 8.75 days per annum, with the cost of absence per employee, per annum at $2,861. Overall, this represents a significant cost to employers, accounting for nearly 4% of total payroll (Direct Health Solutions, 2012). The survey also acknowledges that some 40% of respondents felt that absenteeism was under reported in their organisation. Australian companies lose an estimated $17 billion per year in productivity to absenteeism (Price Waterhouse Coopers, 2007), and in the US this figure rises to a staggering $74 billion (Hall, 2010), suggesting perhaps that investment in employee health and wellbeing is a critical part of sound business strategy. It should be pointed out that a level of absenteeism is unavoidable - people do get sick, do get stomach bugs,

General | 67 headaches, colds, coughs and flu viruses and as a rule, where infectious or communicable diseases are concerned, workers should in fact be encouraged to stay at home rather than coming to work and increasing the infection rate. The need for employer driven intervention to address absenteeism is required when absenteeism is either caused or exacerbated by factors within the working environment. This applies equally to physical and mental health. There are other whitepapers from 2CRisk related to Absenteeism Management and can be sourced from www.2CRisk.com.au, however the highlights of any sustainable absence management program should consist of: • Fit for purpose pre-employment or deployment medicals • Absence management and tracking capability • Health Management programs aimed at identifying poor health trends before they present in individual workers and populations as absenteeism. This may also include health surveillance, monitoring and interventions aimed at educating workers and providing necessary tools to identify physical (and mental) risks so that they can appropriately managed and monitored. In terms of what effect absenteeism has on exposing the risks and health challenges to the aged care sector, tracking the underlying causes, which can be health related, tied to other outside circumstances, or affected by employees commitment to their managers and the organisation (workplace culture) becomes the “canary in the coal mine” in that absenteeism is

inextricably linked to future workers compensation claims and loss of workers through health related conditions that preclude temporary or permanent departures from work.

Building a defence in depth model In health risk management terms, a layered health system is often called a defence in depth (DiD) approach, which has been gleaned from author James Reason’s (1990) Defence in Depth accident trajectory model, or as it is more commonly known the ‘Swiss Cheese model’. The major benefit of this type of approach is to assist in identifying and mitigating risks, which in the aged care sector, would allow organisations a far better understanding of the types of health risks employees are exposed to and allow for careful monitoring over time to see whether they change, or indeed start to present health issues (through absenteeism or similar) that can impact on the individual’s ability to remain in gainful employment for the longer term. Put simply, the Defence in Depth model, when used in an aged care setting allows the service provider to build in layers of defence to safeguard against failure. Failure in this context can mean absenteeism and poor health, which lead into poor work outcomes, disability and injury claims. To apply the Defence in Depth theory in an occupational health setting, organisations need to instil four critical health defence layers that can improve the ability to control health risks:

health. productivity. profitability

2CRisk is an affordable, easy to deploy, on-line health risk management solution that helps employers in the Aged Care sector manage the challenges related to workforce health Addressing health challenges in the Aged Care Sector • Skills shortage and retention

• Ageing workforce

• Chronic health conditions

• Absenteeism

• Work/non-work related injuries

• Productivity loss

• Psychological injury

• Depression

For further information on the health challenges presented to the Aged Care sector, please refer to our article in this edition of Fusion on Page 64

www.2CRisk.com.au

1300 736 361

info@2CRisk.com.au

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General | 69 • Pre-Employment health screening • Health Management (including health surveillance, health risk assessments & health & wellbeing programs) • Injury Management / Rehabilitation (Workers Compensation) • Exit interviews. Each of these four key defence layers has the ability to ‘catch, retard or retire risk’ so that an error trajectory is not achieved and more importantly, the likelihood of a failure is reduced significantly.

Conclusion As with any employment sector, the over goal should be to keep people gainfully employed for as long as possible. The aged care sector is, in this case, no different from any other sector where this desired outcome reduces recruitment, retention, training and overall health costs in areas such as absenteeism, workers compensation claims and temporary or permanent loss of a worker through poor health outcomes. One of the specific challenges to both the residential and home care sectors is the ability to properly understand the inherent risks to employees where there are uncontrolled environments. Whilst this obviously presents the need to risk assess workplaces, be they residential or community based, the major challenge for employers is to be able to control, as much as possible, what impact the work tasks have on an individual basis. In order to do this, a baseline of health for each worker is required and this needs to be closely monitored over time. On an individual basis, this can be done through programs such as pre-employment screening, ongoing health assessments (both questionnaires and assessments) and an appreciation of how changes in both the work environment and the individual can impact on their ability to work. At an organisation level, being able to look for trends in health is critical and will allow for far greater control over designing and implementing health programs that will have a positive impact both for the individual employees and for the organisation as a whole, through factors such as decreasing absenteeism, workers compensation claims and delaying the migration of carers, to being the ones cared for. ■ Mark Cassidy is GM of Risk and Innovation at 2CRisk and has over 15 years of experience working in the area of health risk management. If you would like to find out more about how 2CRisk can help you tackle the challenges of health management, go to www.2CRisk.com.au or you can contact Mark on +61 1300 736 361 or e-mail info@2CRisk.com.au

Reference List www.2CRisk.com.au Australian Institute of Health and Welfare (http://www.aihw.gov.au/aged-care/ options/) 2013 ABS, Labour Force, Australia, Detailed, Quarterly, November 2011 cat. no. 6291.0.55.003. ABS (2009) Community Services 2008-2009. ABS (2006) Census of Population and Housing. Department of Education Employment and Workplace Relations. (2012) Aged Care Sector Forum. Department of Education Employment and Workplace Relations. (2011). Industry Employment Projections. Department of Education Employment and Workplace Relations. Department of Health and Ageing. (2013). The Aged Care Workforce, 2012- Final Report. Department of Health and Ageing. Department of Health and Ageing. (2012a). Living longer. Living better. Canberra: Department of Health and Ageing. Direct Health Solutions (2012) Absence Management Survey. Accessed via: http:// www.dhs.net.au/ Hall, C. (2010). The Hidden Cost of Absenteeism, Workplace Options. London: UK. Price, Waterhouse, Coopers (2007). Workplace Wellness in Australia. Accessed via: http://www.pwc.com.au/industry/healthcare/assets/Workplace-Wellness-Sep10.pdf Productivity Commission. (2011). Caring for older Australians. Report No. 53, Final Inquiry Report. Canberra. Reason, J. (1990) Human Error. Cambridge University Press: London. p. 208 Richardson, S., & Martin, B. (2004). The care of older Australians: A picture of the residential aged care workforce. Adelaide: National Institute of Labour Studies, Flinders University. Safe Work Australia. (2009). Work-related injuries in Australia 2005–06: Community services and health. Canberra: Commonwealth of Australia.

General | 71

How to earn the reputation you deserve By Elizabeth Flatherty, Director of Wavelength PR

LASA has been considering the public face of age services in Australia for some time. Initially it sparked a conversation amongst LASA staff and eventually resulted in the development of the 3 Million Reasons campaign. LASA believes it is important to take a proactive step in developing the image and the reputation that we deserve; rather than one that is painted from a negative media story or a narrow interest group. As part of our commitment to develop a strong and positive image for our industry and support you to develop your own at a local level we invited Elizabeth Flaherty, from Wavelength PR to discuss the issue of reputation.

eputation damage is inevitable in any business, but there are some industries where the stakes are higher when you get it wrong; Aged Care is one of those industries. As a team we have worked on a long list of critical incidents in major health facilities including; • staff dropping premature babies, • sexual assaults on patients, • infectious disease outbreaks including SARS, • power failures, • cockroach infestations and • water contamination. The list of what can, and does, go wrong is extensive. The good news is that one adverse incident does not need to define your reputation. In fact the community, your staff and the local media may proactively support you through the tough times, if you have already earned their trust and respect. The bad news is most organisations do not do what it takes to build a strong enough reputation to weather an inevitable storm well.

Would you prefer 10% bad publicity or 100%? It sounds like an obvious choice, but through inaction most facilities opt for the default of 100% bad publicity. Many organisations are frightened of interacting with the media and to their detriment believe that staying out of the news will keep them out of trouble. Unfortunately a negative story will make the news and not cooperating with media will generally make the story worse. In contrast building a good relationship with local media will stand you in good stead for the tough times. We recommend being proactive in regularly pitching newsworthy stories to them and being accessible. In doing so, you will build a wealth of positive news and a good rapport with the local journalists.

The journalists will still do their job and report when there is a bad story, but it is your choice what percentage of publicity that issue represents for your facility. Being proactive, even with the bad news can help turn the perception around. When the community feels you are doing everything possible and not hiding anything you will have more support. If community groups feel they are being stonewalled you will lose their support. For example it is far better for the local community to learn about an infectious disease outbreak because the organisation is proactively educating the community on infection control and reminding people of the importance of visiting protocols, than to hear about the situation through a disgruntled family member going to the media or talking about it on social media. This same principle of being proactive with the media should be applied to every other group of people who are important to your reputation. Think about what you are doing every day and every month to build a positive reputation with the people who matter to you.

The patient file syndrome When things go wrong there is often another incident that follows shortly after, which is typically due to people overcompensating and inadvertently making the situation worse. My team refer to this as the patient file syndrome. Anyone who has worked in healthcare long enough has experienced a situation where a patient has had a bad experience and the more staff try to improve the situation the more things go wrong. In one instance a nurse decided to personally hold the patient file, clearly the issue then became nobody else could easily access it, which only compounded issues. When there is a significant issue that results in reputational damage followed by another incident, one of two things are occurring in the organisation. The first scenario is something has

72 | General gone wrong and in its wake another incident has occurred, which is mainly bad luck. The other is something has gone wrong and the organisation has been placed under the spotlight of scrutiny and there is actually much more below the surface; not resulting from bad luck, but resulting in a reputation it has long deserved and is only just catching up with it.

There is no magic wand Often when we are called in after a high profile incident, the damage is done and it is merely a mop up. It is disheartening to assess a situation and be able to identify simple steps which could have mitigated the reputational fall out, but that is not simply the benefit of hindsight it is usually the absence of the basic public relations planning which should be part of any modern organisation. Like anything in health, preventative measures are typically far better for the well-being of an organisation and far better on the hip pocket. Having a public relations strategy in place, which can often be administered by your own staff, with a yearly review, is far more worthwhile than calling experts after the damage has occurred. Also, when things have gone wrong it is much simpler walking into an organisation where key staff, including legal counsel: • know who you are, • know you have signed their confidentiality agreements, • know you are aware of patient confidentiality and • know all of the protocols they need to operate within.

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In reputational management we also work to a “golden hour” and you don’t want to spend it struggling with protocols, when you could be responding to a journalist and getting ahead of a story.

Accessible nature and accessible language During a reputational crisis it is not just what you are communicating, but how you are communicating that is important. Too often organisations have a tendency to hide in the bunker of bureaucracy, but it offers little protection and usually engenders more antagonism from the community. The tone and style of how you communicate is critical. The best litmus test of how a message will resonate, is, how would you explain this to somebody sitting in a pub reading the Daily Telegraph? It is easy to make a message complicated and inaccessible, to wrap it up in jargon and verbosity, but the average person in the street sees through this kind of strategy. Keep your messages in plain English so that they are easily understood, but more importantly relatable.

Upshot Reputation management in many ways is increasingly complex with online reputation management strategies, social media, a quicker news cycle, bad news going viral and highly organised protest groups ready to punish organisations for doing the wrong thing. However, the bottom line of reputation management remains the same: you will get the reputation you deserve. If you have a public relations strategy, if you have worked diligently and measurably to develop strong relationships with the people who matter to your organisation and have a workable crisis management plan for when things go wrong, you will weather any reputational storm well. Like anything in life, genuine results take work, not quick fixes. ■

General | 73

TAFE SWSi leads aged care boom

tudent, Julie Briddon, who is currently enrolled in a Certificate III in Aged Care at TAFE SWSi’s Bankstown College, expects the transition from study to work will be easier thanks to a new facility and training techniques offered at the College. “TAFE SWSi really takes aged care study to the next level,” Ms Briddon said. TAFE NSW – South Western Sydney Institute (SWSi) last week, on Thursday 5 September 2013 unveiled a new aged care training facility at its Bankstown College designed to meet the growing needs of the region’s ageing population. Aged care has been identified as an area of need in south western Sydney with more than 127,000 residents aged 70 years and older according to the 2011 Census. The facility will for the first time give students access to a simulated aged care workplace environment at TAFE SWSi’s Bankstown College. More than 200 students annually are expected to benefit from the new facility which includes: • three hospital aged care beds; • an aged care day bed; • a shower recess; and • the latest in aged care technology and teaching aids. In addition to the new facility, TAFE SWSi will become the first TAFE in Australia to offer a specialised aged care training program called Mask ED (KRS simulation) developed by Central Queensland University Professor, Kerry Reid-Searl. As part of the Mask ED (KRS simulation) program, trainers wear a life-like silicone mask and adopt the personality and history of an aged care patient, giving students the opportunity to test their care skills before entering the workplace. TAFE SWSi Institute Director Peter Roberts said the new training facility would ensure students were properly equipped with the practical skills needed to build a successful career in the aged care and home care sectors. “TAFE SWSi strongly believes in teaching students the practical skills they need to excel in the workplace,” Mr Roberts said. “That’s why we have invested in a brand new aged care training facility at Bankstown which mirrors a real workplace environment. “It means students can test their skills in a safe and controlled environment before entering the aged care workforce.” Ms Briddon said the Mask Ed (KRS simulation) program in particular was a great way to prepare for a job in the aged care sector. “Role play exercises like Mask Ed give you the opportunity to think on your feet and respond to the needs of an aged care patient in a safe environment,” Ms Briddon. “It also helps to reinforce that aged care patients are individuals with individual needs and that the care you provide needs to match the individual.”

“By giving students access to the latest aged care technology and teaching aids, I know I will be well prepared for the job in a real workplace situation.” TAFE SWSi also has aged care training facilities at its Wetherill Park and Macquarie Fields colleges.

74 | General The Institute has been teaching aged care for more than 10 years and offers a range of courses in the field, including: • Certificate III Aged Care; • Certificate IV Aged Care; • Certificate III and IV Home and Community Care; • Certificate III and IV Disabilities; as well as • Short courses and skill sets designed to meet specific industry needs. TAFE SWSi aged care courses are taught using face-toface as well as online lessons. All units of competency require workplace assessment. A career in aged care is suited to people with a high level of professionalism, good communication skills and a commitment to the rights of the elderly. TAFE SWSi is one of Australia’s largest educational institutions, delivering programs to more than 72,000 students every year in nine colleges across south western Sydney, in workplaces all over Australia and in partner colleges in China, and the Philippines. ■

Making a difference… Governance

Strategy

Workforce Planning

Managing People

Leadership

The national Realise Performance Annual Remuneration Review for Aged Care and Community Services provides valuable remuneration benchmarking data that providers can use to inform salary decisions in their budget planning process. If you would like more information about the review please give our office a call and one of our consultants will be happy to answer any questions you may have.

www.realiseperformance.com.au 02 8850 7124

General | 75

Aged Care with altruism: A practical guide for aged care workers 2nd Edition. J K Pearce Vivid Publishing: 144 Pages

s I read this book I was swept away to another era, one where people are mindful of manners and cleanliness and privacy. I thought of my Grandmother, I thought about my favourite cookbook (an old time classic). I thought about another time. My first reaction was that this book may not be well received. Perhaps it will not resonate with a young person studying or contemplating to be a personal care assistant. Or the current professional who pay pick this up as a method of self-reflection of their practice. While it sounds strange it then dawned upon me that as we care for older Australians we should be mindful that they lived in very different times to those of today. The tone of this publication keeps one mindful of this constantly. As I continued I found this book to be worthwhile. It is most practical with at times methodical descriptions to how care and services should be performed. This would be a worthwhile companion to all new students as I believe it would provide a ready reference for the fundamentals of care and the ‘lens’ we should use as we deliver care and services. Chapters covered include: the care giver; types of help available to older people; the recipient of care and understanding their needs and comfort; Finding a balance between safety and freedom when providing care; home care and the benefits of domestic help; understanding the intimacy of delivering personal care; avoiding conflict and the importance of a client’s family relationships; the role of the age services team for clients who choose to ‘age in place’; medical, legal and financial considerations for clients; supporting the adjustment to residential care and the kindness necessary for the end stages of life. JK Pearce has a Diploma in Home Science and a Graduate Certificate in Gerontology coupled with 40 years of aged care experience. This is perhaps what makes the book a worthwhile learning tool as it combines contemporary approaches to care with a wealth of personal experience and a clarity and depth of empathy and warmth. The book does suffer from sparse and

outdated references. In regards to the ever changing policies regarding age services it is not a piece to be relied upon. The book is available in softcover ($19.95) and as an e-book. It can be ordered at www.vividpublishing.com.au/ agedcarewithalturism/index.html ■

76 | General

2013/14 2013/14 Calendar of Events

17 – 20 November 2013

23 – 25 February 2014

IAHSA 10th International Conference

23rd Annual Tri-State Conference & Exhibition

Le Royal Méridien Hotel, Shanghai, China www.iahsa.net/China_2013

Albury Entertainment Centre, NSW http://vic.lasa.asn.au/event/tristate2014 Hosted by

29 – 30 May 2014

20 – 22 October 2014

LASA NSW-ACT Congress 2014

LASA National Congress 2014

The Westin, Sydney NSW http://www.nswact.lasa.asn.au/events/upcoming-events

Adelaide Convention Centre, SA www.lasacongress.asn.au

Product News Just Better Care A recent survey by Just Better Care (JBC) shows loneliness and social isolation are the main concerns for elderly people receiving in-home support. The survey, carried out in August, shows the four main issues of concern for the elderly living at home across the nation are loneliness and social isolation followed by mobility and access to transport; loss of independence and lack of finances. CEO of JBC, Trish Noakes said the survey highlights some of the issues we face ensuring older people can stay in their own homes longer: “Our society has increasingly become disjointed with families separated or living apart and this is reflected in the number of older people living on their own and experiencing loneliness or social isolation.

“Looking ahead, these numbers are only set to increase and will provide a major challenge for communities to manage.” The inaugural snapshot survey also shows the major health concerns of the elderly customers receiving in-home support from JBC are dementia and memory loss followed by mobility issues; frailty and mental health and depression. The main services JBC provides to its customers are personal care, domestic assistance, transport and companionship/social support. Mrs Noakes said good communication between support workers and carers was the key to providing good in-home service. “Continuity of care is raised as a major factor in providing good quality in-home care for older people. Good communication

with carers about what is happening, health concerns, emotional concerns, what people are eating etc makes support workers able to perform better for their customer.”

About Just Better Care Just Better Care leads Australia in the provision of in-home support for aged people, people living with a disability and people requiring in-home support, enabling them to live independently at home. Just Better Care Australia operates 30 franchises around Australia, providing around 17,000 hours of support each week, and is Australian owned and operated. Visit www.justbettercare.com.au

Easyway Bath The Easy Way Bath has been developed to assist carers and residents enjoy bathing duties. Correct use of this equipment will reduce the likelihood of back complaints while making the bathing experience more pleasurable. The elevating mechanism is capable of lifting a filled bath, complete with patient to a comfortable working height.

Easy Way Bath can be installed in the place of a regular bath, or can replace an existing bath installation with minimal modifications to services. As the Easy Way Bath is manufactured locally, they can be specified with a number of standard options, including tap ware, bath insert, air flow spa units or to customer’s requirements.

Easy Way Bath is easily operated with large low voltage controls. Actuation is by remote hand controller or the optional foot controller. The Easy Way Bath requires little maintenance by design. Easy Way Bath has an operating height of 670mm to 970mm and has a safe operating load of 280kg.

Product News | 77

PJ Maynard Consulting Pty Ltd® Let’s start at the very beginning A very good place to start When you read you begin with A-B-C When you sing you begin with do-re-mi. While I am no Julie Andrews, it struck me that going back to basics and drawing upon my own personal values and experiences was where I needed to focus my approach to supporting organisations with their executive recruitment. Nearly five years ago, I was coming out of a role with an aged care provider as National Head of Resourcing. Although the role didn’t align with my personal values at that time in my life, it made me realise I wanted to make a bigger difference in the recruitment of aged care executive teams in Australia. At the same time, my grandmother had been suffering, rather than flourishing in a residential aged care facility. So when I found myself recruiting into this sector, I felt compelled to leave a legacy – finding great leaders for a great industry. I relished being an executive recruiter in aged care, my networks were amazing, and I enjoyed making a difference in the sector by creating executive teams, with heart.

So PJ Maynard Consulting Pty Ltd® was born. Having comprehensive and specialist networks in recruitment is an advantage but it must be backed by a quality recruitment framework. Today, PJ Maynard Pty Ltd® uses a process that has been created using past successes combined with the positive experiences of candidates and employers. The PJ Maynard Pty Ltd® recruitment framework is constantly tested, tried and proven. People sourced for roles are high calibre aged care specialists, and treated with respect and care during the recruitment process. Employers are guaranteed a deep understanding of their individual candidate requirements and the unique dynamics of building executive teams. At PJ Maynard Consulting Pty Ltd®, we have over 20 years recruitment experience, 15 in aged care / health care recruitment. What you get when you work with us is an opportunity to source from an amazing talent pool, current and potential leaders, and across the vertical business units. More than 80% of our business is repeat, and we are proud to be really making a difference with our valued clients in an industry where why you do what you do matters. We have National reach, and recruit into NSW, QLD and ACT.

So, let’s start at the very beginning with your recruitment needs, and call PJ Maynard for a conversation about building your executive teams, with heart. (02) 8084 2681, www.pjconsulting.com.au

Walking through the Cloud: Delivering efficiency in aged care via software as a service By Craig Charlton, SVP & General Manager, Asia Pacific, Epicor Software What is software as a service? Running your software via a software as a service (SaaS) deployment means that instead of the system being on your internal computers it is hosted on the Internet. With traditional on-premise software deployments, customers purchase, install, manage and maintain the software as well as supporting infrastructure, such as hardware and networks, in house. With a SaaS deployment, the software vendor hosts, manages and provides customers access to the software as a service over the Internet. The benefits of Cloud software for smaller aged care and residential care facilities While there will always be a demand for on-premise software solutions, there are many benefits for smaller aged care and residential care organisations adopting a SaaS solution. SaaS deployment can save smaller organisations upfront infrastructure costs and the hassle of managing the infrastructure and platforms that run the applications. Rather than pay for the software up-front out of your capital budgets, SaaS customers license it on a subscription basis, usually by per user, per month or a number of transactions. On-going maintenance, upgrades, and support for the software and

infrastructure are all the responsibility of the software vendor and are typically included in the subscription fee. Considerations when selecting the right SaaS solution for your organisation: Initial concerns about security, response time and service availability have diminished for many organisations as SaaS business and computing models have matured and adoption has become more widespread. Vendors must clearly demonstrate the TCO advantages of SaaS, ensure that their products have well-defined data integration and conversion procedures, show price transparency, and have wellarticulated security and data protection stories. When deciding on your SaaS software solution, you must weigh up the maturity of the offering against the agility of the vendor. Additionally, choosing between SaaS and a traditional on-premise deployment isn’t always necessary. Many software vendors are providing hybrid options that combine both deployment models. Organisations can also choose a single code-line solution allowing them to go from a SaaS-based solution to on-premise and vice versa more effectively. The solution can scale with the business unrestricted by deployment models. Epicor Senior Living Solution: Epicor is a leading solutions provider of technology assisting managers in the management and operations of aged care and residential care facilities. Our market leading solution is also available in the Cloud.

78 | Product News

Mederev Mederev was established in 2008 when Keryn Coghill, who had previously developed the first electronic Medication Management tool in Australia, RxRight, developed a structured approach to risk management and training of Medication Management in ACF’s. RMMR/QUM offering included a structured approach on a full suite of services designed to comprehensively assist ACFs in Medication Management, delivered electronically. Mederev Policies and Procedures produced and delivered. They provided a comprehensive supply pharmacy agreement to ensure ACF’s are provided with a package of services and products to ensure a transparent and sustainable relationship. Staff trained at individual sites and mentored on internal Policies and Procedures in Medication as well as Mederev providing audits and competencies to sites ‘in need’. 2010 Stage One Mederev website delivered, providing a secure, accessible repository of all data involved in Medication Management per facility. A first in Australia which included:

1. Medication Reviews (RMMRs) on line 2. Doctors reports 3. ACF staff training 4. Full suite of Polices/Procedures/Audits/Competencies 5. Electronic and printable data which can never be lost 6. Dedicated Hosting Server 7. Modern development platform (.NET)

2011 Stage Two Mederev provides facility information remotely together with the standardisation of Policies and Procedures. 2012 Stage Three Mederev delivered (completed in February 2012) which includes:

1. Enhanced training available to all ACF staff involved in Medication Management on the Policies & Procedures. The data is able to accessed remotely by the facility. 2. Additional training displays and exception reporting are available for management. 3. Enhanced processes for the management of Policy, Competency and Forms documentation.

4. A single Mederev login is available for Managers providing access to multiple ACF’s. 5. Implementation of additional website user classifications which control data accessibility. 6. Enhanced RMMR displays with data filtering. 7. Enhanced RMMR reporting. 8. MAC Reports Tab. 9. Action Plan Tab to house comprehensive reports on what has happened in the Medication space, monthly or more frequently if needed. 10. Various screen display enhancements.

Mederev has received recognition in a number of ACF’s for being responsible for Accreditation compliance standard 2. In 2013 Mederev Training will provide formal CPD points and Virtual Training procedures are also being established. Using the ACF Docs function Aged Care Facilities can have their customised documents and forms uploaded to the website and made available to their staff. Mederev provides an Australian TOTAL Medication Management Compliance Program. It trains all ACF staff in the internal Medication Policies and Procedures of the Organisation and records the complete process for auditing at any time. Mederev Medication Management is a Risk & Compliance product designed to safe guard all parties. Keryn Coghill is an accredited pharmacist with over 18 years of medication management review experience in a pharmacy career of some 39 years which has involved hospital pharmacy, community pharmacy (owner/manager) and expanded roles in institutional care especially aged care. My ‘pharmacy’ philosophy is simple - to improve safety and efficiency in the area of medication management and to maximise pharmacist’s contribution and recognition in this area.

For more information email Keryn, keryn@mederev.com.au

Kate Smeaton Healthcare Recruitment Kate Smeaton Healthcare Recruitment delivers 25 years experience to the Australian Health & Aged Care Industry providing services in Recruitment to the broader Aged Care sector from CEO through to Facility Management level and Registered Nurses. Industry contacts within the Aged Care Advisory Network (ACAN) provides strategic partnering, with key services offering a well rounded service and commitment to the Aged Care sector. Skilled workforce needs are met through valuable sources, locally and internationally with established partnerships covering all aspects of recruitment. Clients will benefit when using Kate Smeaton Healthcare Recruitment by establishing regular communication, a forward thinking strategy with regular consultation relative to the specific role they require. Teamwork, communication and timing are key factors in sourcing the right person to successfully represent the client’s organization.

Candidates are offered full support during the recruitment process realizing a 99% success rate in retained placements. Building ongoing relationships has provided a valuable source of referred candidates and a unique database of skilled people across all levels.

See www.katesmeaton.com.au or call 02 9922 1310.

2014 Executive Study Tour Program Studying and Advancing Global Eldercare

Australian Seniors Living Industry International Study Tours for Executive Managers Our 2013 study tour program sold out in record time. With considerable interest already expressed, we expect 2014 to be similar. Our stimulating 2014 study tour program includes:

Finland/Denmark Northern Lights Tour 29 March - 8 April th

There is opportunity to register for an optional pre-tour recreation extension to the Northern Lights. NASA predicts that the Northern Lights will be more intense than usual during Winter 2013-2014 due to increased sunspot activity.

Canada & NY 15 June - 28 June

Technology based Community Care

UK & Netherlands

13 September - 27 September Innovation in Care Tour will include attendance at the biannual European Association of Homes and Services for the Aged (EAHSA) conference in the Netherlands.

South Africa 28 September - 11 October

Implementing Business Models to face Diversity Aged Care delivery Tour will include attendance at inaugural National Care Forum (NCF) of South Africa congress in Stellenbosch. There is also opportunity to register for an optional post-tour recreational Safari extension.

Open for bookings Scandinavia has positioned itself as the European leader in progressive services for the Elderly. This tour will encompass 2 leading Scandinavian countries in Finland and Denmark. SAGE Delegates will gain access to the CEOs and facilities managers of leading seniors living organisations, visit innovative facilities and gain an understanding of the business models and organisational structures that support them.

Care for the elderly varies greatly among countries and is changing rapidly. This tour will incorporate an IT Community Care focus looking at Canada (Toronto) and New York Community Care delivery and how these regions have met the challenges of IT implementation. The tour will also include Residential Care facilities, however, the main focus will be IT in Community Care.

The tour will be aimed toward looking at innovation in care visiting organisations in South West England. This tour will involve spending a week studying the UK system, engaging at executive level with UK senior managers, local government representatives and peak industry associations. The tour will then progress to the Netherlands for the EAHSA conference.

South Africa is a country of contrasts, rich in its diversity of people, language, culture, fauna and flora, beautiful scenery from the mountains to the sea, and into the rural countryside. This diversity is also reflected in Aged Care and Senior Services and our SAGE tour to this country offers an opportunity to experience this diversity within Aged Care and Retirement Care delivery. Our study tour to this amazing country will be hosted by one of South Africaâ&#x20AC;&#x2122;s senior Aged Care management personnel.

Hurry, these tours will sell out soon! For more information or to register your interest visit www.sagetours.com.au or contact study leader Judy Martin via email jmartin@agedcare.org.au or mobile 0437 649 672.

SAGE Study Tours are a partnership between: a specialist design practice.